Pediatrics Exam 1

In assessing adolescents using Tanner staging, sexual maturity is rated using _________ distinct stages. (Your answer should appear as a number.)

ANS: 5 Tanner stages of adolescent sexual development describe five distinct stages of sexual maturity rating. There are separate rating scales for males and females, but both use five stages.

34. Which is the preferred site for intramuscular injections in infants? a. Deltoid b. Dorsogluteal c. Rectus femoris d. Vastus lateralis

ANS: D The preferred site for infants is the vastus lateralis. The deltoid and dorsogluteal sites are used for older children and adults. The rectus femoris is not a recommended site.

Finished up to ch 40

start with 41 up to 50

A 10-year-old female child requires daily medications for a chronic illness. Her mother tells the nurse that she is always nagging her to take her medicine before school. What is the most appropriate nursing action to promote the child's compliance? 1Establishing a contract with her, including rewards 2Suggesting time-outs when she forgets her medicine 3Discussing with her mother the damaging effects of nagging 4Asking the child to bring her medicine containers to each appointment so they can be counted

1 For school-age children, behavior contracting associated with desirable rewards is an effective method for achieving compliance. Time-outs should be used only if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem-solving rather than criticize the actions. Monitoring the medicine supply may be tried if the contracting is not successful.

A week-old newborn is assessed for body weight, birth marks, and height. The birth weight is lower than what it should be for height. Which physical feature of the newborn makes the nurse conclude that the newborn is affected by Down syndrome?1Short and broad neck2Long and thin fingers3Short and thin lips4Broad and long nose

1 One of the characteristics of Down syndrome is a short, broad neck. These children have an impaired immune system and are at risk for spinal cord compression. Physical features such as long and thin fingers, short and thin lips, and broad and long nose are all common in a normal child and do not indicate any abnormality.

A nurse is planning a class for school-age children on obesity. Which percentile does the body mass index (BMI) need to exceed for a child to be assessed as obese?

ANS: 95 95th When intake of food exceeds expenditure, the excess is stored as fat. Obesity is an excessive accumulation of fat in the body and is assessed in children as a BMI that exceeds the 95th percentile for age.

The nurse is assessing a newborn with Down syndrome. The newborn's parent tells the nurse, "We are having a hard time holding our baby. We didn't have this hard of a time with our other children." What would be the nurse's best response?1"Children with Down syndrome have lower muscle tone."2"This happens in some children because of undeveloped bonding."3"Are you more apprehensive because your child has Down syndrome?"4"You should see a counselor to help you cope with your child's condition."

1 Newborns with Down syndrome have joint hyperflexibility and low muscle tone. This can make it difficult to hold the newborn because he or she can go limp like a rag doll. This makes it difficult for the parents to embrace and provide warmth to their newborn. This may make parents feel that the newborn is not bonding with them, but difficulty holding the child does not indicate impaired bonding between the child and parents. Inability to understand the child's needs and nonverbal communication indicates undeveloped bonding. Asking the parents whether they are more apprehensive does not answer their question. It is also a closed-ended question, which is not therapeutic communication. Telling the parents they need to see a counselor is not appropriate. They just need support and teaching.

A child with autism spectrum disorder is hospitalized for a treatment that will last about 1 week. How should the nurse make the child comfortable?1Ask the parents to accompany the child.2Modify the room according to the child's needs.3Explain the surroundings of the room.4Help the child perform daily routine tasks.

1 Children with autism spectrum disorders often are uncomfortable in a new environment and may not like to be with strangers. Therefore children with an autism spectrum disorder must be accompanied by their parents during hospitalization. While caring for a visually impaired child, the nurse modify the room according to the needs of the child. This helps prevent accidents. Because the child is not visually impaired, the nurse need not explain the surroundings of the room. Children with autism spectrum disorders often do not like assistance and prefer to perform their daily chores by themselves. Therefore the nurse should not help the child with such activities.

The nurse is caring for a child who is scheduled to undergo an ostomy procedure. What are possible causes for a child to need undergo an ostomy procedure? Select all that apply. 1 Necrotizing enterocolitis 2 Hirschsprung disease 3 Crohn disease 4 Diseases of the bladder 5 Difficulty urinating

1, 2, 3, 4 Children may require stomas for various health problems such as necrotizing enterocolitis, imperforate anus, and Hirschsprung disease. In older children, the most frequent causes are Crohn's disease and ureterostomies due to bladder defects. Difficulty in urinating is not reason enough for an ostomy unless the health care provider has diagnosed an underlying disorder that requires an ostomy.

The nurse suspects tissue injury in an infant on intravenous therapy. What parameters will the nurse assess to determine tissue injury? Select all that apply. 1 The amount of redness 2 Blanching 3 The amount of swelling 4 Quality of pulses above infiltration 5 Coolness of the area

1, 2, 3, 5The nurse adheres to certain guidelines available for determining the severity of tissue injury. Staging characteristics, such as the amount of redness, blanching, the amount of swelling, pain, capillary refill, and warmth or coolness of the area, are used to determine severity. The quality of pulses below infiltration is assessed and not above it.

The nurse is assessing a child with autism for prognostic factors. What findings in the child suggest a better prognosis? Select all that apply.1 Male sex2 Early recognition3 Functional speech4 Lower intelligence5 Behavioral impairment

1, 2, 3Male sex carries a more favorable prognosis than female sex. Early recognition allows early intervention to help the child recover. Children with functional speech have a better prognosis than those who do not have functional speech. Children with higher intelligence have a more favorable prognosis than children with lesser intelligence. Children who do not have behavioral impairment have a better prognosis than children with behavioral impairment.

The nurse is caring for a child that has a persistent cough for two days and a fever of over 38.3° C. What should be included in the nursing Interventions if the primary health care provider suspects nasopharyngitis? Select all that apply. 1 Obtain throat swab for culture or perform rapid antigen testing. 2 Instruct the parents to administer oral antibiotics as prescribed. 3 Educate parents singly or in groups about hazards of aspiration. 4 Obtain a prescription to administer antipyretics when needed. 5 Educate the parents about monitoring the blood glucose level.

1, 2, 4The nurse should obtain a throat swab for culture or perform rapid antigen testing. The laboratory test will help in confirming the pathogen causing the nasopharyngitis. The nurse should also instruct the parents about administering oral antibiotics and antipyretics as prescribed by the primary health care provider. The nurse should ask the parents to administer the medications in liquid form. It may be effective in decreasing the throat pain.This is done to make the parents aware of the correct administration and dose of oral medication. Parents are educated about the hazards of aspiration, so the child becomes aware of the dangers of trauma to the trachea from sharp objects. However, this is not a related nursing Intervention for a child suffering from nasopharyngitis. Similarly, blood glucose level monitoring is done for a child with diabetes mellitus. It is not related to nasopharyngitis.

The nurse is educating new parents on how to prevent the occurrence of acute otitis media (AOM) in the child. What preventive measures does the nurse include in the teaching? Select all that apply. 1 Breastfeed the infants for at least 6 months. 2 Discontinue use of the pacifier after 6 months. 3 Give the child analgesic drugs as prescribed. 4 Clean the ear canals with sterile cotton swabs. 5 Preventing exposure to second hand smoke

1, 2, 5Parents are encouraged to reduce risk factors for AOM by breastfeeding infants for at least the first 6 months of their life. This prevents the occurrence of AOM and reduces any risks. The parents are also informed to discontinue the use of pacifier after six months and prevent the child from getting exposed to second-hand smoke for the same reason. Analgesics are used to treat mild pain in the ear when the child has AOM. It is a treatment measure not a preventative measure. Similarly, the parents have to clean the external ear of their child by using sterile cotton swabs to drain the fluid in the ear but they never go inside the ear canals. It is a treatment measure advised with topical antibiotic treatment.

A pregnant woman is diagnosed with a rubella infection during a prenatal checkup. What does the nurse expect the health care provider will tell the patient? Select all that apply. "The newborn may:1 Have vision difficulties."2 Have growth impairment."3 Have difficulty hearing."4 Develop breathing problems."5 Not be able to concentrate."

1, 3 Rubella infections during pregnancy may cause hearing and visual loss in the newborn. However, these impairments may disappear as the child grows. Rubella infections do not cause growth retardation. Growth hormone deficiency or Turner syndrome can lead to growth impairment. Respiratory disorders or allergic reactions can result from hypersensitivities and can cause difficulty breathing in the newborn. A decreased ability to concentrate indicates impaired cognition. It usually results from inadequate intake of omega-3 fatty acids by the mother during pregnancy.

A 4-year-old child is seen in a clinic for a hearing impairment. What action does the nurse observe in the child to confirm hearing impairment? Select all that apply. The child:1 Screeches happily when looking at a toy.2 Has difficulty trying to read a book.3 Does not respond when an alarm sounds.4 Points at his tummy to indicate hunger.5 Speaks fast, stutters, and has speech delay.

1, 3, 4 A child with a hearing impairment yells or screeches in pleasure because the child cannot hear how loud these sounds are. The child also does not respond to loud sounds and prefers nonverbal communication such as pointing. A child who has difficulty reading a book may have a visual impairment. Rapid speech with stuttering and speech delay are symptoms of fragile X syndrome.

The nurse is assessing a patient with strabismus. Which finding would suggest the cause of strabismus? Select all that apply.1 Poor vision2 Short eyeball3 Congenital defect4 Muscle imbalance5 Unequal curvature in the lens

1, 3, 4 Strabismus may result from poor vision and the resulting straining of eye muscles. Strabismus may result from a congenital defect as a developmental anomaly. Strabismus may also result from muscle imbalance caused by neuromuscular disorders. Short eyeball results in development of hyperopia, not strabismus. Unequal curvature of lens results in astigmatism, not strabismus.

The nurse is teaching a group of students about pertussis. The nurse says, "Pertussis and several other respiratory infections are common in young children." What represents the possible etiology for that statement? Select all that apply. 1 Children have weaker immune systems. 2Many children do not get vaccinated. 3 Children have small airways. 4 Children are exposed to more germs. 5 Germs have an affinity for children

1, 3, 4Deficiencies of the immune system place children at risk for infection. Anatomic differences influence the response to respiratory tract infections. The diameter of the airways is smaller in young children, and the distance between structures within the respiratory tract is also shorter, so organisms may move rapidly down the respiratory tract, causing more extensive involvement. Children are often exposed to greater variety of germs than are adults. Lack of vaccination usually leads to polio and other such diseases. Germs do not have any greater affinity for children than for adults.

A child with tonsillitis requires nursing care. The child has recently undergone a tonsillectomy. What should the nurse include in the plan of care in order to minimize the risk of bleeding during the post-operative period? Select all that apply. 1 Give the child a soft or a liquid diet. 2 Advise the child to blow the nose. 3 Instruct the child how to use a cool-mist vaporizer. 4 Instruct the child to cough frequently. 5 Instruct on warm salt-water gargles. 6 Provide analgesic-antipyretic drugs.

1, 3, 5, 6A soft to liquid diet is advised for a child who has recently undergone a tonsillectomy. The child can also use a cool-mist vaporizer to keep the mucous membranes moist during periods of mouth breathing. In addition, warm salt-water gargles and analgesic-antipyretic drugs such as acetaminophen (Tylenol) to promote comfort. The child is always discouraged from blowing their nose and coughing, as these activities may aggravate the trauma of the surgery site and cause bleeding.

The nurse is caring for a child with acute laryngotracheobronchitis (LTB). What assessment findings noted by the nurse would warrant immediate notification of the primary health care provider? Select all that apply. 1 Increased pulse and increased respiratory rate 2 The throat is reddened, swollen, and enlarged 3 Substernal, suprasternal, or intercostal retractions 4 The epiglottis is edematous and is cherry red 5 Flaring of the nares and increased restlessness

1, 3, 5The most important Nursing Intervention for the child with LTB is observation and accurate assessment of the respiratory status. The nurse can detect airway obstruction early if it is noticed that the child has an increased pulse and respiratory rate. In addition, the child often has substernal, suprasternal, and intercostal retractions, flaring nares, and increased restlessness.This occurs due to inflammation of the mucosal lining of the larynx and trachea, which causes a narrowing of the airway. Hence, the child inspires air past the obstruction and into the lungs, producing the characteristic inspiratory stridor. Symptoms such as red and distinctively large throat and cherry red, edematous epiglottis are visible when the child is suffering from epiglottitis and not LTB. Usually, children do not suffer from epiglottitis and LTB simultaneously.

The nurse is teaching a group of students about preventing respiratory infections. Which statement by a student suggests a need for additional teaching? Select all that apply. 1 "Playing with ill children is safe. "2 "Do not eat from the utensils of ill children. "3 "Wash your hands as often as possible. "4 "Reuse tissues to cover the mouth when sneezing. "5 "Keep away from children who are at risk.

1, 4, 5Well children should keep away from ill children because respiratory infections are very contagious. Used tissues should be immediately thrown into the wastebasket and not allowed to accumulate in a pile. Children should keep away from those who are already infected, not from those who they think might be at risk but are well. Using the same utensils can transfer the infection. Frequent hand washing is done to wash away germs.

A child has Group A Beta-hemolytic streptococcal or GABHS infection of the upper airway. What precautionary measures should the nurse ask the child and the parents to take after the child is cured? Select all that apply. 1 "Discard old toothbrushes and replace them with new ones. "2 "Maintain adequate fluid intake and consume nutritional foods 3 "No close contact with the sick child and do not share the personal items." 4 "Apply cold or warm compresses to the neck and gargle with warm saline." 5 "Wash the orthodontic appliances thoroughly as per expert advice."

1, 5The nurse should advise the parent and child to discard the old toothbrushes and replace them with new ones after they have been taking antibiotics for 24 hours. This will prevent the spread of causal organism. Orthodontic appliances should be washed thoroughly because they may harbor the organisms. It is necessary that parents and other household members avoid close contact with the sick child or share personal items with the child during the illness, not after it is cured.Maintaining fluid intake or consuming nutritional food is not a precautionary measure. It is done to prevent dehydration and to provide the child with the right amount of nutritional needs. Steps such as application of cold or warm compresses to the neck and gargling with warm saline are done to provide relief. This is not a precautionary measure

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of: 1pneumothorax. 2bronchodilation. 3carbon dioxide retention. 4increased viscosity of sputum

1The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially caused by a pneumothorax.

The nurse is caring for a child who has recently undergone a tonsillectomy. What steps should the nurse take to facilitate drainage of the secretions? 1Place the child on the abdomen. 2Provide psychological preparation. 3Apply careful suctioning if necessary. 4Have the child sit up and blow the nose.

1The nurse should place the child on his or her abdomen to facilitate drainage of the secretions. Psychological preparation of the child is done before the surgery. It is not necessary after the surgery to facilitate drainage of secretions. Routine suctioning is usually avoided, but when it is performed, it is done carefully to prevent trauma to the oropharynx. The child should not be advised to sit up and blow their nose. This can cause bleeding to the surgical site.

The nurse is preparing a child for an endotracheal tube (ET) placement. How does the nurse verify the placement of the tube? Select all that apply. 1 Visualization of unilateral chest expansion 2 Auscultation over the epigastrium 3 Examination of water vapor in the tube 4 Waveform verification with continuous capnography 5 Examination using a chest radiography

2, 3, 4, 5 ET tube placement should be verified by at least one clinical sign and at least one confirmatory technology. Such technologies include auscultation over the epigastrium and the lung fields bilaterally in the axillary region, examination of water vapor in the tube, and waveform verification with continuous capnography. Chest radiography can also be used to verify placement. Visualization of bilateral (and not unilateral) chest expansion is used to verify placement of the ET tube.

When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child's stress level associated with hospitalization? Select all that apply. 1 Mild temperament 2 Lack of fit between parent and child 3 Below-average intelligence 4 Age 5 Gender

2, 3, 4, 5 Risk factors for increased stress level of a child to illness or hospitalization: "Difficult" temperament; Lack of fit between child and parent; Age (especially between 6 months and 5 years old); Male gender; Below-average intelligence; Multiple and continuing stresses (e.g., frequent hospitalizations).

The nurse is preparing to insert a nasogastric (NG) tube for a child with impaired swallowing capacity. Arrange the steps of the procedure in the correct order. 1.Flush the tube with sterile water. 2.Place child supine with head slightly hyperflexed. 3.Measure the tube for approximate length. 4.Stabilize the tube by holding or taping it to the cheek. 5.Warm the formula to room temperature.

2, 3, 4, 5, 1The child should be in a supine position with head slightly hyperflexed. The tube is measured for approximate length of insertion and marked. After insertion, the tube is stabilized by holding or taping it to the cheek. Warm formula to room temperature before starting the flow. The tube is flushed with sterile water after the feeding.

Which assessment should the nurse perform last when examining a 5-year-old child? a. Heart b. Lungs c. Abdomen d. Throat ANS: D

A The nurse may proceed from head to toe with preschool-age children. More invasive procedures should be saved until the end of the examination. Assessment of the heart is considered noninvasive. B For preschool children, invasive procedures should be left to the end of the examination. Assessment of the lungs is not considered to be frightening. C For preschool children, invasive procedures should be left to the end of the examination. Assessment of the abdomen is not considered to be frightening. D Examination of the mouth and throat is considered to be more invasive than other parts of a physical examination. For preschool children, invasive procedures should be left to the end of the examination.

Children have a total of __________ primary (deciduous) teeth that they begin to lose when they are school age.

ANS: 20 twenty

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? 1Inactivity 2Clings to parent 3Depressed, sad 4Regression to earlier behavior

2 In the protest phase, the child aggressively responds to separation from parents (such as clinging to a parent). Inactivity is characteristic of despair. Depression and sadness are characteristics of despair. Regression to earlier behavior is characteristic of despair.

What does the nurse keep in mind while administering an enema to a child? 1The nurse should not give details about the procedure. 2The buttocks of the child should be held together briefly. 3Pillows should not be used during the procedure. 4Administration of enemas should be noninvasive in children

2 Infants and young children are unable to retain the solution after it is administered, so the buttocks must be held together for a short time to retain the fluid. A careful explanation may help ease any concerns or fears the child may have about the procedure. The enema is administered and expelled while the child is lying with the buttocks over the bedpan and with the head and back supported by pillows. An enema is an intrusive procedure.

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should: 1start the IV line because allowing the child to manipulate the nurse is bad. 2start the IV line because unlimited procrastination results in heightened anxiety. 3postpone starting the IV line until the child is ready so that the child experiences a sense of control. 4postpone starting the IV line until the child is ready so that the child's anxiety is reduced.

2 Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. The nurse should start the IV line, recognizing that the child is attempting to gain control. If the timing of the IV line start was not essential for the start of IV antibiotics, postponing might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.

Early detection of a hearing impairment is critical because of its effect on areas of a child's life. The nurse should evaluate further for effects of the hearing impairment on:1reading development.2speech development.3relationships with peers.4performance at school

2 The ability to hear sounds is essential for the development of speech. Babies imitate the sounds that they hear. The child will have greater difficulty learning to read, but the primary issue of concern is the effect on speech. Relationships with peers and performance at school will be affected by the child's lack of hearing. The effect will be augmented by difficulties with oral communication.

Primary (deciduous) teeth are replaced by permanent teeth. By adulthood the child will have __________ permanent teeth.

ANS: 32 thirty-two

The nurse is caring for a newly admitted 6-month-old with suspected respiratory syncytial virus (RSV) with these vital signs: temperature 101.2 (ax), pulse 130, respiration 56, and oxygen saturation of 89% on room air. What activities would the nurse anticipate doing within the first three hours of admission? 1Administer intravenous (IV) antibiotics and obtain a throat culture. 2Obtain a culture of the nasal secretions and calculate the infant's fluid requirements. 3Give the infant his or her usual oral feedings and place the infant in an oxyhood. 4Place the infant on airborne precautions and place a pediatric nasal cannula running at 2L/min of oxygen.

2Antibiotics are not indicated unless there is a secondary infection and the source of the problem is in the copious nasal secretions, which will be cultured. Because the respiratory rate is so high (even higher than a newborn's), it would be dangerous to feed this infant because of potential aspiration. An oxyhood is used for neonates in the neonatal intensive care unit (NICU) for oxygen, not for 6-month-old infants. The amount of oxygen is too high for this infant and an infant nasal cannula would be used, not a pediatric cannula, which is used on children, not infants.

Which antipyretic is associated with Reye syndrome in children?1Acetaminophen (Tylenol)2Aspirin (Bayer)3Ibuprofen (Advil)4Norfloxacin (Noroxin)

2Aspirin should not be given to children because of its association in children with influenza virus or chickenpox and Reye syndrome. Other antipyretics include acetaminophen (Tylenol), and nonsteroidal antiinflammatory drugs (NSAIDs). Acetaminophen (Tylenol) is the preferred drug. One nonprescription NSAID, ibuprofen (Advil), is approved for fever reduction in children as young as 6 months of age. Norfloxacin (Noroxin) is an antibiotic and is usually prescribed for bacterial infection of the gastrointestinal system.

A 6-month-old infant with respiratory syncytial virus (RSV) has the following vital signs: temperature 100.4 (ax), pulse 140, respiration 68, oxygen saturation 92%, and has just had his or her nose bulb suctioned. What action should the nurse take to best determine the effectiveness of the suctioning? 1Recheck the oxygenation saturation. 2Recount the respirations. 3Listen to the lung sounds. 4Recount the heart rate.

2When reassessing the infant's condition, re-check the previously abnormal value that correlates with the physiological system or anatomical area where the intervention was done. Because an infant this age is an obligatory nose breather, when the nose is congested with secretions the respiratory rate can increase substantially. In this case, the respiratory rate increased to far above normal for an infant this age. The values of the oxygenation saturation and the heart rate are reflective of the increased respiratory rate needed because of the secretions, which are thick and "bubbling" when RSV is present. The nurse will need to listen to lung sounds, but the best action to evaluate the effectiveness of suctioning is to obtain a respiratory rate following the suctioning activity. Similarly, the nurse will recheck oxygen saturation and heart rate to denote clinical response to therapy.

The nursing instructor is explaining the risk factors and pathogenesis of Down syndrome to a group of nursing students. What information should the nurse include in the explanation? Select all that apply. 1 It is caused by a mutation of chromosomes.2 It is more likely to occur if the paternal age is more than 35 years.3 It is more likely to occur if the maternal age is more than 35 years.4 It is caused by acquisition of an extra sex chromosome.5 It is caused by acquisition of an extra autosomal chromosome.

3, 5 Maternal age more than 35 years increases the risk of having babies with Down syndrome. Down syndrome is caused by the presence of an extra autosomal chromosome. Down syndrome is not caused by a mutation of chromosomes. Advanced paternal age is not a risk factor for Down syndrome. There is no extra sex chromosome in children with Down syndrome.

A child in the clinic exhibits reduced visual acuity in one eye despite appropriate optical correction. The nurse expects the child's health care provider to diagnosis the child with:1myopia.2hyperopia.3amblyopia.4astigmatism.

3 Visual acuity in one eye despite appropriate optical correction is amblyopia. Myopia is nearsightedness, which is the ability to see objects up close but not clearly at a distance. Hyperopia is farsightedness, which is the ability to see distant objects clearly but not those up close. Astigmatism is an alteration in vision caused by unequal curvature in the refractive apparatus of the eye.

The parents of a cognitively impaired child ask the nurse for guidance with discipline. The nurse's best response is:1"Discipline is ineffective with cognitively impaired children."2"Discipline is not necessary for cognitively impaired children."3"Behavior modification is an excellent form of discipline."4"Physical punishment is the most appropriate form of discipline."

3 Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential in assisting the child in developing boundaries. Positive behaviors and desirable actions should be reinforced. Most children with cognitive impairment will not be able to understand the reason for the physical punishment; consequently behavior will not change as a result of the punishment.

A couple visits the hospital for a prenatal checkup. On reviewing the genetic analysis report, the nurse finds that the male partner has fragile X syndrome. What should the nurse interpret from these findings? Select all that apply.1 All of their sons will have a 50% chance of being affected.2 All of their sons will be carriers for fragile X syndrome.3 The chance of a daughter being affected is 50%.4 All daughters will be carriers for fragile X syndrome.5 All sons will be carriers and will have fragile X syndrome.

3, 4 Fragile X syndrome is an X-linked dominant syndrome with reduced penetrance. About 50% of daughters with fathers affected by fragile X syndrome will be affected because the dominant X chromosome can be from the affected father. All daughters with an affected father will be carriers. The sons get Y chromosomes from the father, so they are not necessarily carriers of the syndrome or affected by the syndrome. The sons can be carriers or affected if the syndrome is passed from the mother.

The nurse is assessing a child with Down syndrome. What findings in the child should alert the nurse to report to the health care provider immediately? Select all that apply.1 Loss of pain sensation2 Loss of impulse control3 Loss of established motor skill4 Loss of established bowel control5 Loss of established bladder control

3, 4, 5 Loss of established motor skill and bowel and bladder control indicate spinal cord compression and must be reported immediately. The child with Down syndrome may have persistent neck pain caused by spinal cord compression. These children do not have impaired pain sensation. Children with Down syndrome are not aggressive. Loss of impulse control is not seen in such children.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after the child receives his gastrostomy feeding, there is often a backup of formula feeding into the tube. As a result, the nurse should:1position the child in a supine position after feedings.2position the child on his or her left side after feedings.3leave the gastrostomy tube open and suspended after feedings.4leave the gastrostomy tube clamped after feedings.

3By keeping the tube open to air, the buildup of pressure on the operative site will be prevented. The child should be positioned on the right side with head elevated at approximately 30 degrees. The formula is backing up into the tube because of the delayed emptying. Leaving the tube clamped will create pressure on the operative site.

Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary? 1C, D 2A, E, K 3A, D, E, K 4C, folic acid

3Vitamins A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. Vitamin C is not one of the fat-soluble vitamins. Vitamin D also needs to be supplemented. Vitamin C and folic acid are not fat soluble.

What is a common postoperative complication of anesthesia? 1Respiratory tract infections 2Cardiac arrest 3Infection of the joints 4Resistance to anesthetic agents

4

You are caring for a 44-lb child who is hospitalized with vomiting and severe dehydration. The physician has ordered parenteral rehydration therapy to restore circulation. The order is for sodium chloride (0.9%) solution in a 20 mL/kg bolus. How much will you give?

ANS: 400 mL The child's weight must first be converted from pounds to kilograms (1 kg = 2.2 lb): 44 lb =20 kg. Next multiply 20 kg 20 mL = 400 mL. The bolus will be 400 mL.

The diagnosis of cognitive impairment is based on the presence of:1intelligence quotient (IQ) of 75 or less.2IQ of 70 or less.3subaverage intellectual functioning, deficits in adaptive skills, and onset at any age.4subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.

4 The diagnosis of cognitive impairment includes subaverage intellectual functioning and deficits in adaptive skills, including an onset before age 18. IQ is only one component of the diagnosis of cognitive impairment. The onset of the deficit must be before age 18 to meet the diagnosis of cognitive impairment.

The parents brought their child to the emergency department after a needle penetrated the child's eye. Which action should the nurse perform while caring for the child?1Examine the eye to look for foreign bodies.2Irrigate the eye to remove the needle from the eye.3Evert the upper eyelid to wash the eye thoroughly.4Observe for hyphema and reaction of the pupil to light.

4 If a child has a penetrating eye injury of any kind, the nurse should examine the eye to determine whether any aqueous humor has leaked from the penetration site. The nurse should observe the presence of hyphema, or bleeding from the eye. The nurse should also assess for pupillary reaction to light because it helps assess the functioning of the pupil. The nurse does not need to examine the eye for foreign bodies because there is already a foreign body in the eye. If the child is experiencing a penetrating eye injury, the nurse does not irrigate the eye to remove the object because this can further damage the cornea. In the case of chemical burns, the nurse rinses the eye by everting the upper eyelid.

It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent: 1otitis media. 2diabetes insipidus. 3nephrotic syndrome. 4acute rheumatic fever.

4Children with Group A ß-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media and diabetes insipidus are not sequelae to GABHS. Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for glomerulonephritis, not nephritic syndrome.

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: 1atrophic changes in the mucosal wall of intestines. 2hypoactivity of the autonomic nervous system. 3hyperactivity of the sweat glands. 4mechanical obstruction caused by increased viscosity of mucous gland secretions.

4Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.

Adolescent sexuality refers to the thoughts, feelings, and behaviors related to the teen's sexual identity. The most recent research (2009) indicates that 46% of all adolescents have been involved in some kind of sexual activity. The only complete protection from pregnancy and sexually transmitted diseases (STDs) is ____________.

ANS: abstinence Adolescents should be encouraged that there is nothing wrong with abstaining from sexual activity. Adolescents who engage in sexual activity at a young age are more likely to participate in other high-risk behaviors such as alcohol and drug use. Adolescents who demonstrate high self-esteem are more likely to delay sexual intercourse.

The nurse has just assisted in the delivery of a female infant to first-time parents. The infant is suctioned, dried, and placed skin-to-skin on her mother's chest. This allows for significant interaction between mother and baby and is known as _____________.

ANS: attachment Parent-infant attachment is one of the most important aspects of infant psychosocial development. Initiated immediately after birth, attachment is strengthened by many mutually satisfying interactions between parents and their infant during the first few months of life. Attachment is a sense of belonging or connection with each other.

When a child is hospitalized, one component of their plan of care is the use of therapeutic play. This care is often provided by a(n) _____________.

ANS: child life specialist Child life specialists are available in many hospitals to share their expertise in child growth and development, and the use of play. Using a collaborative approach with the nurse, activities are planned to meet both the physical and psychological needs of the child.

A type of play that allows children to act out roles and experiences that may have happened to them, that they fear may happen, or that they have observed in others is known as ______ play.

ANS: dramatic This type of play can be spontaneous or guided and often includes medical or nursing equipment. It is especially valuable for children who have had or will have multiple procedures or hospitalizations

It is late winter when a 7-year-old child reports to the school nurse with fever, headache, myalgia, and glandular swelling. After assessment the nurse's preliminary diagnosis includes the viral infection most commonly known as ________.

ANS: mumps The classic indication of mumps is parotid glandular swelling, although a number of children will have no such swelling. This is often accompanied by fever. The parents should be notified and provided with educational information regarding care of the child with the mumps.

Adolescents' eyes and ears are fully developed and, with the exception of minor infections, the sensory system remains quite healthy during this period of development. The mother of a 12-year-old complains to the nurse that she is concerned that her daughter frequently needs changes to her corrective lenses. This is a condition known as ___________.

ANS: myopia Myopia (nearsightedness) occurs in early adolescence, between the ages of 11 and 13 and is a normal part of adolescent development.

After a serious illness or trauma the child's ability to function may change. Once the acute situation has resolved, the child may be transferred to a __________ hospital

ANS: rehabilitation Children with neurologic injuries, such as head injuries and children with serious burns may thrive in the environment of a rehabilitation hospital, which resembles the home setting. In this setting the child is cared for by a multidisciplinary team who focuses on what he or she can do, rather than their limitations.

Bodily fluids are composed of two elements; water and _____.

ANS: solutes Water is the primary constituent of bodily fluids. An infant's weight is approximately 75% water compared to the adult's weight, which is 55% to 60% water. Solutes are composed of both electrolytes and nonelectrolytes. The body's solutes include sodium, potassium, chloride, calcium, and magnesium.

A disturbance in the flow and time patterning of speech is known as ____________.

ANS: stuttering stammering During the preschool years, children often have experiences they want to share but had difficulty putting the words together. Children at this stage commonly repeat whole words or phrases and interject "um" into their speech. This may be more frequent during times of excitement or when formulating long and complex sentences. Parents can help their child by focusing on the idea that the child is expressing not on how the child is speaking. Parents should not complete the child's sentences or draw attention to the child's speech

Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)? a. "I know the only way to prevent STDs is to not be sexually active." b. "I practice safe sex because I wash myself right after sex." c. "I won't get any kind of STD because I take the pill." d. "I only have sex if my boyfriend wears a condom."

ANS: A Feedback A Abstinence is the only foolproof way to prevent an STD. B STDs are transmitted through body fluids (semen, vaginal fluids, blood). Perineal hygiene will not prevent an STD. C Oral contraceptives do not protect women from contracting STDs. D A condom can reduce but not eliminate an individual's chance of acquiring an STD.

Which activity is most appropriate for developing fine motor skills in the school-age child? a. Drawing b. Singing c. Soccer d. Swimming

ANS: A Feedback A Activities such as drawing, building models, and playing a musical instrument increase the school-age child's fine motor skills. B Singing is an appropriate activity for the school-age child, but it does not increase fine motor skills. C The school-age child needs to participate in group activities to increase both gross motor skills and social skills, but group activities do not increase fine motor skills. D Swimming is an activity that also increases gross motor skills.

Which play activity should the nurse implement to enhance deep breathing exercises for a toddler? a. Blowing bubbles b. Throwing a Nerf ball c. Using a spirometer d. Keeping a chart of deep breathing

ANS: A Feedback A Age-appropriate play for a toddler to enhance deep breathing is blowing bubbles. B Throwing a Nerf ball does not enhance deep breathing. C Using a spirometer and keeping a chart of deep breathing are more appropriate for a school-age child. D Using a spirometer and keeping a chart of deep breathing are more appropriate for a school-age child.

The nurse is obtaining vital signs on a 1-year-old child. What is the most appropriate site for assessing the pulse rate? a. Apical b. Radial c. Carotid d. Femoral

ANS: A Feedback A Apical pulse rates are taken in children younger than 2 years. B Radial pulse rates may be taken in children older than 2 years. C It is difficult to palpate the carotid pulse in an infant. D The femoral pulse is palpated when comparing peripheral pulses, but it is not used to measure an infant's pulse rate.

Which diet would the nurse recommend to the mother of a child who is having mild diarrhea? a. Rice, potatoes, yogurt, cereal, and cooked carrots b. Bananas, rice, applesauce, and toast c. Apple juice, hamburger, and salad d. Whatever the child would like to eat

ANS: A Feedback A Bland but nutritious foods including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt, cooked vegetables, and lean meats are recommended to prevent dehydration and hasten recovery. B These foods used to be recommended for diarrhea (BRAT diet). These foods are easily tolerated, but the BRAT diet is low in energy, density, fat, and protein. C Fatty foods, spicy foods, and foods high in simple sugars should be avoided. D The child should be offered foods he or she likes but should not be encouraged to eat fatty foods, spicy foods, and foods high in simple sugars.

The nurse advises the mother of a 3-month-old exclusively breastfed infant to a. Start giving the infant a vitamin D supplement. b. Start using an infant feeder and add rice cereal to the formula. c. Start feeding the infant rice cereal with a spoon at the evening feeding. d. Continue breastfeeding without any supplements.

ANS: A Feedback A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets. B An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods are not recommended for a 3-month-old infant. C Rice cereal and other solid foods are contraindicated in a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age. D Because breast milk is not an adequate source of fluoride, infants need to be given a fluoride supplement in addition to a vitamin D supplement.

The ability to mentally understand that 1 + 3 = 4 and 4 - 1 = 3 occurs in which stage of cognitive development? a. Concrete operations b. Formal operations c. Intuitive thought d. Preoperations

ANS: A Feedback A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations. B The formal operations stage deals with abstract reasoning and does not occur until adolescence. C Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing. D In preoperational thinking, the child is usually able to add 1 + 3 = 4 but is unable to retrace the process.

In terms of fine motor development, what should the 7-month-old infant be able to do? a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A Feedback A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. B The crude pincer grasp is apparent at approximately age 9 months. C The child can scribble spontaneously at age 15 months. D At age 12 months, the child can release cubes into a cup.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. The nurse should interpret this as being a. A belief common at this age b. A belief that forms the basis for most religions c. Suggestive of excessive family pressure d. Suggestive of a failure to develop a conscience

ANS: A Feedback A Children at this age may view illness or injury as a punishment for a real or imagined mystique. B The belief in divine punishment is common at this age. C The belief in divine punishment is common at this age. D The belief in divine punishment is common at this age.

According to Piaget, the adolescent is in the fourth stage of cognitive development, or period of what? a. Formal operations b. Concrete operations c. Conventional thought d. Postconventional thought

ANS: A Feedback A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. B Concrete operations usually develops between ages 7 and 11 years. C Conventional and postconventional thought refer to Kohlberg's stages of moral development. D Conventional and postconventional thought refer to Kohlberg's stages of moral development.

Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth.

ANS: A Feedback A Development, a continuous and orderly process, provides the basis for increases in the child's function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. B An increase in the number and size of cells is a definition for growth. C Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. D Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.

A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.

ANS: A Feedback A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls. B Puberty occurs 1 1/2 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls). C Puberty occurs approximately 1 year earlier in African-American girls than in white girls. D Physical growth is slow and steady during the school-age years.

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is a. Erikson b. Freud c. Kohlberg d. Piaget

ANS: A Feedback A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. B Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. C Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's. D Jean Piaget's cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

The most fatal type of burn in the toddler age-group is a. Flame burn from playing with matches b. Scald burn from high-temperature tap water c. Hot object burn from cigarettes or irons d. Electric burn from electrical outlets

ANS: A Feedback A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group. B These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. C These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. D These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use.

A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The best explanation for this is that a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs.

ANS: A Feedback A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. B This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. C This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. D This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern.

The environment, both physical and psychosocial, is a significant determinate of growth and development outcomes before and after birth. Nurses can assist parents in preventing environmental injury for their 2-year-old toddler by teaching them to avoid the most common sources of exposure. This anticipatory guidance includes teaching related to a. Avoiding sun exposure, secondhand smoke, and lead b. Socioeconomic status, primarily poverty c. Maternal smoking and alcohol intake during pregnancy d. The passing of environmental toxins through breast milk

ANS: A Feedback A Lead can be present in the home and in toys made overseas. Environmental injury can also be the result of mercury, pesticides (flea and tick collars), radon, and exposure to the sun and secondhand smoke. It is important for the nurse to provide health teaching related to these factors. B The nurse is unable to influence socioeconomic status. C It is too late for the nurse to instruct the mother regarding smoking or alcohol intake during pregnancy. This should have been included in prenatal teaching. D It is unlikely that a 2-year-old child will still be breastfeeding.

What is the best response for the nurse to give a parent about contacting the physician regarding an infant with diarrhea? a. "Call your pediatrician if the infant has not had a wet diaper for 6 hours." b. "The pediatrician should be contacted if the infant has two loose stools in an 8-hour period." c. "Call the doctor immediately if the infant has a temperature greater than 100° F." d. "Notify the pediatrician if the infant naps more than 2 hours."

ANS: A Feedback A No urine output in 6 hours needs to be reported because it indicates dehydration. B Two loose stools in 8 hours is not a serious concern. If blood is obvious in the stool or the frequency increases to one bowel movement every hour for more than 8 hours, the physician should be notified. C A fever greater than 101° F should be reported to the infant's physician. D It is normal for the infant who is not ill to nap for 2 hours. The infant who is ill may nap longer than the typical amount.

A nurse is reviewing pediatric physical assessment techniques. Which statement about performing a pediatric physical assessment is correct? a. Physical examinations proceed systematically from head to toe unless developmental considerations dictate otherwise. b. The physical examination should be done with parents in the examining room for children of any age. c. Measurement of head circumference is done until the child is 5 years old. d. The physical examination is done only when the child is cooperative.

ANS: A Feedback A Physical assessment usually proceeds from head to toe; however, developmental considerations with infants and toddlers dictate that the least threatening assessments be done first to obtain accurate data. B Having parents in the examining room with adolescents is not appropriate. C Head circumference is routinely measured until 36 months of age. D Children will not always be cooperative during the physical examination. The examiner will need to incorporate communication and play techniques to facilitate cooperation.

Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer

ANS: A Feedback A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. B Nesting blocks are more appropriate for a 12- to 15-month-old child. C A bicycle with training wheels is appropriate for a preschool or young school-age child. D A computer can be appropriate as early as the preschool years.

How should the nurse advise parents whose preschooler used to sleep through the night and now awakens at intervals after a short hospitalization? a. Regressive behavior after a hospitalization is normal and usually short term. b. The child is probably expressing anger. c. Egocentric behavior often manifests itself when the child is left alone to sleep. d. The child is probably feeling pain and needs further evaluation.

ANS: A Feedback A Regression is manifested in a variety of ways, is normal, and usually is short term. B Nighttime waking is not associated with anger. C Egocentric behavior is not an explanation for nighttime waking. D More information is needed before assessment of pain can be made.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

ANS: A Feedback A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. B The ability to roll from back to abdomen usually occurs at 6 months old. C Sitting erect without support is a developmental milestone usually achieved by 8 months. D The 10-month-old infant can usually move from a prone to a sitting position.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as a. Signs of stress b. Developmental delay c. Physical problem causing emotional stress d. Lack of adjustment to school environment

ANS: A Feedback A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. B This child is exhibiting signs of stress. C This child is exhibiting signs of stress. D This child is exhibiting signs of stress.

Which is appropriate play for a 6-month-old infant? a. Pat-a-cake, peek-a-boo b. Ball rolling, hide-and-seek game c. Bright rattles and tactile toys d. Push and pull toys

ANS: A Feedback A Six-month-old children enjoy playing pat-a-cake and peek-a-boo. B Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games. C Four-month-old infants enjoy bright rattles and tactile toys. D Twelve-month-old infants enjoy playing with push and pull toys.

The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acid-base balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children? a. The respiratory, renal, and chemical-buffering systems b. The kidneys balance acid; the lungs balance base c. The cardiovascular and integumentary systems d. The skin, kidney, and endocrine systems

ANS: A Feedback A The acid-base system is regulated by chemical buffering, respiratory control of carbon dioxide, and renal regulation of bicarbonate and secretion of hydrogen ions. B Both the kidneys and the lungs, along with the buffering system, contribute to acid-base balance. Neither system regulates acid or base balances exclusively. C The cardiovascular and integumentary systems are not part of acid-base regulation in the body. D Chemical buffers, the lungs, and the kidneys work together to keep the blood pH within normal range.

The nurse palpated the anterior fontanel of a 14-month-old infant and found that it was closed. What does this finding indicate? a. This is a normal finding. b. This finding indicates premature closure of cranial sutures. c. This is abnormal and the child should have a developmental evaluation. d. This is an abnormal finding and the child should have a neurologic evaluation.

ANS: A Feedback A The anterior fontanel should be completely closed by 12 to 18 months of age. B A closed anterior fontanel at 14 months of age does not indicate premature closure of cranial sutures. C This finding is not abnormal and does not necessitate a developmental evaluation. D This finding is not abnormal and does not indicate the need for a neurologic examination.

A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse's best response to the parents about this behavior? a. "Your child is showing a normal response to the stress of hospitalization." b. "Your child is not coping effectively with hospitalization. We'll need to get a consult from the doctor due to this behavioral problem." c. "It is helpful for parents to stay with children during hospitalization." d. "You can avoid this if you leave after your child falls asleep."

ANS: A Feedback A The child is exhibiting a healthy attachment to the father. B The child's behavior represents the protest stage of separation and does not represent maladaptive behavior. C This response places undue stress and guilt on the parents. D This response fosters the child's mistrust.

Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation; airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.

ANS: A Feedback A The child's skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on Contact and Airborne Precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and health care providers from acquiring this disease. B The child's skin lesions are characteristic of varicella. Additional measures must be instituted to protect other patients and staff who may be susceptible to the disease. C Certain viral illnesses such as rubella and fifth disease are known to affect the fetus if the woman contracts the disease during pregnancy. This child appears to have varicella. Pregnancy is not a contraindication to caring for a child with varicella. D The child appears to have varicella. Screening visitors for immunity to measles is irrelevant. It is important to screen visitors for immunity to varicella.

A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is a. Testicular enlargement b. Facial hair c. Scrotal enlargement d. Voice deepens

ANS: A Feedback A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. B During Tanner stages 4 and 5, facial hair appears at the corners of the upper lip and chin. C As testosterone secretion increases, the penis, testes, and scrotum enlarge. D During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen.

Which choice includes the components of a complete pediatric history? a. Statistical information, client profile, health history, family history, review of systems, lifestyle and life patterns b. Vital signs, chief complaint, and list of previous problems c. Chief complaint, including body location, quality, quantity, timeframe, and alleviating and aggravating factors d. Pertinent developmental and family information

ANS: A Feedback A The identified items are included in a complete pediatric history. B Vital signs, chief complaint, and list of previous problems do not constitute a complete history. C A problem-oriented history includes specific information about the chief complaint. D Pertinent developmental and family information are part of the complete history.

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

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

Which is the most developmentally appropriate intervention when working with the hospitalized adolescent? a. Encourage peers to call and visit when the adolescent's condition allows. b. Encourage the adolescent's friends to continue with their daily activities; the adolescent has concrete thinking and will understand. c. Discourage questions and concerns about the effects of the illness on the adolescent's appearance. d. Ask the parents how the adolescent usually copes in new situations.

ANS: A Feedback A The peer group is important to the adolescent's sense of belonging and identity; therefore separation from friends is a major source of anxiety for the hospitalized adolescent. B Adolescents should have advanced beyond concrete thinking. In addition, hospitalized adolescents may be upset if their friends continue with daily activities without them. Communication, interacting, and meeting with friends will be important. C Questions and concerns should be encouraged regarding the adolescent's appearance and the effects of illness on appearance. D How the adolescent copes should be asked directly of the adolescent.

Which action is the primary concern in the treatment plan for a child with persistent vomiting? a. Detecting the cause of vomiting b. Preventing metabolic acidosis c. Positioning the child to prevent further vomiting d. Recording intake and output

ANS: A Feedback A The primary focus of managing vomiting is detection of the cause and then treatment of the cause. B Metabolic alkalosis results from persistent vomiting. Prevention of complications is the secondary focus of treatment. C The child with persistent vomiting should be positioned upright or side-lying to prevent aspiration. D Recording intake and output is a nursing intervention, but it is not the primary focus of treatment.

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

ANS: A Feedback A The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. B Undescended testes cannot be predictably palpated. C Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. D Privacy should always be provided for children.

The nurse is performing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as a(n) a. Normal finding b. Questionable finding—infant should be rechecked in 1 month c. Abnormal finding—indicates need for immediate referral to practitioner d. Abnormal finding—indicates need for developmental assessment

ANS: A Feedback A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior fontanel closes between 2 and 3 months of age. B Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required. C Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required. D Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

A 3-month-old infant born at 38 weeks of gestation will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as a. Normal development b. Significant developmental lag c. Slightly delayed development as a result of prematurity d. Suggestive of a neurologic disorder such as cerebral palsy

ANS: A Feedback A This is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. B The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task. C The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task. D The child is age-appropriate. No evidence of neurologic dysfunction is present.

The nurse percussing over an empty stomach expects to hear which sound? a. Tympany b. Resonance c. Flatness d. Dullness

ANS: A Feedback A Tympany is a high-pitched, loud-intensity sound heard over air-filled body parts such as the stomach and bowel. B Resonance is a low-pitched, low-intensity sound elicited over hollow organs such as the lungs. C Flatness is a high-pitched, soft-intensity sound elicited by percussing over solid masses such as bone or muscle. D Dullness is a medium-pitched, medium-intensity sound elicited when percussing over high-density structures such as the liver.

18. When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? a. Administering the medication with a syringe (without needle) placed along the side of the infant's tongue. b. Administering the medication as rapidly as possible with the infant securely restrained. c. Mixing the medication with the infant's regular formula or juice and administering by bottle. d. Keeping the child upright with the nasal passages blocked for a minute after administration.

ANS: A Administer the medication with a syringe without needle placed alongside of the infant's tongue. The contents are administered slowly in small amounts, allowing the child to swallow between deposits. Medications should be given slowly to avoid aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking/eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. The child may associate the altered taste with the food and refuse to eat in future. Holding the child's nasal passages increases the risk of aspiration.

12. The nurse gives an injection in a patient's room. Which method should the nurse use to dispose of the needle? a. Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room. b. Dispose of syringe and needle in a rigid, puncture-resistant container in an area outside of patient's room. c. Cap needle immediately after giving injection and dispose of in proper container. d. Cap needle, break from syringe, and dispose of in proper container.

ANS: A All needles (uncapped and unbroken) are disposed of in a rigid, puncture-resistant container located near the site of use. Consequently, these containers should be installed in the patient's room. The uncapped needle should not be transported to an area distant from use.

3. The most appropriate nursing action to implement when a preschooler being prepped for outpatient surgery refused to allow the parent to remove his/her underwear? a. Allow the child to wear their underpants. b. Discuss to the mother why this is important. c. Ask the mother to explain to her child why he/she must remove the underwear. d. Explain in a kind, matter-of-fact manner that this is hospital policy.

ANS: A It is appropriate for the child to leave his/her underpants on. This allows his/her some measure of control during the foot surgery. The mother should not be required to make the child more upset. The child is too young to understand what hospital policy means.

31. A 6-year-old child is hospitalized for intravenous (IV) antibiotic therapy. He eats little on his "regular diet" trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. Which is the best nursing action? a. Request these favorite foods for him. b. Identify healthier food choices that he likes. c. Explain that he needs fruits and vegetables. d. Reward him with ice cream at the end of every meal that he eats.

ANS: A Loss of appetite is a symptom common to most childhood illnesses. To encourage adequate nutrition, favorite foods should be requested for the child. Even though these substances are not nutritious, they can provide necessary fluid and calories and can be supplemented with additional fruits and vegetables. Ice cream and other desserts should not be used as rewards or punishment.

9. A 3 year old has a 102° F fever associated with a viral illness that has not responded to acetaminophen. The nurse's action should be based on what knowledge about fevers in children? a. Fevers such as this are common with viral illnesses. b. Seizures are common in children when antipyretics are ineffective. c. Fever over 102° F indicates greater severity of illness. d. Fever over 102° F indicates a probable bacterial infection.

ANS: A Most fevers are of brief duration, have limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

20. When teaching a mother how to administer eyedrops, where should the nurse instruct to place them? a. In the conjunctival sac that is formed when the lower lid is pulled down. b. Carefully under the upper eyelid while it is gently pulled upward. c. On the sclera while the child looks to the side. d. Anywhere as long as drops contact the eye's surface.

ANS: A The lower lid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball.

11. The nurse wore gloves during a dressing change. When the gloves are removed, the nurse should perform which initial action? a. Wash hands thoroughly. b. Check the gloves for leaks. c. Rinse gloves in disinfectant solution. d. Apply new gloves before touching the next patient.

ANS: A When gloves are worn, the hands are washed thoroughly after removing the gloves because both latex and vinyl gloves fail to provide complete protection. Gloves should be disposed of after use and hands should be thoroughly washed again before new gloves are applied.

30. What critical information should the nurse incorporate into care when using restraints on a child? a. Use the least restrictive type of restraint. b. Tie knots securely so they cannot be untied easily. c. Secure the ties to the mattress or side rails. d. Remove restraints every 4 hours to assess skin.

ANS: A When restraints are necessary, the nurse should institute the least restrictive type of restraint. Knots must be tied so that they can be easily undone for quick access to the child. The ties are never tied to the mattress or side rails. They should be secured to a stable device, such as the bed frame. Restraints are removed every 2 hours to allow for range of motion, position changes, and assessment of skin integrity.

You are working as the triage nurse in a pediatric emergency room. You receive a telephone call from the mother of an adolescent whose front tooth was completely knocked out of his mouth while he was playing soccer. The mother is seeking advice. Which is the appropriate response? Select all that apply. a. Rinse the tooth in lukewarm tap water. b. Place the tooth in saline, milk, or water. c. Scrub the tooth with a disinfectant, such as mouth wash. d. Bring the child to the emergency room within the next hour for the best prognosis.

ANS: A, B Feedback Correct Rinse the tooth in lukewarm tap water—this is a correct response. Place the tooth in saline, milk, or water—this is a correct response. Incorrect The tooth should not be scrubbed, and cleaning agents and disinfectants should be avoided. The prognosis is best if the injury is treated within 30 minutes.

A preschooler is diagnosed with helminthes. The child's mother is very upset and wants to know how her child could have contracted this illness. After obtaining a detailed history, the nurse identifies all possible transmission modes. Select all modes that apply. a. Playing in the backyard sandbox b. Not washing hands before eating c. Placing hands in the mouth and nail biting d. Skin-to-skin contact with other children e. Scratches from a neighborhood cat

ANS: A, B, C Feedback Correct Common helminthes include roundworm, pinworm, tapeworm, and hookworm. Children are frequently infected as the result of frequent hand-mouth activity (unwashed hands, nail biting, not washing hands after using the toilet) and the likelihood of fecal contamination from sandboxes (especially if dogs and cats deposit fecal material in them). Other causes include not adequately washing fruits and vegetables before eating them and drinking contaminated water. Incorrect Skin-to-skin contact with other children and scratches from a cat are not transmission modes for helminthes.

Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply) a. The child spends an inordinate amount of time in the nurse's office. b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.

ANS: A, B, C Feedback Correct Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them. Incorrect These are not indications of bullying.

Which demonstrates the school-age child's developing logic in the stage of concrete operations? Select all that apply. a. The school-age child is able to recognize that 1 lb of feathers is equal to 1 lb of metal. b. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time. c. The school-age child understands the principles of adding, subtracting, and reversibility. d. The school-age child has thinking that is characterized by egocentrism, animism, and centration.

ANS: A, B, C Feedback Correct The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations. Incorrect This type of thinking occurs in the intuitive thought stage, not the concrete operations stage of development.

Which play patterns does a 3-year-old child typically display? Select all that apply. a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play

ANS: A, B, C, E Feedback Correct Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years. Incorrect Structured play is typical of school-age children.

The traditional areas of school health nursing that are still prevalent in many school systems include (select all that apply) a. Health screening b. Emergency care c. Intensive care d. Communicable disease management e. Health care advice

ANS: A, B, D, E Feedback Correct Health screening such as vision, hearing, and growth checks can provide information about problems that may affect the child's ability to learn. School nurses are often the first to provide care for children experiencing an unintentional injury, either on the playground or in the school building. The nurse must assess children for illnesses that may be transmitted to other children, provide care and isolation until a parent can pick up the child from school. The school nurse can be a source of referral for families in need of health care services. Incorrect Seriously ill hospitalized children may require intensive care. Another role appropriate for the school nurse is supervision of specialized care for children with chronic health needs. School attendance by these children may include the need for catheterization, gastric tube feedings, and suctioning.

The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? Select all that apply. a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.

ANS: A, B, D, E Feedback Correct Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap before fatigue or a snack if mealtime is delayed will be helpful in alleviating the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. Incorrect The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.

Hearing seems to be relatively acute, even at birth, as shown by reflexive generalized reaction to noise. All newborns should undergo hearing screening at birth, before hospital discharge. In addition, assessment for hearing deficits should take place at every well-baby visit. Risk factors for hearing loss include (select all that apply) a. Structural abnormalities of the ear b. Family history of hearing loss c. Alcohol or drug use by the mother during pregnancy d. Gestational diabetes e. Trauma

ANS: A, B, E Feedback Correct Structural abnormalities of the ear, a family history of hearing loss, and trauma are risk factors for hearing loss. Other risk factors include persistent otitis media and developmental delay. The American Academy of Pediatrics suggests that infants who demonstrate hearing loss be eligible for early intervention and specialized hearing and language services. Incorrect Prenatal alcohol or drug intake and gestational diabetes are not risk factors for hearing loss in the infant.

What is an age-appropriate nursing intervention to facilitate psychological adjustment for an adolescent expected to have a prolonged hospitalization? Select all that apply. a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. d. Follow home routines. e. Encourage parents to bring in favorite foods.

ANS: A, B, E Feedback Correct These are all developmentally appropriate approaches to facilitate adjustment and coping for an adolescent who will be experiencing prolonged hospitalization. Incorrect Involving parents in care and following home routines are important interventions for the preschool child who is in the hospital. Adolescents do not need parents to assist in their care. They are used to performing independent self-care. Adolescents may want their parents to be nearby, or they may enjoy the freedom and independence from parental control and routines.

2. The advantages of the ventrogluteal muscle as an injection site in young children include which of the following? (Select all that apply.) a. Less painful than vastus lateralis b. Free of important nerves and vascular structures c. Cannot be used when child reaches a weight of 20 lbs d. Increased subcutaneous fat, which increases drug absorption e. Easily identified by major landmarks

ANS: A, B, E Less painful, free of important nerves and vascular structures, and easily identifiable are advantages of the ventrogluteal muscle. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. Cannot be used when a child is 20 lbs or more and increased subcutaneous fat are not advantages of the ventrogluteal muscle as an injection site in young children.

Which assessment findings indicate to the nurse that a child has excess fluid volume? Select all that apply. a. Weight gain b. Decreased blood pressure c. Moist breath sounds d. Poor skin turgor e. Rapid bounding pulse

ANS: A, C, E Feedback Correct A child with fluid volume excess will have a weight gain, moist breath sounds due to the excess fluid in the pulmonary system, and a rapid bounding pulse. Other signs seen with fluid volume excess are increased blood pressure, edema, and fatigue. Incorrect Decreased blood pressure and poor skin turgor are signs of fluid volume deficit.

A nurse has completed a teaching session for parents about "baby-proofing" the home. Which statements made by the parents indicate an understanding of the teaching? Select all that apply. a. "We will put plastic fillers in all electrical plugs." b. "We will place poisonous substances in a high cupboard." c. "We will place a gate at the top and bottom of stairways." d. "We will keep our household hot water heater at 130 degrees." e. "We will remove front knobs from the stove."

ANS: A, C, E Feedback Correct By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs form the stove can prevent burns. Incorrect Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.

Which interventions are appropriate for preventing childhood obesity? Select all that apply. a. Establish consistent times for meals and snacks. b. Eliminate all snacks. Eat three nutritious meals a day. c. Teach the family and child how to select foods and prepare foods. d. Encourage schools to provide snack machines with popcorn, cookies, and diet soda. e. Limit computer and television time.

ANS: A, C, E Feedback Correct Preventing obesity includes encouraging families to establish consistent times for meals and snacks and discouraging between-meal eating. Parents and children also need to be taught how to select and prepare healthful foods. Because snacks are an important aspect in childhood nutrition, nutritious snacks should be identified. School-age children usually require a healthful snack after school and in the evening. A child who spends time with social media has less interest in physical activity and going outdoors. Incorrect Snacks are an important aspect in childhood nutrition. Nutritious snacks should be identified, not eliminated. Healthy snack options include fruit, popcorn, nuts, and yogurt, not cookies and diet soda. In schools with snack machines, children may use their lunch money to purchase high-calorie snacks versus a nutritious lunch.

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach? Select all that apply. a. Secure in a rear-facing, upright car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

ANS: A, C, E Feedback Correct Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. Incorrect The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an airbag.

The nurse should provide which information to parents about the prevention of parasitic infections? Select all that apply. a. Perform good handwashing. b. Diaper a child when swimming. c. Avoid cleaning the bathroom facilities with bleach. d. Shoes should be worn outside. e. Fruits and vegetables should be washed before eating.

ANS: A, D, E Feedback Correct Children are more commonly infected with parasites than adults, primarily as a result of frequent hand-to-mouth activity and the likelihood of fecal contamination. Good handwashing can prevent the transmission. Shoes should be worn when outside to prevent transmission, and fruits and vegetables should be washed before eating. Incorrect The child should not swim in a pool that allows diapered children. The bathroom facilities should be cleaned with bleach to decrease the chance of transmission.

Injuries claim many lives during adolescence. Which factors contribute to early adolescents engaging in risk-taking behaviors? Select all that apply. a. Peer pressure b. A desire to master their environment c. Engagement in the process of separation from their parents d. A belief that they are invulnerable e. Impulsivity

ANS: A, D, E Feedback Correct Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability ("It can't happen to me") are evident in adolescence. Impulsivity places adolescents in unsafe situations. Incorrect Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training.

Why is observation for 24 hours in an acute-care setting often appropriate for children? a. Longer hospital stays are more costly. b. Children become ill quickly and recover quickly. c. Children feel less separation anxiety when hospitalized for 24 hours. d. Families experience less disruption during short hospital stays.

ANS: B Feedback A A child's state of wellness, rather than cost, determines the length of stay. B Children become ill quickly and recover quickly; therefore they can require acute care for a shorter period of time. C Separation anxiety is primarily a factor of the stage of development, not the length of hospital stay. D Family disruption is a secondary outcome of a child's hospitalization; it does not determine length of stay.

In which age-group does the child's active imagination during unfamiliar experiences increase the stress of hospitalization? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: B Feedback A A toddler's primary response to hospitalization is separation anxiety. B Active imagination is a primary characteristic of preschoolers. C School-age children experience stress with loss of control. D Adolescents experience stress from separation from their peers.

The nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.

ANS: B Feedback A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). C By 2 years of age, 60% to 70% of the toddler's speech is understandable. D The toddler's vocabulary contains approximately 300 or more words.

The mother of a 10-month-old infant tells the nurse that her infant "really likes cow's milk." What is the nurse's best response to this mother? a. "Milk is good for him." b. "It is best to wait until he is a year old before giving him cow's milk." c. "Limit cow's milk to his bedtime bottle." d. "Mix his cereal with cow's milk and give him formula in a bottle."

ANS: B Feedback A Although milk is a good source of calcium and protein for children after the first year of life, it is not the best source of nutrients for children younger than 1 year old. B It is best to wait until the infant is at least 1 year old before giving him cow's milk because of the risk of allergies and intestinal problems. Cow's milk protein intolerance is the most common food allergy during infancy. C Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. D Cereal can be mixed with formula.

Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation b. Emergency hospitalization c. Outpatient admission d. Rehabilitation admission

ANS: B Feedback A Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission. B Emergency hospitalization involves (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety. C Outpatient admission generally involves preparation time for the family and child. Because of the lower level of acuteness in these settings, anxiety levels are not as high. D Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the child's and family's anxiety.

Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year of age? a. 14 3/4 lb b. 22 1/8 lb c. 29 1/2 lb d. Unable to estimate weigh at 1 year

ANS: B Feedback A An infant doubles birth weight by 6 months of age. B An infant triples birth weight by 1 year of age. C An infant quadruples birth weight by 2 years of age. D Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight.

Which statement made by a mother is consistent with a developmental delay? a. "I have noticed that my 9-month-old infant responds consistently to the sound of his name." b. "I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand." c. "I am so happy when my 1 1/2-month-old infant smiles at me." d. "My 5-month-old infant is not rolling over in both directions yet."

ANS: B Feedback A An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. B Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay. C A social smile is present by 2 months of age. D Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.

What is the best response by the nurse to a parent asking about antidiarrheal medication for her 18-month-old child? a. "It is okay to give antidiarrheal medication to a young child as long as you follow the directions on the box for correct dosage." b. "Antidiarrheal medication is not recommended for young children because it slows the body's attempt to rid itself of the pathogen." c. "I'm sure your child won't like the taste, so give extra fluids when you give the medication." d. "Antidiarrheal medication will lessen the frequency of stools, but give your child Gatorade to maintain electrolyte balance."

ANS: B Feedback A Antidiarrheal medications are not recommended for children younger than 2 years old. B Antidiarrheal medications may actually prolong diarrhea because the body will retain the organism causing the diarrhea, further increasing fluid and electrolyte losses. The use of these medications is not recommended for children younger than 2 years old because of their binding nature and potential for toxicity. C This action is inappropriate because antidiarrheal medications should not be given to a child younger than 2 years old. D It is not appropriate to advise a parent to use antidiarrheal medication for a child younger than 2 years old. Education about appropriate oral replacement fluids includes avoidance of sugary drinks, apple juice, sports beverages, and colas.

Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry? a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty in completing assignments d. Decreasing expectations to eliminate potential failures

ANS: B Feedback A Asking peers for feedback reinforces the child's feelings of failure. B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery. C When teachers or parents complete children's homework for them, it sends the message that you do not trust them to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate. D Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.

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

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

Which statement by a mother indicates that her 5-month-old infant is ready for solid food? a. "When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow." b. "She has just started to sit up without any support." c. "I am surprised that she weighs only 11 pounds. I expected her to have gained some weight." d. "I find that she really has to be encouraged to eat."

ANS: B Feedback A Children who are ready to manage solid foods are able to move food to the back of their throats to swallow. This child's extrusion reflex may still be present. B Sitting is a sign that the child is ready to begin with solid foods. C Infants who weigh less than 13 pounds and demonstrate a lack of interest in eating are not ready to be started on solid foods. D Infants who are difficult feeders and do not demonstrate an interest in solid foods are not ready to be started on them.

A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development b. Moral development c. Psychosocial development d. Psychosexual development

ANS: B Feedback A Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. B The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment. C Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. D Although a task during adolescence is the development of a sexual identity, the teenager's dependence on the parents' sanctioning of right or wrong behavior is more appropriately related to moral development.

What should be included in health teaching to prevent Lyme disease? a. Complete the immunization series in early infancy. b. Wear long sleeves and pants tucked into socks while in wooded areas. c. Give low-dose antibiotics to the child before exposure. d. Restrict activities that might lead to exposure for the child.

ANS: B Feedback A Currently there is no vaccine available for Lyme disease. The Lyme disease vaccine had been approved for persons ages 15 to 70 years; however, was withdrawn from the market in 1992. B Wearing long sleeves and pants, and tucking the pants into socks keeps ticks on the clothing and prevents them from hiding on the body. C Antibiotics are used to treat, not prevent, Lyme disease. D Children should be allowed to maintain normal growth and development with activities such as hiking.

The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with what? a. Cyanosis b. Erythema c. Vitiligo d. Nevi

ANS: B Feedback A Cyanosis in a dark-skinned child appears as a black coloration of the skin. B In dark-skinned children, erythema appears as dusky red or violet skin coloration. C Vitiligo refers to areas of depigmentation. D Nevi are areas of increased pigmentation.

Which statement, made by a 4-year-old child's father, is true about the care of the preschooler's teeth? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth." c. "My son's 'permanent teeth' will begin to come in at 4 to 5 years of age." d. "Fluoride supplements can be discontinued when my son's 'permanent teeth' erupt."

ANS: B Feedback A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. C Secondary teeth erupt at approximately 6 years of age. D If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

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

ANS: B Feedback A Each deep tendon reflex is tested separately. B The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. C Each sense is tested separately. D Although this test enables the nurse to evaluate the child's ability to follow directions, it is used primarily for cerebellar function.

Which is assessed with Tanner staging? a. Hormone levels b. Secondary sex characteristics c. Response to growth hormone secretion tests d. Hyperthyroidism

ANS: B Feedback A Hormone levels are assessed by their concentration in the blood. B Tanner stages are used to assess staging of secondary sex characteristics at puberty. C Growth hormone secretion tests are not associated with Tanner staging. D Tanner stages are not associated with hyperthyroidism.

How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until they are approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

ANS: B Feedback A Infants do not receive maternal immunity to pertussis and are susceptible to pertussis. Pertussis is highly contagious and is associated with a high infant mortality rate. B Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. C Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis. D Erythromycin is used to treat pertussis. It will not prevent the disease.

A mother of a 2-month-old infant tells the nurse, "My child doesn't sleep as much as his older brother did at the same age." What is the best response for the nurse? a. "Have you tried to feed the baby more often?" b. "Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time." c. "It is helpful to keep a record of your baby's eating, waking, sleeping, and elimination patterns and to come back in a week to discuss them." d. "This infant is difficult. It is important for you to identify what is bothering the baby."

ANS: B Feedback A Infants typically do not need more caloric intake to improve sleep behaviors. B Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. C Keeping intake, output, waking, and sleeping data is not typically helpful to discuss differences among infants' behaviors. D Just because an infant may not sleep as much as a sibling did does not justify labeling the child as being difficult. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep.

Based on concepts related to the normal growth and development of children, which child would have the most difficulty with separation from family during hospitalization? a. A 5-month-old infant b. A 15-month-old toddler c. A 4-year-old child d. A 7-year-old child

ANS: B Feedback A Infants younger than 6 months of age will generally adapt to hospitalization if their basic needs for food, warmth, and comfort are met. B Separation is the major stressor for children hospitalized between ages 6 and 30 months. C Although separation anxiety occurs in hospitalized preschoolers, it is usually less obvious and less serious than that experienced by the toddler. D The school-age child is accustomed to separation from parents. Although hospitalization is a stressor, the 7-year-old child will have less separation anxiety than a 15-month-old toddler.

According to Erikson, the psychosocial task of adolescence is to develop a. Intimacy b. Identity c. Initiative d. Independence

ANS: B Feedback A Intimacy is the developmental stage for early adulthood. B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. C Initiative is the developmental stage for early childhood. D Independence is not one of Erikson's developmental stages.

Which STD should the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell? a. Human papillomavirus b. Bacterial vaginosis c. Trichomonas d. Chlamydia

ANS: B Feedback A Manifestations of the human papillomavirus are anogenital warts that begin as small papules and grow into clustered lesions. B Bacterial vaginosis is characterized by a profuse, white, malodorous (fishy smelling) vaginal discharge that sticks to the vaginal walls. C Infections with Trichomonas are frequently asymptomatic. Symptoms in females may include dysuria, vaginal itching, burning, and a frothy, yellowish-green, foul-smelling discharge. D Many people with chlamydial infection have few or no symptoms. Urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection.

A nurse is conducting a health education class for a group of school-age children. Which statement made by the nurse is correct about the body's first line of defense against infection in the innate immune system? a. Nutritional status b. Skin integrity c. Immunization status d. Proper hygiene practices

ANS: B Feedback A Nutritional status is an indicator of overall health, but it is not the first line of defense in the innate immune system. B The first lines of defense in the innate immune system are the skin and intact mucous membranes. C Immunizations provide artificial immunity or resistance to harmful diseases. D Practicing good hygiene may reduce susceptibility to disease, but it is not a component of the innate immune system.

Which expected outcome is developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times.

ANS: B Feedback A Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness. C A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. D Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

What predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age-group

ANS: B Feedback A Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue. B During growth spurts, the need for sleep is increased. C Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue. D Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue.

Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious? a. "You need to be stricter so that your teen stops trying to test the limits." b. "You need to collaborate with your daughter and set limits that are perceived as being reasonable." c. "Increasing your teen's involvement with her peers will improve her self-esteem." d. "Allow your teenager to choose the type of discipline that is used in your home."

ANS: B Feedback A Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process. C Increasing peer involvement does not typically increase self-esteem. D Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

Many adolescents decide to follow a vegetarian diet during their teen years. The nurse can advise the adolescent and his or her parents that a. This diet will not meet the nutritional requirements of growing teens. b. A vegetarian diet is healthy for this population. c. An adolescent on a vegetarian diet is less likely to eat high-fat or low-nutrient foods. d. A vegetarian diet requires little extra meal planning.

ANS: B Feedback A Several dietary organizations have suggested that a vegetarian diet, if correctly followed, is healthy for this population. B A vegetarian diet is healthy for this population, and the low-fat aspect of the diet can prevent future cardiovascular problems. C As with any adolescent, nurses need to advise teens who follow a vegetarian eating plan to avoid low-nutrient, high-fat foods. D The nurse can assist with planning food choices that will provide sufficient calories and necessary nutrients. The focus is on obtaining enough calories for growth and energy from a variety of fruits and vegetables, whole grains, nuts, and soymilk.

A preschool aged child will be receiving immunizations. Which statement identifies an appropriate level of language development for a 4-year-old child? a. The child has a vocabulary of 300 words and uses simple sentences. b. The child uses correct grammar in sentences. c. The child is able to pronounce consonants clearly. d. The child uses language to express abstract thought.

ANS: B Feedback A Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. B The 4-year-old child is able to use correct grammar in sentence structure. C The 4-year-old child typically has difficulty in pronouncing consonants. D The use of language to express abstract thought is developmentally appropriate for the adolescent.

What is the best response to a parent of a 2-month-old infant who asks when the infant should first receive the measles vaccine? a. "Your baby can get the measles vaccine now." b. "The first dose is given any time after the first birthday." c. "She should be vaccinated between 4 and 6 years of age." d. "This vaccine is administered when the child is 11 years old."

ANS: B Feedback A Some immunizations are initiated at 2 months of age, but not the measles vaccine. B The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. C The second dose of MMR is recommended at 4 to 6 years of age. D Children should receive their second MMR dose no later than 11 to 12 years of age.

Which tool measures body fat most accurately? a. Stadiometer b. Calipers c. Cloth tape measure d. Paper or metal tape measure

ANS: B Feedback A Stadiometers are used to measure height. B Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. C Cloth tape measures should not be used because they can stretch. D Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development? a. The child's addition and subtraction ability b. The child's ability to classify c. The child's vocabulary d. The child's play activity

ANS: B Feedback A Subtraction and addition are appropriate cognitive activities for the young school-age child. B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes. C Vocabulary is not as valid an assessment of cognitive ability as is the child's ability to classify. D Play activity is not as valid an assessment of cognitive function as is the child's ability to classify.

Which developmental assessment instrument is appropriate to assess a 5-year-old child? a. Brazelton Behavioral Scale b. Denver Developmental Screening Test II (DDST-II) c. Dubowitz Scale d. New Ballard Scale

ANS: B Feedback A The Brazelton Behavioral Scale is used for newborn assessment. B The DDST-II is used for infants and children between birth and 6 years of age. C The Dubowitz Scale is used for estimation of gestational age. D The New Ballard Scale is used for newborn screening.

Which chart should the nurse use to assess the visual acuity of an 8-year-old child? a. Lea chart b. Snellen chart c. HOTV chart d. Tumbling E chart

ANS: B Feedback A The Lea chart tests vision using four different symbols designed for use with preschool children. B The Snellen chart is used to assess the vision of children older than 6 years of age. C The HOTV chart tests vision by using graduated letters and is designed for use with children ages 3 to 6 years. D The tumbling E chart uses the letter E in various directions and is designed for use with children ages 3 to 6 years.

A preschool-aged child tells the nurse "I was bad, that's why I got sick." What is the best rationale for this child's statement? a. The child has a fear that mutilation will lead to death. b. The child's imagination is very active, and he may believe the illness is a result of something he did. c. The child has a general understanding of body integrity at this age. d. The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.

ANS: B Feedback A The child has imaginative thoughts at this stage of growth and development. B The child may believe that an illness occurred as a result of some personal deed or thought or perhaps because he touched something or someone. C Preschoolers do not have the cognitive ability to connect mutilation to death and do not have a sound understanding of body integrity. D The preschooler fears all types of intrusive procedures whether undergoing a simple procedure such as an IV start or something more invasive such as surgery.

What is the most important factor in determining the rate of fluid replacement in the dehydrated child? a. The child's weight b. The type of dehydration c. Urine output d. Serum potassium level

ANS: B Feedback A The child's weight determines the amount of fluid needed, not the rate of fluid replacement. One milliliter of body fluid is equal to 1 g of body weight; therefore a loss of 1 kg (2.2 lb) is equal to 1 L of fluid. B Isonamtremic and hyponatremic dehydration resuscitation involves fluid replacement over 24 hours. Hypernatremic dehydration involves a slower replacement rate to prevent a sudden decrease in the sodium level. C Urine output is not a consideration for determining the rate of administration of replacement fluids. D Potassium level is not as significant in determining the rate of fluid replacement as the type of dehydration.

Which is the preferred site for administration of the Hib vaccine to an infant? a. Deltoid b. Anterolateral thigh c. Upper, outer aspect of the arm d. Dorsal gluteal region

ANS: B Feedback A The deltoid muscle is not used for infants. B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants. C Subcutaneous injections can be given in the upper arm. The HIB vaccine is given by the intramuscular route. D The dorsal gluteal site is never used for vaccines.

Which strategy is the best approach when initiating the physical examination of a 9-month-old male infant? a. Undress the infant and do a head-to-toe examination. b. Have the parent hold the child on his or her lap. c. Put the infant on the examination table and begin assessments at the head. d. Ask the parent to leave because the infant will be upset.

ANS: B Feedback A The head-to-toe approach needs to be modified for the infant. Uncomfortable procedures, such as the otoscopic examination, should be left until last. B Infants 6 months and older feel stranger anxiety. It is easier to do most of the examination on the parent's lap to lessen anxiety. C The infant may feel less fearful if placed in the parent's lap or with the parent within visual range if placed on the examining table. The head-to-toe approach is modified for the infant. D There is no reason to ask a parent to leave when an infant is being examined. Having the parent with the infant will make the experience less upsetting for the infant.

What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

ANS: B Feedback A The macular rash with rubeola appears after the prodromal stage. B Koplik spots appear approximately 2 days before the appearance of a rash. C Petechiae on the soft palate occur with rubella. D Crops of vesicles on the trunk are characteristic of varicella.

Which strategy is not always appropriate for pediatric physical examination? a. Take the history in a quiet, private place. b. Examine the child from head to toe. c. Exhibit sensitivity to cultural needs and differences. d. Perform frightening procedures last.

ANS: B Feedback A The nurse should collect the child's health history in a quiet, private area. B The classic approach to physical examination is to begin at the head and proceed through the entire body to the toes. When examining a child, however, the examiner must tailor the physical assessment to the child's age and developmental level. C The nurse should always be sensitive to cultural needs and differences among children. D When examining children, painful or frightening procedures should be left to the end of the examination.

Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence.

ANS: B Feedback A The peer group validates acceptable behavior during adolescence. B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being "self-centered or lazy." C Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. D Conformity becomes less important in late adolescence.

Which assessment finding is considered a neurologic soft sign in a 7-year-old child? a. Plantar reflex b. Poor muscle coordination c. Stereognostic function d. Graphesthesia

ANS: B Feedback A The plantar reflex is a normal response. When the lateral aspect of the sole of the foot is stroked in a movement curving medially from the heel to the ball, the response will be plantar flexion of the toes. B Poor muscle coordination is a neurologic soft sign. C Stereognostic function refers to the ability to identify familiar objects placed in each hand. D Graphesthesia is the ability to identify letters or numbers traced on the palm or back of the hand with a blunt point.

Which statement by a mother of a toddler indicates a correct understanding of the use of discipline? a. "I always include explanations and morals when I am disciplining my toddler." b. "I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving." c. "I believe that discipline should be done by only one family member." d. "My rule of thumb is no more than one spanking a day."

ANS: B Feedback A The toddler's cognitive level of development precludes the use of explanations and morals as a part of discipline. B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. C Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary. D Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. In addition, spanking is an inappropriate method of disciplining a child.

29. Which nursing action is the most appropriate when applying a face mask to a child prescribed oxygen therapy? a. Set the oxygen flow rate at less than 6 L/min. b. Make sure the mask fits properly. c. Keep the child warm. d. Remove the mask for 5 minutes every hour.

ANS: B A properly fitting face mask is essential for adequate oxygen delivery. The oxygen flow rate should be greater than 6 L/min to prevent rebreathing of exhaled carbon dioxide. Oxygen delivery through a face mask does not affect body temperature. A face mask used for oxygen therapy is not routinely removed.

Which question most likely elicits information about how a family is coping with a child's hospitalization? a. "Was this admission an emergency?" b. "How has your child's hospitalization affected your family?" c. "Who is taking care of your other children while you are here?" d. "Is this the child's first hospitalization?"

ANS: B Feedback A This is a closed-ended question. The nurse needs to ask other questions to gather additional information. B Open-ended questions encourage communication. Ensuring a positive outcome from the hospital experience can be optimized by the nurse addressing the health needs of family members, as well as the needs of the child. C This is a closed-ended question. The parent answers the question with a short response. The nurse must ask additional questions to learn more about the family. D The parent would answer "yes" or "no" to this question and expect the conversation to be over. The nurse must ask additional questions to learn more about the family.

The nurse is assessing a 4-year-old child's visual acuity. He is planning to attend preschool next week. The results indicate a visual acuity of 20/40 in both eyes. The child's father asks the nurse about his son's results. Which response, if made by the nurse, is correct? a. "Your child will need a referral to the ophthalmologist before he can attend preschool next week." b. "Your child's visual acuity is normal for his age." c. "The results of this test indicate your child may be color blind." d. "Your child did not pass the screening test. He will need to return within the next few weeks to be reevaluated."

ANS: B Feedback A This is within the normal range for visual acuity at 4 years of age. The 4-year-old's acuity is usually 20/30 to 20/40. There is no need for evaluation by an ophthalmologist at this time. B This is the correct response. C The child's visual acuity is within normal range for his age. Color vision is evaluated by different methods than visual acuity. D This is within the normal range for visual acuity at 4 years of age. The 4-year-old's acuity is usually 20/30 to 20/40. There is no need for further evaluation at this time.

The mother of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the mother is a. "It is important for your toddler to eat three meals a day and nothing in between." b. "It is not unusual for toddlers to eat less." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Giving your child a multivitamin supplement daily will increase your toddler's appetite."

ANS: B Feedback A Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. B Physiologically, growth slows and appetite decreases during the toddler period. C Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. D Supplemental vitamins are important for all children, but they do not increase appetite.

A mother asks when toilet training is most appropriately initiated. What is the nurse's best response? a. "When your child is 12 to 18 months of age." b. "When your child exhibits signs of physical and psychological readiness." c. "When your child has been walking for 9 months." d. "When your child is able to sit on the 'potty' for 10 to 15 minutes."

ANS: B Feedback A Toilet training is not arbitrarily started at 12 to 18 months of age. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. The average toddler is not ready until 18 to 24 months of age. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents. B Neurologic development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful. C One of the physical signs of readiness for toilet training is that the child has been walking for 1 year. D The ability to sit on the "potty" for 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.

Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain

ANS: B Feedback A Young infants are not as likely to be as frightened as toddlers by hospitalization because they are not as aware of the environment. B Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. C The 9-year-old child's cognitive ability is sufficient enough for the child to understand the reason for hospitalization. D The 15-year-old adolescent has the cognitive ability to interpret the reason for hospitalization.

An important consideration for the school nurse who is planning a class on bicycle safety is a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear bicycle helmets if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra-large seat.

ANS: B Feedback A Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. C The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. D Children should not ride double.

33. After collecting blood by venipuncture in the antecubital fossa, what intervention should the nurse implement in order to assure control of any bleeding? a. Keep arm extended while applying a bandage to the site. b. Keep arm extended, and apply pressure to the site for a few minutes. c. Apply a bandage to the site, and keep the arm flexed for 10 minutes. d. Apply a gauze pad or cotton ball to the site, and keep the arm flexed for several minutes.

ANS: B Applying pressure to the site of venipuncture stops the bleeding and aids in coagulation. Pressure should be applied before a bandage is applied.

15. What is the most appropriate statement for the nurse to make to a 5-year-old child who is undergoing a venipuncture? a. "You must hold still or I'll have someone hold you down. This is not going to hurt." b. "This will hurt like a pinch. I'll get someone to help hold your arm still so it will be over fast and hurt less." c. "Be a big boy and hold still. This will be over in just a second." d. "I'm sending your mother out so she won't be scared. You are big, so hold still and this will be over soon."

ANS: B Honesty is the best approach. Children should be told what sensation they will feel during a procedure. A 5-year-old child should not be expected to hold still, and assistance ensures safety to everyone. Telling the child that "This will be over in just a second" is not supportive or honest. Parents should be encouraged to remain with the child unless they are extremely uncomfortable doing so.

2. The nurse is planning how to best prepare a 4-year-old child for some diagnostic procedures. What guideline should the nurse consider when preparing a preschooler for a diagnostic procedure? a. Planning for a short teaching session of about 30 minutes. b. Telling the child that procedures are never a form of punishment. c. Keeping equipment out of the child's view. d. Using correct scientific and medical terminology in explanations.

ANS: B Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment. Teaching sessions for this age-group should be 10 to 15 minutes in length. Demonstrate the use of equipment and allow the child to play with miniature or actual equipment. Explain the procedure and how it affects the child in simple terms.

21. A 2-year-old child comes to the emergency department demonstrating signs of dehydration and hypovolemic shock. Which best explains why an intraosseous infusion is started? a. It is less painful for small children. b. Rapid venous access is not possible. c. Antibiotics must be started immediately. d. Long-term central venous access is not possible.

ANS: B In situations in which rapid establishment of systemic access is vital and venous access is hampered, such as peripheral circulatory collapse and hypovolemic shock, intraosseous infusion provides a rapid, safe lifesaving alternative. The procedure is painful, and local anesthesia and systemic analgesia are given. Antibiotics could be given when vascular access is obtained. Long-term central venous access is time-consuming, and intraosseous infusion is used in an emergency situation.

26. In preparing to give "enemas until clear" to a young child, the nurse should select which solution? a. Tap water b. Normal saline c. Oil retention d. Fleet solution

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Fleet enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the Fleet enema can result in diarrhea, which can lead to metabolic acidosis.

4. Using knowledge of child development, what is the best approach when preparing a toddler for a procedure? a. Avoid asking the child to make choices. b. Demonstrate the procedure on a doll. c. Plan for the teaching session to last about 20 minutes. d. Show necessary equipment without allowing child to handle it.

ANS: B Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure. In preparing a toddler for a procedure, the child is allowed to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it.

25. A child is receiving total parenteral nutrition (TPN; hyperalimentation). At the end of 8 hours, the nurse observes the solution and notes that 200 mL/8 hr is being infused rather than the ordered amount of 300 mL/8 hr. The nurse should adjust the rate so that how much will infuse during the next 8 hours? a. 200 mL b. 300 mL c. 350 mL d. 400 mL

ANS: B The TPN infusion rate should not be increased or decreased without the practitioner being informed because alterations in rate can cause hyperglycemia or hypoglycemia. Knowing this will result in the infusion rate being set to the original prescribed flow rate.

14. What is an important nursing consideration when performing a bladder catheterization on a young boy? a. Use clean technique, not Standard Precautions. b. Insert 2% lidocaine lubricant into the urethra. c. Lubricate catheter with water-soluble lubricant such as K-Y Jelly. d. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

ANS: B The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparing the child and parents, selecting the correct catheter, and using appropriate insertion technique. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and Standard Precautions for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure.

19. Guidelines for intramuscular administration of medication in school-age children include what instruction? a. Inject medication as rapidly as possible. b. Insert the needle quickly, using a dart-like motion. c. Penetrate the skin immediately after cleansing the site, before skin has dried. d. Have the child stand, if possible, and if he or she is cooperative.

ANS: B The needle should be inserted quickly in a dart-like motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before skin is penetrated. Place the child in a lying or sitting position.

28. What information should the nurse include when teaching parents how to care for a child's gastrostomy tube at home? a. Never turn the gastrostomy button. b. Clean around the insertion site daily with soap and water. c. Expect some leakage around the button. d. Remove the tube for cleaning once a week.

ANS: B The skin around the tube insertion site should be cleaned with soap and water once or twice daily. The gastrostomy button should be rotated in a full circle during cleaning. Leakage around the tube should be reported to the physician. A gastrostomy tube is placed surgically. It is not removed for cleaning.

Tattoos have become increasingly popular among mainstream adolescents. Like clothing and hairstyles, tattoos serve to define one's identity. It is important for nurses to caution adolescents on the health risks of obtaining a tattoo. These include (select all that apply) a. Amateur tattoos are difficult to remove. b. Tattoos pose a risk for bloodborne and skin infections. c. Health care professionals must be notified of the existence of a tattoo before a magnetic resonance imaging (MRI) scan. d. Tattoo dyes may cause allergic reactions. e. Tattoo parlors are well regulated.

ANS: B, C, D Feedback Correct Tattoos carry the risk for contracting bloodborne diseases such as hepatitis B and HIV. Infection, allergic reaction to the dye, scarring, or keloid formation can occur. Should an MRI ever be required, it is important to notify the health care professionals, because the dyes can contain iron and other metals. Incorrect Amateur tattoos are easily removed; however, studio tattoos made with red and green dye are extremely difficult to remove. Very little regulation exists in the tattoo industry; therefore, the cleanliness of each tattoo parlor varies. Teens should be counseled to avoid making an impulsive decision to get a tattoo.

A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? Select all that apply. a. Concrete thinking b. Egocentrism c. Animism d. Magical thought e. Ability to reason

ANS: B, C, D Feedback Correct The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thought (believes that thinking something causes that event). Incorrect Concrete thinking is seen in school-age children, and ability to reason is seen with adolescents.

A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? Select all that apply. a. Airborne isolation b. Administration of vancomycin (Vancocin) c. Contact isolation d. Administration of mupirocin (Bactroban) ointment to the nares e. Administration of cefotaxime (Cefotetan)

ANS: B, C, D Feedback Correct Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The patient is placed in contact isolation to prevent spread of the infection to other patients. Incorrect The infection is not transmitted by the airborne route so only contact isolation is required. This infection is resistant to cephalosporins.

The prevalence of obesity in the United States has risen dramatically in both adults and children. The increase in the number of overweight children is addressed in Healthy People 2020. Strategies designed to approach this issue include (select all that apply) a. Decreased calcium and iron intake b. Increased fiber and whole grain intake c. Decreased use of sugar and sodium d. Increase fruit and vegetable intake e. Decrease the use of solid fats

ANS: B, C, D, E Feedback Correct Along with these recommendations, children at risk for being overweight should be screened beginning at age 2 years. Children with a family history of dyslipidemia or early cardiovascular disease development, children whose body mass index percentile exceeds the definition for overweight, and children who have high blood pressure should have a fasting lipid screen. Incorrect The nurse should instruct parents that calcium and iron intake should be increased as part of this strategy.

Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? Select all that apply. a. The child should be allowed to stay home until the anxiety about going to school is resolved. b. Parents should be empathetic yet firm in their insistence that the child attends school. c. A modified school attendance may be necessary. d. Parents need to pick the child up at school whenever the child wants to come home. e. Parents need to communicate with the teachers about the situation.

ANS: B, C, E Feedback Correct In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselor's or school nurse's office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school. Incorrect Parents should not pick the child up at school once the child is there. The principal and teacher should be told about the situation so that they can cooperate with the treatment plan.

A school nurse is screening children for scoliosis. Which assessment findings should the nurse expect to observe for scoliosis? Select all that apply. a. Pain with deep palpation of the spinal column b. Unequal shoulder heights c. The trouser pant leg length appears shorter on one side d. Inability to bend at the waist e. Unequal waist angles

ANS: B, C, E Feedback Correct The assessment findings associated with scoliosis include unequal shoulder heights, trouser pant leg length appearing shorter on one side meaning unequal leg length, and unequal waist angles. Incorrect Scoliosis is a nonpainful curvature of the spine so pain is not expected and the child is able to bend at the waist adequately.

A nurse is performing an assessment on a newborn. Which vital signs indicate a normal finding for this age group? Select all that apply. a. Pulse of 80-125 a minute b. B/P of systolic 65-95 and diastolic 30-60 c. Temperature of 36.5-37.3 Celsius (axillary) d. Temperature of 36.4-37 Celsius (axillary) e. Respirations of 30-60 a minute

ANS: B, C, E Feedback Correct The normal vital signs for a newborn are temperature 36.5 to 37.3 Celsius (axillary), pulse rate of 120-160 a minute, respiratory rate of 30-60 a minute, systolic B/P of 65-95, and diastolic B/P of 30-62. A temperature of 36.4-37 Celsius is normal for an older child. A pulse rate of 80-125 is normal for a 4-year-old child. Incorrect A pulse rate of 80-125 per minute and temperature of 36.4-37° C are both too low for a well-newborn.

Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? Select all that apply. a. Plans to try out for the debate team at school b. Skipping classes to go to the mall c. Hanging out with friends they have had since childhood d. Unexplained source of money e. Fear of the police

ANS: B, D, E Feedback Correct Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is also a sign. A change in attitude toward participating in activities is another sign of gang involvement. Incorrect Plans to try out for the debate team at school are not a sign of gang involvement. Hanging out with friends he or she has had since childhood is not a sign of gang involvement.

What should the nurse recognize as a possible indicator of child abuse in a 4-year-old child being treated for ear pain at the emergency department on a chilly Christmas Day in New York State? Select all that apply. a. The child extends his arms to be hugged by the nurse. b. The child is wearing clean, baggy shorts, sandals, and an oversized T-shirt. c. The child answers all questions in complete sentences, and smiles afterward. d. The child has dirty, broken teeth. e. The child states "I'm so fat" when the nurse tells his mother he weighs 25 lb.

ANS: B, D, E Feedback Correct These clothes are inappropriate attire for December in New York State. Even though the clothes are clean, dressing inappropriately for the weather is a potential indicator of child abuse. Clothing that is too large or small for the child's size also requires further evaluation. Dirty, broken teeth are an indicator of potential child abuse. A child who is 4 years old and weighs only 25 lb is thin for his age. Body image distortion (being thin but describing self as fat) is a potential indicator of child abuse. A child who is too thin for his height should also be further evaluated. Incorrect Although it may be unusual for this child to want to hugged by the nurse, it is not an indicator of child abuse. Answering questions using complete sentences and smiling is appropriate for a 4-year-old.

Which milestone is developmentally appropriate for a 2-month-old infant? a. Pulled to a sitting position, head lag is absent. b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted. c. The infant can lift his or her head from the prone position and briefly hold the head erect. d. In the prone position, the infant is fully able to support and hold the head in a straight line.

ANS: C Feedback A A 2-month-old infant's neck muscles are stronger than those of a newborn; however, head lag is present when pulled to a sitting position. B A 2-month-old infant continues to have some head lag when pulled to a sitting position. C A 2-month-old infant is able to briefly hold the head erect when in a prone position. If a parent were holding the infant against the parent's shoulder, the infant would be able to lift his or her head briefly. D It is not until 4 months of age that the infant can easily lift his or her head and hold it steadily erect when in the prone position.

What term should be used in the nurse's documentation to describe auscultation of breath sounds that are short, popping, and discontinuous on inspiration? a. Pleural friction rub b. Bronchovesicular sounds c. Crackles d. Wheeze

ANS: C Feedback A A pleural friction rub has a grating, coarse, low-pitched sound. B Bronchovesicular sounds are auscultated over mainstem bronchi. They are clear, without any adventitious sounds. C Crackles are short, popping, discontinuous sounds heard on inspiration. D Wheezes are musical, high-pitched, predominant sounds heard on expiration.

When is the most appropriate time to inspect the genital area during a well-child examination of a 14-year-old girl? a. It is not necessary to inspect the genital area. b. Examine the genital area first. c. After the abdominal assessment. d. Do the genital inspection last.

ANS: C Feedback A A visual inspection of all areas of the body is included in a physical examination. B Examination of the genital area can be embarrassing. It is not be appropriate to begin the examination of this area. C It is best to incorporate the genital assessment into the middle of the examination. This allows ample time for questions and discussion. If possible, proceed from the abdominal area to the genital area. D Assessing the genital area earlier in the examination allows more time for the adolescent to ask questions and engage in discussion.

Which children are at greater risk for not receiving immunizations? a. Children who attend licensed daycare programs b. Children entering school c. Children who are home schooled d. Young adults entering college

ANS: C Feedback A All states require immunizations for children in daycare programs. B All states require immunizations for children entering school. C Home-schooled children are at risk for being underimmunized and need to be monitored. D Most colleges require a record of immunizations as part of a health history.

Which action is appropriate when the nurse is assessing breath sounds of an 18-month-old crying child? a. Ask the parent to quiet the child so the nurse can listen. b. Auscultate breath sounds and chart that the child was crying. c. Encourage the child to play with the stethoscope to distract and to calm down before auscultating. d. Document that data are not available because of noncompliance.

ANS: C Feedback A Asking a parent to quiet the child may or may not work. B Auscultating while the child is crying typically results in less than optimal data. C Distracting the child with an interesting activity can assist the child to calm down so an accurate assessment can be made. D Documenting that the child is not compliant is not appropriate. An assessment needs to be completed.

Which statement is the most accurate about moral development in the 9-year-old school-age child? a. Right and wrong are based on physical consequences of behavior. b. The child obeys parents because of fear of punishment. c. The school-age child conforms to rules to please others. d. Parents are the determiners of right and wrong for the school-age child.

ANS: C Feedback A Children 4 to 7 years of age base right and wrong on consequences. B Consequences are the most important consideration for the child between 4 and 7 years of age. C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval. D Parents determine right and wrong for the child younger than 4 years of age.

Which assessment is most relevant to the care of an infant with dehydration? a. Temperature, heart rate, and blood pressure. b. Respiratory rate, oxygen saturation, and lung sounds. c. Heart rate, sensorium, and skin color. d. Diet tolerance, bowel function, and abdominal girth.

ANS: C Feedback A Children can compensate and maintain an adequate cardiac output when they are hypovolemic. Blood pressure is not as reliable an indicator of shock as are changes in heart rate, sensorium, and skin color. B Respiratory assessments will not provide data about impending hypovolemic shock. C Changes in heart rate, sensorium, and skin color are early indicators of impending shock in the child. D Diet tolerance, bowel function, and abdominal girth are not as important indicators of shock as heart rate, sensorium, and skin color.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given a. Skim milk b. Whole cow's milk c. Commercial iron-fortified formula d. Commercial formula without iron

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

Which factor has the greatest influence on child growth and development? a. Culture b. Environment c. Genetics d. Nutrition

ANS: C Feedback A Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences. B Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics. C Genetic factors (heredity) determine each individual's growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent. D Nutrition is critical for growth and plays a significant role throughout childhood.

What is the primary purpose of a transitional object? a. It helps the parents deal with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

ANS: C Feedback A Decreased parental guilt (distress) is an indirect benefit of a transitional object. B A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. D A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered a. Unnecessary information, because the child is 3 years old b. An important part of the family history c. An important part of the child's past growth and development d. An important part of the child's review of systems

ANS: C Feedback A Developmental milestones provide important information about the child's physical, social, and neurologic health. B The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings should be included in the family history. C Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. D The review of systems does not include the developmental milestones.

Why do peer relationships become more important during adolescence? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C Feedback A During adolescence, the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. B Parents continue to play an important role in the personal and health-related decisions. C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. D The peer group forms the transitional world between dependence and autonomy.

What assessment should the nurse make before initiating an intravenous (IV) infusion of dextrose 5% in 0.9% normal saline solution with 10 mEq of potassium chloride for a child hospitalized with dehydration? a. Fluid intake b. Number of stools c. Urine output d. Capillary refill

ANS: C Feedback A Fluid intake does not give information about renal function. B Stool count sheds light on intestinal function. Renal function is the concern before potassium chloride is added to an IV solution. C Potassium chloride should never be added to an IV solution in the presence of oliguria or anuria (urine output less than 0.5 mL/kg/hr). D Assessment of capillary refill does not provide data about renal function.

At what age is an infant first expected to locate an object hidden from view? a. 4 months of age b. 6 months of age c. 9 months of age d. 20 months of age

ANS: C Feedback A Four-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. B Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. C By 9 months of age, an infant will actively search for an object that is out of sight. D Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around age 9 months.

In general, the earliest age at which puberty begins is ____ years in girls and _____ years in boys. a. 13; 13 b. 11; 11 c. 10; 12 d. 12; 10

ANS: C Feedback A Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys. B Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys. C Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually, there is a 2-year difference in the age at onset. D Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys.

The nurse is performing a comprehensive physical examination on a young child in the hospital. At what age can the nurse expect a child's head and chest circumferences to be almost equal? a. Birth b. 6 months c. 1 year d. 3 years

ANS: C Feedback A Head circumference is larger than chest circumference until approximately 12 months of age. B Chest circumference is smaller than head circumference until approximately 1 year of age. C Head and chest measurements are almost equal at 1 year of age. D By 3 years of age, the chest circumference exceeds the head circumference.

What is the best explanation for a 2-year-old child who is quiet and withdrawn on the fourth day of a hospital admission? a. The child is protesting her separation from her caregivers. b. The child has adjusted to the hospitalization. c. The child is experiencing the despair stage of separation. d. The child has reached the stage of detachment.

ANS: C Feedback A In the protest stage, the child would be agitated, crying, resistant to caregivers, and inconsolable. B Toddlers do not readily "adjust" to hospitalization and separation from caregivers. C In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic. D The detachment stage occurs after prolonged separation. During this phase, the child becomes interested in the environment and begins to play.

Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

ANS: C Feedback A Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. B Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier those delays in development are discovered and intervention initiated, the less dramatic their effect will be. D Normal growth and development is orderly and proceeds in a predictable pattern based on each individual's abilities and potentials.

Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide? a. "Tell your friend to come to the clinic immediately." b. "You need to gather details about your friend's suicide plan." c. "Your friend's threat needs to be taken seriously, and immediate help for your friend is important." d. "If your friend mentions suicide a second time, you will want to get your friend some help."

ANS: C Feedback A Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. B It is important to determine whether a person threatening suicide has a plan of action; however, the best information for the 15-year-old to have is that all threats of suicide should be taken seriously and immediate help is important. C Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. D It is imperative that help is provided immediately for a teenager who is talking about suicide. Waiting until the teen discusses it a second time may be too late.

The parents of a newborn infant state, "We will probably not have our baby immunized because we are concerned about the risk of our child being injured." What is the nurse's best response? a. "It is your decision." b. "Have you talked with your parents about this? They can probably help you think about this decision." c. "The risks of not immunizing your baby are greater than the risks from the immunizations." d. "You are making a mistake."

ANS: C Feedback A It is the parents' decision not to immunize the child; however, the nurse has a responsibility to inform parents about the risks to infants who are not immunized. B Grandparents can be supportive but are not the primary decision makers for the infant. C Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines. D Telling parents that they are making a mistake is an inappropriate response.

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of IV antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he stops crying. b. Tell the child big boys and girls "don't cry." c. Let the child decide which color arm board to use with the IV. d. Administer a narcotic analgesic for pain to quiet the child.

ANS: C Feedback A Leaving the child alone robs the child of support when a coping difficulty exists. B Crying is a normal response to stress. C Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child's coping skills. D The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization. Although administration of a topical analgesic is indicated before restarting the child's IV, a narcotic analgesic is not indicated.

The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies? a. Measles b. Roseola c. Rubella d. Herpes simplex virus (HSV)

ANS: C Feedback A Measles is not associated with congenital defects. B Most cases of roseola occur in children 6 to 18 months old. C The rubella virus can cross the placenta and infect the fetus, causing fetal anomalies. D HSV can be transmitted to the newborn infant during vaginal delivery, causing multisystem disease. It is not transmitted transplacentally to the fetus during gestation.

A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? a. DTaP, Hib, HepB, MCV, varicella b. DTaP, Hib, HepB, HPV, IPV, Rota c. DTaP, Hib, HepB, PCV, Rota d. DTaP, Hib, HepB, PCV, HepA

ANS: C Feedback A Meningococcal vaccine should be administered to children at 11 to 12 years of age. B Human papillomavirus vaccine is administered to adolescent girls only. C DTaP, Hib, HepB, PCV, IPV, and Rota are appropriate immunizations for an unimmunized 2-month-old child. D HepA is recommended for all children at 1 year of age.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as a. Behavior that encourages bullying and sexism b. Behavior that reinforces poor peer relationships c. Characteristic of social development of this age d. Characteristic of children who later are at risk for membership in gangs

ANS: C Feedback A Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. B Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. D A boys-only club does not have a direct correlation with later gang activity.

What does the nurse need to know when observing a chronically ill child at play? a. Play is not important to hospitalized children. b. Children need to have structured play periods. c. Children's play is a form of communication. d. Play is to be discouraged because it tires hospitalized children.

ANS: C Feedback A Play is important to all children in all environments. Play for children is a mechanism for mastering their environment. B Although children's play activities appear to be unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. C Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments. D Children who have fewer energy reserves still require play. For these children, less-active play activities will be important.

The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. "Your teenager needs clearer and stricter limits about her behavior." b. "Your teenager needs more responsibility at home." c. "During adolescence this behavior is not unusual." d. "The behavior is abnormal and needs further investigation."

ANS: C Feedback A Stricter limits are not an appropriate response for a behavior that is part of normal development. B More responsibility at home is not an appropriate response for this situation. C Egocentric and narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity. D The behavior is normal and needs no further investigation.

The nurse is explaining Tanner staging to an adolescent and her mother. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronologic age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty that are based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics

ANS: C Feedback A Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. B The puberty stage in girls begins with breast development. Puberty stage in boys begins with genital enlargement. C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. D Primary sexual characteristics are not the basis of Tanner staging.

Home care is being considered for a young child who is ventilator dependent. Which factor is most important in deciding whether home care is appropriate? a. Level of parents' education b. Presence of two parents in the home c. Preparation and training of family d. Family's ability to assume all health care costs

ANS: C Feedback A The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. B At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. C One of the essential elements is the training and preparation of the family. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. D Few families can assume all health care costs. Financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required.

Which statement indicates that a father understands the treatment for his child who has scarlet fever? a. "I can stop the medicine when my child feels better." b. "I will apply antibiotic cream to her rash twice a day." c. "I will give the penicillin for the full 10 days." d. "My child can go back to school when she has been on the antibiotic for a week."

ANS: C Feedback A The bacteria will not be eradicated if a partial course of antibiotics is given. B Treatment of scarlet fever does not include topical antibiotic cream. C It is necessary to give the entire course of antibiotic for 10 to 14 days. Penicillin is the preferred treatment for any streptococcal infection. D The child is no longer contagious after 24 hours of antibiotic therapy and can return to daycare or school.

In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor in preparing a child for kindergarten entry? a. The child's ability to sit still b. The child's sense of learned helplessness c. The parent's interactions and responsiveness to the child d. Attending a preschool program

ANS: C Feedback A The child's ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. B Learned helplessness is the result of a child feeling that he or she has no effect on the environment and that his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. C Interactions between the parent and child are an important factor in the development of academic competence. Parental encouragement and support maximize a child's potential. D Preschool and daycare programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

Which therapeutic approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy? a. Arrange for the child to go to the playroom daily. b. Ask the child to draw you a picture of himself or herself. c. Allow the child to participate in injection play. d. Give the child stickers for cooperative behavior.

ANS: C Feedback A The hospitalized child should have opportunities to go to the playroom each day if the child's condition warrants. This free play does not have any specific therapeutic purpose. B Children can express their thoughts and beliefs through drawing. Asking the child to draw a picture of himself or herself may not elicit the child's feelings about the treatment. C Injection play is an appropriate intervention for the child who has to undergo frequent blood work, injections, intravenous therapy, or any other therapy involving syringes and needles. D Rewards such as stickers may enhance cooperative behavior. They will not address coping with painful treatments.

Which is a priority in counseling parents of a 6-month-old infant? a. Increased appetite from secondary growth spurt b. Encouraging the infant to smile c. Securing a developmentally safe environment for the infant d. Strategies to teach infants to sit up

ANS: C Feedback A The infant's appetite and growth velocity decrease in the second half of infancy. B Although a social smile should be present by 6 months of age, encouraging this is not of higher priority than ensuring environmental safety. C Safety is a primary concern as an infant becomes increasingly mobile. D Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary.

Which is an appropriate nursing intervention for the hospitalized neonate? a. Assign the neonate to a room with other neonates. b. Provide play activities in the hospital room. c. Offer the neonate a pacifier between feedings. d. Request that parents bring a security object from home.

ANS: C Feedback A The neonate is not aware of other children. The choice of roommate will not affect the neonate socially. It is important for older children to room with similar-age children. B Formal play activities are not relevant for the neonate. C The neonate needs opportunities for nonnutritive sucking and oral stimulation with a pacifier. D Having parents bring a security object from home is applicable to older children.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C Feedback A The nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. B The child is not exhibiting anxiety, just requesting clarification of what will be occurring. C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. D The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure.

The parent of 2-week-old Sarah asks the nurse whether Sarah needs fluoride supplements, because she is exclusively breastfed. The nurse's best response is a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 6 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Feedback A The recommendation is to begin supplementation at 6 months. B The amount of water that is ingested and the amount of fluoride in the water are considered when supplementation is being considered. C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. D The amount of water that is ingested and the amount of fluoride in the water are considered when supplementation is being considered.

The nurse is planning a teaching session for a young child and her parents. According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the _______ period of cognitive development. a. Sensorimotor b. Formal operations c. Concrete operations d. Preoperational

ANS: C Feedback A The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant's world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. B Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy. D The preoperational stage is a period of egocentrism in which the child's judgments are illogical and dominated by magical thinking and animism.

According to Piaget, the 6-month-old infant is in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Feedback A The use of reflexes is primarily during the first month of life. B Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. C Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction because of the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. D The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 b. S3, S4 c. Murmur d. Physiologic splitting

ANS: C Feedback A These are normal heart sounds. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves. B S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. C Murmurs are the sounds that are produced in the heart chambers or major arteries from the purulence of blood flow. Murmurs create a blowing and swooshing sound. D Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

ANS: C Feedback A This type of care decreases cost. B This type of care decreases risk of infection. C Outpatient and day facility care do not provide extended care; therefore a child requiring extended care should be transferred to the hospital, causing increased stress to the child and parents. D This type of care minimizes separation of the child from family.

Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."

ANS: C Feedback A Toddlers need fluoride supplements when they use a water supply that is not fluorinated. B Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. D A small nylon bristle brush works best for cleaning toddlers' teeth.

Having explanations for all procedures and selecting their own meals from hospital menus is an important coping mechanism for which age-group? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: C Feedback A Toddlers need routine and parental involvement for coping. B Preschoolers need simple explanations of procedures. C School-age children are developmentally ready to accept detailed explanations. School-age children can select their own menus and become actively involved in other areas of their care. D Detailed explanations and support of peers help adolescents cope.

7. The nurse is caring. What skin care interventions for an unconscious child should be included in the plan of care? a. Avoiding use of pressure reduction on the bed. b. Massaging reddened bony prominences to prevent deep tissue damage. c. Using drawsheet to move child in bed to reduce friction and shearing injuries. d. Avoiding rinsing skin after cleansing with mild antibacterial soap to provide a protective barrier.

ANS: C A drawsheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Bony prominences should not be massaged if reddened. Deep tissue damage can occur. Pressure-reduction devices should be used to redistribute weight instead. The skin should be cleansed with mild nonalkaline soap or soap-free cleaning agents for routine bathing.

6. The nurse monitoring a child for signs and symptoms of malignant hyperthermia should be alert for which early sign of this disorder? a. Apnea b. Bradycardia c. Muscle rigidity d. Decreased blood pressure

ANS: C Early signs of malignant hyperthermia include tachycardia, increasing blood pressure, tachypnea, mottled skin, and muscle rigidity. Apnea is not a sign of malignant hyperthermia. Tachycardia, not bradycardia, is an early sign of malignant hyperthermia. Increased, not decreased, blood pressure is characteristic of malignant hyperthermia.

10. What intervention is appropriate when administering tepid water or sponge baths prescribed for hyperthermia in children? a. Add isopropyl alcohol to the water. b. Direct a fan on the child in the bath. c. Stop the bath if the child begins to chill. d. Continue the bath for 5 minutes.

ANS: C Environmental measures such as sponge baths can be used to reduce temperature if tolerated by the child and if they do not induce shivering. Shivering is the body's way of maintaining the elevated set point. Compensatory shivering increases metabolic requirements above those already caused by the fever. Ice water and isopropyl alcohol are inappropriate, potentially dangerous solutions. Fans should not be used because of the risk of the child developing vasoconstriction, which defeats the purpose of the cooling measures. Little blood is carried to the skin surface, and the blood remains primarily in the viscera to become heated. The child is placed in a tub of tepid water for 20 to 30 minutes.

17. The nurse administering a bitter oral medication to an infant or small child should mix the medication with what substance? a. A bottle of formula or milk. b. Any food the child is going to eat. c. A teaspoon of jam or ice cream. d. Large amounts of water to dilute medication sufficiently.

ANS: C Mix the drug with a small amount (about 1 teaspoon) of sweet-tasting substance. This will make the medication more palatable to the child. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking/eating, it is difficult to determine how much medication was consumed. Medication should not be mixed with essential foods and milk. The child may associate the altered taste with the food and refuse to eat in future.

35. What nursing consideration is related to the administration of oxygen (O2) in an infant? a. Humidify the oxygen if the infant can tolerate it. b. Assess the infant to determine how much oxygen should be given. c. Arterial oxygen saturation (SaO2) readings are used to guide O2 therapy. d. Direct the oxygen flow so that it blows directly into the infant's face in a hood.

ANS: C Pulse oximetry is a continuous, noninvasive method of determining arterial oxygen saturation (SaO2) to guide oxygen therapy. Oxygen is drying to the tissues. Oxygen should always be humidified when delivered to a patient. A child receiving oxygen therapy should have the oxygen saturation monitored at least as frequently as vital signs. Oxygen is a medication, and it is the responsibility of the practitioner to modify dosage as indicated. Humidified oxygen should not be blown directly into an infant's face.

16. What important consideration in providing atraumatic care should the nurse consider when preforming a venipuncture on a 6-year-old child? a. Use an 18-gauge needle if possible. b. If not successful after four attempts, have another nurse try. c. Restrain the child only as needed to perform venipuncture safely. d. Show the child equipment to be used before procedure.

ANS: C Restrain the child only as needed to perform the procedure safely; an alternative would be the use of therapeutic hugging. Use the smallest gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Keep all equipment out of sight until used.

27. What nursing action is appropriate for specimen collection? a. Follow sterile technique for specimen collection. b. Sterile gloves are worn if the nurse plans to touch the specimen. c. Use Standard Precautions when handling body fluids. d. Avoid wearing gloves in front of the child and family.

ANS: C Standard Precautions should always be used when handling body fluids. Specimen collection is not always a sterile procedure. Gloves should be worn if there is a chance the nurse will be contaminated. The choice of sterile or clean gloves will vary according to the procedure or specimen. The child and family should be educated in the purpose of glove use, including the fact that gloves are used with every patient, so that they will not be offended or frightened.

24. What intervention should the nurse implement when suctioning a child with a tracheostomy? a. Encouraging the child to cough to raise the secretions before suctioning. b. Selecting a catheter with a diameter three-fourths as large as the diameter of the tracheostomy tube. c. Ensuring that each pass of the suction catheter take no longer than 10 seconds. d. Allowing the child to rest after every 5 times the suction catheter is passed.

ANS: C Suctioning should require no longer than 10 seconds per pass. Otherwise the airway may be occluded for too long. If the child is able to cough up secretions, suctioning may not be indicated. The catheter should have a diameter one-half the size of the tracheostomy tube. If it is too large, it might block the child's airway. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear.

5. The nurse is cleaning multiple facial abrasions on a 9-year-old who was brought to the emergency department by his/her mother. When the child begins crying and screaming loudly, what intervention should the nurse implement to best manage this situation? a. Calmly ask the child to be quieter. b. Suggest that his/her mother help the child to relax. c. Tell the child it is okay to cry and scream. d. Suggest that he/she talk to his/her mother as a form of distraction.

ANS: C The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. The child needs to know that it is all right to cry. There is no reason for him to be quieter. He is too upset and needs to be able to express his feelings.

1. What should the nurse consider when having consent forms signed for surgery and procedures on children? a. Only a parent or legal guardian can give consent. b. The person giving consent must be at least 18 years old. c. The risks and benefits of a procedure are part of the consent process. d. A mental age of 7 years or older is required for a consent to be considered "informed." \

ANS: C The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

13. Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. How should the nurse collect small amounts of urine for these tests? a. Apply a urine-collection bag to the perineal area. b. Tape a small medicine cup to the inside of the diaper. c. Aspirate urine from cotton balls inside the diaper with a syringe. d. Aspirate urine from a superabsorbent disposable diaper with a syringe.

ANS: C To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. If diapers with absorbent material are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine, and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. Taping a small medicine cup to the inside of the diaper is not feasible; the urine will spill from the cup. Diapers with superabsorbent gels absorb the urine, so there is nothing to aspirate.

What should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)? Select all that apply. a. The child's height and weight b. The parent's ability to comprehend the results c. The child's mood d. The parent-child interaction e. The child's chronologic age

ANS: C, E Feedback Correct The results of the screening test are valid if the child acted in a normal and expected manner. The child's chronologic age in years, months, and days must be calculated in order to draw the age line. This is necessary in order to perform an accurate DDST-II. Reliability and validity of the test can be altered if the child is not feeling well or is under the influence of medications. Incorrect The child's height and weight are not relevant to the DDST-II screening process. The parent's ability to understand the results of the screening is not relevant to the validity of the test. The parent-child interaction is not significantly relevant to the test results.

What should be included in the care for a neonate who was diagnosed with pertussis? a. Monitoring hemoglobin level b. Hearing test before discharge c. Serial platelet counts d. Treatment of all close contacts with a prophylactic antibiotic

ANS: D Feedback A Pertussis does not affect the hemoglobin level. B A complication of pertussis is not hearing impairment. C Pertussis does not affect platelets. D Erythromycin, azithromycin, or clarithromycin is given to all close contacts for the child diagnosed with pertussis.

What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Communicate with the child's daytime caretaker about eliminating the afternoon nap. d. Use a nightlight in the child's room.

ANS: D Feedback A A dark, quiet room may be scary to a preschooler. B High-carbohydrate snacks increase energy and do not promote relaxation. C Most 2-year-olds take one nap each day. Many give up the habit by age 3 years. Insufficient rest during the day can lead to irritability and difficulty sleeping at night. D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room.

Which assessment finding in a preschooler suggests the need for further investigation? a. The child is able to dress independently. b. The child rides a tricycle. c. The child has an imaginary friend. d. The child has a 2-lb weight gain in 12 months.

ANS: D Feedback A A preschool child should be able to dress independently. B A preschool child should be able to ride a tricycle. C Imaginary friends are common for preschoolers. D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated.

When counseling parents and children about the importance of increased physical activity, the nurse can emphasize a. Anaerobic exercise should comprise a major component of the child's daily exercise. b. All children should be physically active for at least 2 hours per day. c. It is not necessary to participate in physical education classes at school if a student is taking part in other activities. d. Making exercise fun and a habitual activity.

ANS: D Feedback A Aerobic exercise should comprise a major component of children's daily exercise; however, physical activity should also include muscle and bone strengthening activities. B Children and adolescents should be physically active for at least 1 hour daily. C Encourage all student to participate fully in any physical education classes. D It is important to make exercise a fun and a habitual activity. Encourage parents to investigate their community's different activity programs. This includes recreation centers, parks, and the YMCA.

A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "My mother has told us that if we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will have to go back in for my cat Fluffy because she will be scared."

ANS: D Feedback A All children should know two different escape routes from the house, in case one is blocked. B It is important for children to be taught how to call 911 in an emergency. C All families should have a predetermined meeting place away from the house. D Children should be taught never to return to a burning house, not even for a pet.

Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment

ANS: D Feedback A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age. C Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment. D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment.

The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown shopper at the grocery store. What is the best response for the nurse to make to the mother? a. "You could consider leaving the infant more often with other people so he can adjust." b. "You might consider taking him to the doctor because he may be ill." c. "Have you noticed whether the baby is teething?" d. "This is a sign of stranger anxiety and demonstrates healthy attachment."

ANS: D Feedback A An infant who manifests stranger anxiety is showing a normal sign of healthy attachment. This behavior peaks at 7 to 9 months and is developmentally appropriate. The mother leaving the child more often will not change this developmental response to new strangers. B Assessing developmental needs is appropriate before taking an infant to a physician. C Pain from teething expressed by the infant's cries would not occur only when the mother left the room. D The nurse can reassure parents that healthy attachment is manifested by stranger anxiety in late infancy.

A mother asks the nurse, "When should I begin to clean my baby's teeth?" What is the best response for the nurse to make? a. "You can begin when all her baby teeth are in." b. "You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth." c. "I don't think you have to worry about that until she can handle a toothbrush." d. "You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary."

ANS: D Feedback A An infant's teeth need to be cleaned as soon as they erupt. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. B Because toothpaste contains fluoride and infants will swallow the toothpaste, parents should avoid its use. C The infant's teeth need to be cleaned by the parent as soon as they erupt. Even when a child has the ability to hold a toothbrush, the parent should continue cleaning the child's teeth. D An infant's teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate.

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

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

What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby? a. "Have you talked with your parents about this?" b. "Do you have plans to continue school?" c. "Will you be able to support the baby?" d. "Can you tell me how your life will be if you have an infant?"

ANS: D Feedback A Asking the teenager whether she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. B A direct question about continuing school will not facilitate communication. Open-ended questions encourage communication. C Asking the teenager about how she will support the child will not facilitate communication. Open-ended questions encourage communication. D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen's perception and reality orientation.

Which statement best describes why infants are at greater risk for dehydration than older children? a. Infants have an increased ability to concentrate urine. b. Infants have a greater volume of intracellular fluid. c. Infants have a smaller body surface area. d. Infants have an increased extracellular fluid volume.

ANS: D Feedback A Because the kidneys are immature in early infancy, there is a decreased ability to concentrate the urine. B Infants have a larger proportion of fluid in the extracellular space. C Infants have proportionately greater body surface area in relation to body mass, which creates the potential for greater fluid loss through the skin and gastrointestinal tract. D The larger ratio of extracellular fluid to intracellular fluid predisposes the infant to dehydration.

Which measurement is not indicated for a 4-year-old well-child examination? a. Blood pressure b. Weight c. Height d. Head circumference

ANS: D Feedback A Blood pressure measurements are taken on all children at every ambulatory visit. B Weight is measured at every well-child examination. C Height is measured at every well-child examination. D Head circumference is measured on all children from birth to 3 years. Children older than 3 years of age with questionable head size or a history of megalocephaly, hydrocephalus, or microcephaly should have their head circumference assessed at every visit. A 4-year-old without a history of these problems does not need his or her head circumference measured.

A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease. What intervention should be taken to prevent varicella from developing? a. No intervention is needed unless varicella develops. b. Administer the varicella vaccine as soon as possible. c. The child should begin a course of oral antibiotics. d. The child should be prescribed acyclovir.

ANS: D Feedback A Children taking oral corticosteroids are immunosuppressed and are at high risk for serious complications. Intervention must be taken to prevent the disease when exposure occurs. B The varicella vaccine is a live virus vaccine and is contraindicated for an immunosuppressed child. C An antibiotic is not effective in treating varicella zoster, which is a virus. D For children receiving short-term corticosteroid treatment, acyclovir is often used in the treatment plan.

The mother of a 10-month-old infant asks the nurse about beginning to wean her child from his bottle. Which statement by the mother suggests that the child is not ready to be weaned? a. "My son is frequently throwing his bottle down." b. "The baby takes a few ounces of formula from the bottle." c. "He is constantly chewing on the nipple. It concerns me." d. "He consistently is sucking."

ANS: D Feedback A Decreased interest in the bottle starts between 6 and 12 months. Throwing the bottle down is a sign of a decreased interest in the bottle. B When the child is taking more fluids from a cup and decreasing amounts from the bottle, the child is demonstrating a readiness for weaning. C Chewing on the nipple is another sign that the infant is ready to be weaned. D Consistent sucking is a sign that the child is not ready to be weaned.

A nurse is teaching parents about diarrhea. Which statement by the parents indicates understanding of the teaching? a. Diarrhea results from a fluid deficit in the small intestine. b. Organisms destroy intestinal mucosal cells, resulting in an increased intestinal surface area. c. Malabsorption results in metabolic alkalosis. d. Increased motility results in impaired absorption of fluid and nutrients.

ANS: D Feedback A Diarrhea results from fluid excess in the small intestine. B Destroyed intestinal mucosal cells result in decreased intestinal surface area. C Loss of electrolytes in the stool from diarrhea results in metabolic acidosis. D Increased motility and rapid emptying of the intestines result in impaired absorption of nutrients and water. Electrolytes are drawn from the extracellular space into stool, and dehydration results.

What do parents of preschool children need to understand about discipline? a. Both parents and the child should agree on the method of discipline. b. Discipline should involve some physical restriction. c. The method of discipline should be consistent with the discipline methods of the child's peers. d. Discipline should include positive reinforcement of desired behaviors.

ANS: D Feedback A Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied. B Discipline does not necessarily need to include physical restriction. C Discipline does not need to be consistent with that of the child's peers. D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors.

Which statement made by a parent indicates incorrect information about intervention for a child's fever? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter preparations that contain aspirin."

ANS: D Feedback A Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the child's comfort. B Adequate hydration will help maintain a normal body temperature. C Acetaminophen or ibuprofen should be used as directed for fever control. D Aspirin products are avoided because of the possibility of development of Reye's syndrome. The parent should check labels on all over-the-counter products to be sure they do not contain aspirin.

What discharge information should the nurse give to the parents of a male adolescent who has been diagnosed with the Epstein-Barr virus? a. It is particularly important to protect the adolescent's head during physical activities. b. The teen will feel like himself and be back to his usual routines in a week. c. The treatment of the Epstein-Barr virus is prolonged bed rest, usually lasting several months. d. Fatigue may persist, and the adolescent may need to increase school activities gradually.

ANS: D Feedback A During the acute and recovery phases, activity restrictions, which include no contact sports or roughhousing, are implemented to protect the child's enlarged spleen from rupture. B The recovery process from infectious mononucleosis is a slow and gradual one. C Bed rest is indicated during the acute stage of the illness, usually lasting 2 to 4 weeks. D The recovery period is often lengthy and fatigue may continue, necessitating a gradual return to school activities.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that a. Children in 5th grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development.

ANS: D Feedback A Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. B They should be encouraged to ask questions. C Preadolescents need precise and concrete information. D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development.

You are the nurse admitting a toddler to the pediatric infectious disease unit. What is the single most important component of the child's physical examination? a. Assessment of heart and lungs b. Measurement of height and weight c. Documentation of parental concerns d. Obtaining an accurate history

ANS: D Feedback A Heart and lung assessment is not as important as an accurate history. B A single measurement of height and weight is not as significant as determining growth over time. The child's growth pattern can be elicited from the history. C Documentation of parental concerns is not as relevant to the physical examination as an accurate history. D An accurate history is most helpful in identifying problems and potential problems.

Which immunizations should be used with caution in children with an allergy to eggs? a. HepB b. DTaP c. Hib d. MMR

ANS: D Feedback A HepB is safe for children with an egg allergy. B DTaP is safe for children with an egg allergy. C Hib is safe for children with an egg allergy. D Live measles vaccine is produced by using chick embryo cell culture, so there is a remote possibility of anaphylactic hypersensitivity in children with egg allergies. Most reactions are actually the result of other components in the vaccine.

What is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration? a. Estimating insensible fluid loss b. Collecting urine for culture and sensitivity c. Palpating the posterior fontanel d. Measuring the infant's weight

ANS: D Feedback A Infants have a greater total body surface area and therefore a greater potential for fluid loss through the skin. It is not possible to measure insensible fluid loss. B Urine for culture and sensitivity is not usually part of the treatment plan for the infant who is dehydrated from diarrhea. C The posterior fontanel closes by 2 months of age. The anterior fontanel can be palpated during an assessment of an infant with dehydration. D Weight is a crucial indicator of fluid status. It is an important criterion for assessing hydration status and response to fluid replacement.

The home health nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals? a. Family and nurse b. Child, family, and nurse c. All professionals involved d. Child, family, and all professionals involved

ANS: D Feedback A Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family. B Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family. C Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family. D In the home, the family is a partner in each step of the nursing process. The family priorities should guide the planning process. Both short-term and long-term goals should be outlined and agreed on by the child, family, and professionals involved.

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

ANS: D Feedback A It is difficult to teach this age-group to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. B Fluoridated toothpaste is still indicated, but very small amounts are used. C Fluoride supplementation is not recommended until after age 6 months. D The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount.

Which comment is most developmentally typical of a 7-year-old boy? a. "I am a Power Ranger, so don't make me angry." b. "I don't know whether I like Mary or Joan better." c. "My mom is my favorite person in the world." d. "Jimmy is my best friend."

ANS: D Feedback A Magical thinking is developmentally appropriate for the preschooler. B Opposite-sex friendships are not typical for the 7-year-old child. C Seven-year-old children socialize with their peers, not their parents. D School-age children form friendships with peers of the same sex, those who live nearby, and other children who have toys that they enjoy.

Examination of the abdomen is performed correctly by the nurse in which order? a. Inspection, palpation, and auscultation b. Palpation, inspection, and auscultation c. Palpation, auscultation, and inspection d. Inspection, auscultation, and palpation

ANS: D Feedback A Palpation is always performed last because it may distort the normal abdominal sounds. B Palpation is always performed last because it may distort the normal abdominal sounds. C Palpation is always performed last because it may distort the normal abdominal sounds. D The correct order of abdominal examination is inspection, auscultation, and palpation.

Which intervention helps a hospitalized toddler feel a sense of control? a. Assign the same nurses to care for the child. b. Put a cover over the child's crib. c. Require parents to stay with the child. d. Follow the child's usual routines for feeding and bedtime.

ANS: D Feedback A Providing consistent caregivers is most applicable for the very young child, such as the neonate and infant. B Placing a cover over the child's crib may increase feelings of loss of control. C Parents are encouraged, rather than expected, to stay with the child during hospitalization. D Familiar rituals and routines are important to toddlers and give the child a sense of control. Following the child's usual routines during hospitalization minimizes feelings of loss of control.

Which behavior is not demonstrated in the 8-year-old child? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Understands that pouring liquid from a small to large container does not change the amount d. Engages in fantasy and magical thinking

ANS: D Feedback A School-age children enter the stage of concrete operations. They learn that their point of view is not the only one. B The school-age child has a sense of humor. The child's increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. C The school-age child understands that properties of objects do not change when their order, form, or appearance does. D The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development.

What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a sibling's repeated hospitalizations? a. Recommend that the child be sent to visit the grandmother until the sibling returns home. b. Inform the parent that the child is too young to visit the hospital. c. Assume the child understands that the sibling will soon be discharged because the child asks no questions. d. Help the mother give the child a simple explanation of the treatment, and encourage the mother to have the child visit the hospitalized sibling.

ANS: D Feedback A Separation from family and home may intensify fear and anxiety. B Parents are experts on their children and need to determine when their child can visit a hospital. C Children may have difficulty expressing questions and fears and need the support of parents and other caregivers. D Needs of a sibling will be better met with factual information and contact with the ill child.

A 3 1/2-year-old child who is toilet trained has had several "accidents" since hospital admission. What is the nurse's best action in this situation? a. Find out how long the child has been toilet trained at home. b. Encourage the parents to scold the child. c. Explain how to use a bedpan and place it close to the child. d. Follow home routines of elimination.

ANS: D Feedback A Some regression to previous behaviors is normal during hospitalization, even when the child has been practicing the skill for some time. B Hospitalization is a stressful experience. If the incontinence is caused by anxiety, scolding is not indicated and may increase the anxiety. C Developmentally, the 3 1/2-year-old child cannot use a bedpan independently. D Cooperation will increase and anxiety will decrease if the child's normal routine and rituals are maintained.

Which statement made by a mother of a school-age boy indicates a need for further teaching? a. "My child is playing soccer this year." b. "He is always busy with his friends playing games. He is very active." c. "I limit his television watching to about 2 hours a day." d. "I am glad his coach is a good role model. He emphasizes the importance of winning in today's society. The kids really are disciplined."

ANS: D Feedback A Team sports such as soccer are appropriate for exercise and refinement of motor skills. B School-age children need to participate in physical activities, which contribute to their physical fitness skills and well-being. C Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities. D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group.

When planning care for adolescents, the nurse should a. Teach parents first, and they, in turn, will teach the teenager. b. Provide information for their long-term health needs because teenagers respond best to long-range planning. c. Maintain the parents' role by providing explanations for treatment and procedures to the parents only. d. Give information privately to adolescents about how they can manage the specific problems that they identify.

ANS: D Feedback A Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. B Teenagers are more interested in immediate health care needs than in long-term needs. C Teenagers are at the developmental level that allows them to receive explanations about health care directly from the nurse. D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider.

In providing anticipatory guidance to parents, which parental behavior is the most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe

ANS: D Feedback A Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children. B Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child. C Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning. D Parents living what they believe gives nonambivalent messages and fosters the child's moral development and reasoning.

Which cranial nerve is assessed when the child is asked to imitate the examiner's wrinkled frown, wrinkled forehead, smile, and raised eyebrow? a. Accessory b. Hypoglossal c. Trigeminal d. Facial

ANS: D Feedback A To assess the accessory nerve, the examiner palpates and notes the strength of the trapezius and sternocleidomastoid muscles against resistance. B To assess the hypoglossal nerve, the examiner asks the child to stick out the tongue. C To assess the trigeminal nerve, the child is asked to identify a wisp of cotton on the face. The corneal reflex and temporal and masseter muscle strength are evaluated. D The facial nerve is assessed as described in the question.

A parent asks the nurse how she will know whether her child has fifth disease. The nurse should advise the parent to be alert for which manifestation? a. Bull's-eye rash at the site of a tick bite b. Lesions in various stages of development on the trunk c. Maculopapular rash on the trunk that lasts for 2 days d. Bright red rash on the cheeks that looks like slapped cheeks

ANS: D Feedback A The bull's-eye rash at the site of a tick bite is a manifestation of Lyme disease. B Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp. C Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days. D Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance.

What should the nurse advise the mother of a 4-year-old child to bring with her child to the outpatient surgery center on the day of surgery? a. Snacks b. Fruit juice boxes c. All of the child's medications d. One of the child's favorite toys

ANS: D Feedback A The child will be NPO before surgery; therefore including snacks for the child is contraindicated. B The child will be NPO before surgery. Unnecessary stress will result when the child is denied the juice. C It is not necessary to bring all medications on the day of surgery. The medication the child has been receiving should have been noted during the preoperative workup. The parent should be knowledgeable of which medications the child has been taking if further information is necessary. D A familiar toy can be effective in decreasing a child's stress in an unfamiliar environment.

Which statement concerning physiologic factors is true? a. The infant has a slower metabolic rate than an adult. b. An infant has an inability to digest protein and lactase. c. Infants have a slower circulatory response than adults do. d. The kidneys of an infant are less efficient in concentrating urine than an adult's kidneys.

ANS: D Feedback A The infant's metabolic rate is faster, not slower, than an adult's. B Although the newborn infant's gastrointestinal system is immature, it is capable of digesting protein and lactase, but the ability to digest and absorb fat does not reach adult levels until approximately 6 to 9 months of age. C Circulation is faster in infants than in adults. D The infant's kidneys are not as effective at concentrating urine compared with an adult's because of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance.

A child has a 2-day history of vomiting and diarrhea. He has hypoactive bowel sounds and an irregular pulse. Electrolyte values are sodium, 139 mEq/L; potassium, 3.3 mEq/L; and calcium, 9.5 mg/dL. This child is likely to have which of the following electrolyte imbalances? a. Hyponatremia b. Hypocalcemia c. Hyperkalemia d. Hypokalemia

ANS: D Feedback A The normal serum sodium level is 135 to 145 mEq/L. A level of 139 mEq/L is within normal limits. B A serum calcium level less than 8.5 mg/dL is considered hypocalcemia. C A serum potassium level greater than 5 mEq/L is considered hyperkalemia. D A serum potassium level less than 3.5 mEq/L is considered hypokalemia. Clinical manifestations of hypokalemia include muscle weakness, decreased bowel sounds, cardiac irregularities, hypotension, and fatigue.

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

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

In girls, the initial indication of puberty is a. Menarche b. Growth spurt c. Growth of pubic hair d. Breast development

ANS: D Feedback A The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. B The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. C The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche.

During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is a. Abnormal, requiring further investigation b. Abnormal unless it occurs in conjunction with knock-knee c. Normal if the condition is unilateral or asymmetric d. Normal, because the lower back and leg muscles are not yet well developed

ANS: D Feedback A This is an expected finding in toddlers. B This is an expected finding in toddlers. C Further evaluation is needed if it persists beyond age 2 to 3 years, especially in African-American children. D Genu varum (bowlegged) is common in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed.

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

ANS: D Feedback A This is not indicative of a child who has unreasonable expectations, but rather normal development. B Toddlers use ritualistic behaviors to maintain necessary structure in their lives. C This is not regression, which is a retreat from a present pattern of functioning. D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container.

The nurse is discussing toddler development with the mother of a 2 1/2-year-old child. Which statement by the mother indicates she has an understanding of how to help her daughter succeed in a developmental task while hospitalized? a. "I always help my daughter complete tasks to help her achieve a sense of accomplishment." b. "I provide many opportunities for my daughter to play with other children her age." c. "I consistently stress the difference between right and wrong to my daughter." d. "I encourage my daughter to do things for herself when she can."

ANS: D Feedback A Toddlers should be encouraged to do what they can for themselves. B Toddlers participate in parallel play. They play next to rather than with age mates. C Excessive stress on the differences between right and wrong can stifle autonomy in the toddler and foster shame and doubt. D The toddler's developmental task is to achieve autonomy. Encouraging toddlers to do things for themselves assists with this developmental task (i.e. feeding self, putting on own socks.)

Which action is initiated when a child has been scratched by a rabid animal? a. No intervention unless the child becomes symptomatic b. Administration of immune globulin around the wound c. Administration of rabies vaccine on days 3, 7, 14, and 28 d. Administration of both immune globulin and vaccine as soon as possible after exposure

ANS: D Feedback A Transmission of rabies can occur from bites with contaminated saliva, scratches from the claws of infected animals, airborne transmission in bat-infested caves, or in a laboratory setting. Rabies is fatal if no intervention is taken to prevent the disease. B Human rabies immune globulin is infiltrated locally around the wound and the other half of the dose is given intramuscularly. This is only part of the treatment after rabies exposure. C The rabies vaccine is given within 48 hours of exposure and again on days 3, 7, 14, and 28. D Human rabies immune globulin and the first dose of the rabies vaccine are given after exposure.

A 17-month-old child is expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Sensorimotor period

ANS: D Feedback A Trust is Erikson's first stage. B Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. C Secondary circular reactions last from approximately ages 4 to 8 months. D The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. Learning in this stage occurs mainly by trial and error.

Which parameter correlates best with measurements of the body's total muscle-mass to fat ratio? a. Height b. Weight c. Skin-fold thickness d. Mid arm circumference

ANS: D Feedback A Height is reflective of past nutritional status. B Weight is indicative of current nutritional status. C Skin-fold thickness is a measurement of the body's fat content. D Mid arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores.

When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. What is the best explanation for this? a. Some form of cancer b. Local scalp infection common in children c. Infection or inflammation distal to the site d. Infection or inflammation close to the site

ANS: D Feedback A Tender lymph nodes are not usually indicative of cancer. B A scalp infection usually does not cause inflamed lymph nodes. C The lymph nodes close to the site of inflammation or infection would be inflamed. D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location.

Clostridium difficile (C-difficile) is a gram-positive anaerobic bacteria known to cause diarrhea, abdominal cramps, and fever. The CDC has reported that children are at minimal risks as this infection affects primarily the elderly or patients who are immunocompromised. Is this statement true or false?

ANS: F In 2005, the CDC reported an increase in the number of cases of Clostridium difficile in children who were previously thought to be at minimal risk. Children ages 1 to 4 are primarily affected.

32. What procedure is recommended to facilitate a heelstick on an ill neonate to obtain a blood sample? a. Apply cool, moist compresses. b. Apply a tourniquet to the ankle. c. Elevate the foot for 5 minutes. d. Wrap foot in a warm washcloth.

ANS: D Before the blood sample is taken, the heel is heated with warm moist compresses for 5 to 10 minutes to dilate the blood vessels in the area. Cooling causes vasoconstriction, making blood collection more difficult. A tourniquet is used to constrict superficial veins. It will have an insignificant effect on capillaries. Elevating the foot will decrease the blood in the foot available for collection.

23. It is important to make certain that sensory connectors and oximeters are compatible since wiring that is incompatible increases the risk of which injury? a. Hyperthermia b. Electrocution c. Pressure necrosis d. Burns under sensors

ANS: D It is important to make certain that sensor connectors and oximeters are compatible. Wiring that is incompatible can generate considerable heat at the tip of the sensor, causing second- and third-degree burns under the sensor. Incompatibility would cause a local irritation or burn, not hyperthermia. A low voltage is used, which should not present risk of electrocution. Pressure necrosis can occur from the sensor being attached too tightly, but this is not a problem of incompatibility.

36. When administering a gavage feeding to a school-age child, the nurse should implement what intervention to assure safety? a. Lubricate the tip of the feeding tube with Vaseline to facilitate passage. b. Check the placement of the tube by inserting 20 mL of sterile water. c. Administer feedings over 5 to 10 minutes. d. Position the child on the right side after administering the feeding.

ANS: D Position the child with the head elevated about 30 degrees and on the right side or abdomen for at least 1 hour. This is in the same manner as after any infant feeding to minimize the possibility of regurgitation and aspiration. Insert a tube that has been lubricated with sterile water or water-soluble lubricant. With a syringe, inject a small amount of air into the tube, while simultaneously listening with a stethoscope over the stomach area. Feedings should be administered via gravity flow and take from 15 to 30 minutes to complete.

8. What is an appropriate intervention to encourage food and fluid intake in a hospitalized child? a. Force child to eat and drink to combat caloric losses. b. Discourage participation in noneating activities until caloric intake is sufficient. c. Administer large quantities of flavored fluids at frequent intervals and during meals. d. Give high-quality foods and snacks whenever child expresses hunger.

ANS: D Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, macaroni, and cheese should be available. Forcing a child to eat only meets with rebellion and reinforces the behavior as a control mechanism. Large quantities of fluid may decrease the child's hunger and further inhibit food intake.

22. When caring for a child with an intravenous infusion, the nurse should include which intervention in the plan of care? a. Using a macrodropper to facilitate reaching the prescribed flow rate. b. Avoid restraining the child to prevent undue emotional stress. c. Changing the insertion site every 24 hours. d. Observing the insertion site frequently for signs of infiltration.

ANS: D The nursing responsibility for intravenous therapy is to calculate the amount to be infused in a given length of time, set the infusion rate, and monitor the apparatus frequently, at least every 1 to 2 hours, to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. A minidropper (60 drops/mL) is the recommended intravenous tubing in pediatrics. The intravenous site should be protected. This may require soft restraints on the child. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. Frequent change exposes the child to significant trauma.

You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunizations cannot be given? Select all that apply. a. DTaP b. HepA c. IPV d. Varicella e. MMR

ANS: D, E Feedback Correct Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children. Incorrect DTaP, HepA, and IPV can be given safely.

1. The nurse is preparing for the admission of an infant who will have several procedures performed. In which situation is informed consent required? (Select all that apply.) a. Catheterized urine collection b. Intravenous (IV) line insertion c. Oxygen administration d. Lumbar puncture e. Bone marrow aspiration

ANS: D, E Informed consent is required for invasive procedures that involve risk to a child, such as a lumbar puncture, chest tube insertion, and bone marrow aspirations. Catheterized urine collection, IV line insertion, and oxygen administration all fall under this category.

A designated safe place can enhance the child's security while in the hospital. For example, intrusive procedures that may cause discomfort or anxiety are best done in the child's room. Is this statement true or false?

ANS: F Any invasive procedures should be performed in the treatment room, not the child's room. The playroom should also be a place for play, not treatments or medication administration. The nurse should consider the child's age and developmental level when deciding where to perform procedures that might be painful or distressing.

The number of hours spent sleeping decreases as the child grows older. Children ages 6 and 7 years require approximately 9 or 10 hours of sleep per night. Is this statement true or false?

ANS: F Children ages 6 and 7 actually need approximately 12 hours of sleep per night. Some children also continue to need an afternoon nap or quiet time to restore energy levels. The 12-year-old needs approximately 9 to 10 hours of sleep at night. Adequate sleep is important for school performance and physical growth. Inadequate sleep can cause irritability, inability to concentrate, and poor school performance.

The nurse who provides care for young children with fluid and electrolyte imbalance understands that they are more vulnerable to changes in fluid balance than adults. Under normal conditions the amount of fluid ingested during the day should equal the amount of fluid lost. Sensible water loss is that which occurs through the respiratory tract and skin. Is this statement true or false?

ANS: F Sensible water loss occurs through urine output. Insensible water loss occurs through the skin and respiratory tract. Insensible water loss per unit of body weight is significantly higher in infants and young children due to the faster respiratory rate and higher evaporative water losses.

The CDC recommends that all health care providers use the World Health Organization (WHO) growth standards to monitor growth for infants and children aged 0-2 years. For children ages 2 and older the CDC growth chart should be used. These charts are standardized and appropriate for all children. Is this statement true or false?

ANS: F There are special growth charts available for premature or very low birth weight infants, and children with specific conditions that may affect size and growth (i.e., Down syndrome).

The rate of Sudden Infant Death Syndrome (SIDS), now the third leading cause of death in infants, has increased despite international efforts and the Back to Sleep campaign. Is this statement true or false?

ANS: F This statement is incorrect. SIDS, which for a long time was the second leading cause of infant deaths, has decreased in part because of the Back to Sleep program. It is important for both hospital and clinic nurses to educate parents on safe sleep strategies for their infant.

Alterations in acid-base balance can affect cellular metabolism and enzymatic processes. When alterations in pH become too much for buffer systems to handle, compensatory mechanisms are activated. If the pH drops below normal than acidosis will occur. Is this statement true or false?

ANS: T Acidosis is the result of a drop in blood pH. The respiratory rate and depth will increase, removing carbon dioxide and raising blood pH. Conversely in the presence of alkalosis, respiratory rate and depth decrease, lowering blood pH.

Human cytomegalovirus (CMV) infection is a common cause of congenital infection and is the leading cause of hearing loss and intellectual disability in the United States. The neonate may be infected during the prenatal, perinatal, or postnatal period. Only infections acquired in utero cause permanent infection. Is this statement true or false

ANS: T Approximately one third of women with primary CMV infection transmit the virus to the fetus. The prevalence is one in 150 live births. Only 10% of infected newborns go on to manifest symptoms. These include jaundice, lethargy, seizures, petechiae, respiratory distress, enlarged liver, and microcephaly.

An important part of the physical exam is the otoscopic examination of the ear. The ear canal should be straightened prior to visualization. If the child is younger than 3, this is accomplished when the nurse pulls the pinna of the ear down and back. Is this the correct procedure?

ANS: T If the child is older than 3, the pinna is pulled up and back. As much of the ear canal as possible should be visible before the speculum is inserted into the auditory meatus.

Parents are often concerned about their toddler's interest in and curiosity about gender differences. Sex play and masturbation are common among toddlers. Is this statement true or false?

ANS: T Nurses can reassure parents that self-exploration and exploration of another toddler's body is normal behavior during early childhood. Parents should respect the child's curiosity as normal and not judge them as being "bad."

The use of electronic or digital media for communication has had a negative effect on the language development of adolescents. Is this statement true or false?

ANS: T Text messaging, instant messaging, blogs, and Twitter all contribute to abbreviated communication techniques, which eliminate not only grammar and sentence construction, but also word development (e.g., using ur, for you are).

Breastfeeding is the ideal method for providing nutrition to the human infant and is recommended by the American Heart Association, the American Academy of Pediatrics, and the World Health Organization. Infants should be exclusively breastfed for a minimum of 4 months and preferably 6 months. Is this statement true or false?

ANS: T This statement is correct. Solid food should not be introduced until 4 to 6 months of age. Breastfeeding should accompany solid food introduction until 1 year of age.

____________________ is the leading cause of death in children of every age-group beyond 1 year of age.

ANS: Unintentional injury

The most common cause of death in the adolescent age-group involves a. Drownings b. Firearms c. Drug overdoses d. Motor vehicles

Feedback A Drownings are major concerns in adolescence but do not cause the majority of deaths. B Firearms are major concerns in adolescence but do not cause the majority of deaths. C Drug overdoses are major concerns in adolescence but do not cause the majority of deaths. D Risk taking behaviors play a major role in the high incidence of motor vehicle injuries and death among teenagers i.e. alcohol use, failure to wear a seatbelt, and inexperience.

. In which section of the health history should the nurse record that the parent brought the infant to the clinic today because of frequent diarrhea? a. Review of systems b. Chief complaint c. Lifestyle and life patterns d. Health history

Feedback A The review of systems includes past health functions of body systems. B The chief complaint is documented using the child's or parent's words for the reason the child was brought to the health care center. C Lifestyle and life patterns include the child's interaction with the social, psychological, physical, and cultural environment. D Health history includes birth history, growth and development, common childhood illnesses, immunizations, hospitalizations, injuries, and allergies.

Which statement about performing a pediatric physical assessment is correct for a school-age child? Select all that apply. a. Physical examinations proceed systematically from head to toe. b. The physical examination should be done with parents in the waiting room. c. Measurement of head circumference is obtained. d. The physical examination is done only when the child is cooperative. e. Remove clothing and have the child put on an examination gown.

Feedback Correct Physical assessment usually proceeds from head to toe; however if developmental delays exist, considerations dictate that the least threatening assessments be done first to obtain accurate data. School-age children are at a developmental stage when they should be cooperative for the physical examination. Children of this age are usually modest, and an examination gown should be provided. Incorrect Having parents in the examining room with adolescents is not appropriate, but is appropriate for children of other age-groups. Parents usually are not kept in the waiting room. Measurement of head circumference is obtained on children 36 months of age or less.

The nurse is preparing to administer a vaccine to a child. The child is refusing to take the vaccination because of fear of bleeding. What should the nurse do in this situation? 1Tell the child he or she can pick the bandage color. 2Tell the child bleeding will stop in a few seconds. 3Request a staff member sit beside the child. 4Give a favorite toy to the child for distraction.

The child is refusing to take vaccination because of fear of bleeding and pain. The nurse should ask the child to select the color of the bandage to be used. This reassures the child and will make him or her feel better. Giving a favorite toy to the child for playing is not helpful for relieving the fear. A favorite toy may help the child sleep at night.

The nurse finds that a patient has developed tachycardia and tachypnea after administration of a muscle relaxant. What is an appropriate nursing action? 1Administer dantrolene sodium intravenously. 2Use hot compresses on the neck and axillae. 3Assess the patient's history of surgical procedures. 4Administer an inhaled anesthetic.

The nurse should administer dantrolene sodium intravenously as the patient is showing signs of malignant hyperthermia (MH). Symptoms of MH include hypercarbia, elevated temperature, tachycardia, tachypnea, acidosis, muscle rigidity, and rhabdomyolysis. The nurse uses ice packs on the groin, axillae, and neck as MH is usually accompanied by hyperthermia. A family or previous history of sudden high fever associated with a surgical procedure and myotonia increase the risk for MH. But the patient will not be assessed for it now as MH has already set in. Use of inhaled anesthetics increase the risk of MH; therefore, they should not be administered as the patient is exhibiting symptoms of MH.

The parents of a preschool child ask the nurse why their child needs to have her "eyes tested." The nurse explains that although evaluating the visual acuity in a young child can be difficult, the American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age _________ years.

three The American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age 3 years. Tools available for testing the visual acuity of preschool children include Lea cards, tumbling Es, and the HOTV chart.