Peds Chapter 4-8

The parent of 12-month-old Chris says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much of a mess." The most appropriate response by the nurse is:

"He is old enough to feed himself. Let's think of ways to make the mess more tolerable." At 12 months the child should be self-feeding. Because children this age eat primarily finger foods, it is useful to offer the parent suggestions for keeping mess to a minimum.

A mother tells the nurse that she will visit her 2-year-old child tomorrow around noon. During the child's bath, the child asks for Mommy. The best response the nurse can give is:

"Mommy will be here after lunch." Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time.

Which is considered one of the best strategies to prevent smoking in teenagers?

Emphasizing immediate effects of smoking Emphasizing immediate effects of smoking has proved to be the most effective strategy for preventing smoking. Information focuses on tobacco smell and other negative aesthetic issues. This works because of the adolescents' focus on the here and now.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy in the toddler?

Encouraging the toddler to do things for self when capable of doing them Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable.

A 16-year-old girl tells the school nurse that she has not started to menstruate yet. The onset of secondary sexual characteristics occurred in this girl about three years ago. The appropriate action by the nurse is to:

refer the adolescent for an evaluation. Lack of menstruation 3 years after the onset of secondary sexual characteristics meets the definition of primary amenorrhea and should be evaluated.

A 4-year-old child is having an increase in angry outbursts in preschool. The child is very aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. The child's parents ask the nurse for advice. The most appropriate intervention by the nurse is to:

refer the child for professional help. Angry outbursts in preschool is not expected behavior; the child should be referred to a competent professional to deal with the aggression

Nursing interventions to promote health during middle childhood include:

reinforcing education of the child and parents regarding the need for good dental hygiene because these are the years in which permanent teeth erupt. Because the permanent teeth are present, it is important for the child to learn how to care for these teeth.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse's suggestions regarding participation in sports at this age should include:

sports participation is encouraged if the sport is appropriate to the child's abilities. The parents should help the child select a sport that is suitable to her capabilities and interests.

Austin, age 3 years, has cerebral palsy and is currently hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. The most appropriate nursing action related to feeding Austin is to:

stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing. Because the jaw is compromised, more normal control can be achieved if the feeder provides stability. Manual jaw control assists with head control, correction of neck and trunk hyperextension, and jaw stabilization.

Poison prevention in toddlers can best be done by:

storing all poisonous substances in a locked cabinet. Storing poisonous substances out of reach is an appropriate action.

In planning sex education and contraceptive teaching for adolescents, the nurse should consider that:

teenagers need contraception education in oral, visual, and written forms. Sex education and contraceptive information need to be concrete and concise. Oral presentations with visual demonstrations and written information with diagrams should be provided.

In boys, the initial indication of puberty is:

testicular enlargement. Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 and 14 years during Tanner stage 2 development.

A 12-year-old child being seen in the clinic has not received the vaccine for the hepatitis B virus (HBV). The nurse should recommend that:

the three-dose series of HBV vaccine should be started. Adolescents should be vaccinated against hepatitis B at this age if it has not been done previously.

A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). The most appropriate recommendation by the nurse is:

the use of condoms. Condoms provide the best available barrier to the organisms that cause STDs.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. The nurse's response is based on:

there is no need to restrain nonnutritive sucking during infancy. Nonnutritive sucking reaches its peak at about 18 to 20 months of age.

According to Erikson, infancy is concerned with acquiring a sense of:

trust. The task of infancy is the development of trust.

For a toddler with sleep problems, the nurse should suggest:

using a transitional object. A transitional object may help the child ease anxiety and facilitate sleep.

Girls have an increase in weight and fat deposition during puberty. Nursing considerations related to this include:

giving reassurance that these changes are normal. A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the child's sex. A healthy balance must be achieved between expected healthy weight gain and obesity.

The parents of a 4-year-old girl are worried because she has an imaginary playmate. The nurse's response is based on the knowledge that:

imaginary playmates are normal and useful at this age. Imaginary playmates are a part of normal development at this age.

The nurse is concerned with the prevention of communicable disease. Primary prevention results from:

immunizations. Communicable diseases are prevented through immunization, which is primary prevention.

Nursing responsibilities in the management of adolescent obesity include:

incorporating favorite foods into the child's diet. Incorporating small amounts of the adolescent's favorite foods will increase adherence to the nutritional plan. Eliminating them all causes a perception of deprivation.

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of:

initiative. Preschoolers focus on developing initiative. The stage is known as initiative versus guilt.

A 16-year-old adolescent male tells the school nurse that he is gay. The nurse's response is based on knowledge that:

it is important to provide a nonthreatening environment in which he can discuss this matter. The nurse needs to be open and nonjudgmental in interactions with adolescents. This will provide a safe environment in which to provide appropriate health care.

At bedtime, Kimberly, age 4 years, lies down and sleeps without any parental intervention. Kimberly sometimes wakes her parents at night by screaming, thrashing, and sweating, and appears frightened. Yet Kimberly is not aware of her parents' presence when they check on her. This is most likely:

night terror. During night terrors the child is only partially aroused; therefore she does not remember her parents' presence.

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The nurse should explain to this parent that this is:

normal because the onset of pubescence is usually earlier in girls than it is in boys. Girls begin puberty an average of approximately 2 years before boys

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs/practices. The nurse should recognize that this is:

normal in spiritual development. Skepticism describes stage 4 in spiritual development. Adolescents attempt to determine which of their parental standards and beliefs to incorporate into their own.

At 18 months of age, a child has a vocabulary of

only 10 words.

When preparing parents to teach their children about human sexuality, the nurse should emphasize:

parents should determine exactly what the child wants to know before answering a question about sex. It is important that the parent answer the question that the child is curious about and not redirect the child's focus by relaying higher level information than was requested.

The preschooler's thought process is egocentric. The most effective approach for communication is through:

play. Play is the child's way to learn to understand and adjust to situations.

When discussing sex and sexual activities with adolescents, the nurse should:

present normal body functions in a straightforward manner. The nurse should provide accurate and complete information that is presented with correct terminology.

Nursing responsibilities when caring for the suicidal adolescent include:

recognizing the warning signs that indicate a young person might attempt suicide. It is imperative that the nurse recognize warning signs of a potential suicide

A 2-year-old child who is ventilator dependent will be discharged soon. The family expresses concern that the child might change the ventilator settings by exploring the control knobs and buttons. The nurse should:

recommend ways to cover the controls to reduce the risk of the child changing settings. If the equipment does not have lockout capabilities, then clear plastic covers and tape should be applied.

A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention?

"We stopped using the car seat now that my child is older." A car seat should be used until the child weighs 40 pounds, at approximately 4 years of age. After that point, a booster seat that complies with federal safety guidelines should be used. Seat belts must be used with the booster seat.

Why are infants particularly vulnerable to acceleration-deceleration head injuries?

Musculoskeletal support of head is insufficient. The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants.

An infant is expected to be able to say "mama" and "dada" with meaning by age:

10 months. At 10 months, infants say sounds with meaning.

A child at 24 months uses

2- to 3-word phrases.

A child at 3 years of age uses

3- to 4-word sentences.

The nurse would expect that most children would be using sentences of 6 to 8 words by age:

5 years. Children can make sentences of 6 to 8 words at 5 years of age. Most will use all parts of speech and construct sentences of the length an adult would use.

The school nurse is discussing dental health with children in first grade. Which should be included?

Emphasize the importance of brushing before bedtime. Children should be taught to brush their teeth after meals and snacks and before bedtime; the children should already have been instructed in this regard

Which statement is most characteristic of the motor skills of a 24-month-old child?

A toddler's activities begin to produce purposeful results. Gross and fine motor mastery occur with other activities.

Which characteristic best describes the fine motor skills of a 5-month-old infant?

Able to grasp object voluntarily This characteristic is appropriate for a 5-month-old infant.

The school nurse is teaching a class on injury prevention. Which should be included when firearms are discussed?

Adolescence is the peak age for ending up as victim or offender in the case of injury involving a firearm. Gun carrying among adolescents is on the rise. The increase in gun availability is linked to increased gun deaths among children, especially given the psychosocial development characteristics of adolescents.

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he is left with his grandparents. The nurse's response is based on which observation?

An infant screaming when left with grandparents is a normal reaction for this age. The infant is feeling stranger anxiety, which is expected for this age.

Which is most descriptive of the spiritual development of the older adolescent?

Beliefs become more abstract. Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which should be included?

Brush the teeth with plain water if the child does not like toothpaste. Some children do not like the flavor of toothpaste or the foaming that results. Plain water should be used in this case.

Which is descriptive of the social development of school-age children?

Children frequently have "best friends." Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid.

Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, what can gradually be achieved by the toddler?

Control of anal and urethral sphincters The voluntary control of elimination occurs between 18 and 24 months.

Which best describes the 4-year-old's concept of death?

Death is temporary. Death is seen as a temporary departure.

Which consideration is important for the school nurse planning a class on injury prevention for adolescents?

During adolescence, a need exists for discharging energy, often at the expense of logical thinking. The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy, coupled with risk taking, which puts them at risk.

Which is characteristic of the psychosocial development of school-age children?

Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. The school-age child is eager to develop skills and participate in activities. Not all children are able to do all tasks well, and the child must be prepared to accept some feelings of inferiority.

During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure whether his son is ready for kindergarten. The child's birthday is close to the cutoff date and the child has not attended preschool. Which is the nurse's best recommendation?

Get a developmental screening A developmental screening will provide the necessary information to help the family determine readiness.

Which is the most appropriate recommendation for relief of teething pain?

Give the child a frozen teething ring to relieve inflammation. Cold reduces inflammation and should be used for relief of teething irritation.

Which should the nurse recommend to help a toddler cope with the birth of a new sibling?

Give the toddler a doll on which he or she can imitate parenting. The toddler can participate in the activity of caring for a new family member.

Which statement about bottle-mouth caries is correct?

Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. Sweet liquids pooling in the mouth during sleep cause dental caries.

How does the onset of the pubertal growth spurt compare in girls and boys?

In girls, it occurs about 1 year before it appears in boys. Average age of onset is 9.5 years for girls and 10.5 years for boys.

The nurse notices that a toddler is more cooperative when taking medicine from a small cup rather than from a large cup. This is an example of which characteristic of preoperational thought?

Inability to conserve The smaller cup makes it look like less medicine.

Which behavior is most characteristic of the concrete operations stage of cognitive development?

Increasingly logical and coherent thought processes Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects.

The nurse is giving anticipatory guidance to the parent of a 5-year-old. Which is the most appropriate to include?

Inform the parent to expect a more tranquil period at this age. The end of preschool/beginning of school age is a more tranquil period.

Which best describes colic?

It is paroxysmal abdominal pain or cramping manifested by episodes of loud crying. A paroxysmal abdominal pain or cramping manifested by episodes of loud crying is the correct definition of colic.

Ashley, age 4 years, is afraid of dogs. The nurse should recommend which to her parents to help Ashley cope with this fear?

Let Ashley watch other children play with a dog. The parents should actively seek ways to deal with fear. By observing other children at play with dogs, the child can learn to adapt.

Which is an important consideration in preventing injuries during middle childhood?

Most injuries occur in or near school or home.

Which intervention lowers the risk of sudden infant death syndrome (SIDS)?

Putting the infant to sleep in the supine position The "Back to Sleep" campaign is given credit for reducing the rate of SIDS in the United States.

Which statement explains why it can be difficult to assess a child's dietary intake?

Recall of food consumption is frequently unreliable. It is difficult for parents to recall exactly what their child has eaten. Concurrent food diaries are somewhat more reliable

According to Piaget, at what stage of development do children typically solve problems through trial and error?

Sensorimotor During the sensorimotor stage, infants and young toddlers develop a sense of cause and effect.

The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. The most appropriate recommendation by the nurse is that:

fluids in addition to breast milk are not needed. The child will nurse according to needs. Additional fluids are not necessary for the breastfed baby.

Which is an important consideration related to childhood stress?

Some children are more vulnerable to stress than others. Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress.

The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem?

Start putting her to bed while still awake. Parents need to develop bedtime rituals that involve putting the child in bed while still awake.

Which is descriptive of the nutritional requirements of preschool children?

The quality of the food consumed is more important than the quantity. It is essential that the child eat a balanced diet with essential nutrients.

Which of the following statements helps explain the growth and development of children?

The sequence of developmental milestones is predictable. There is a fixed, precise order to child development.

Which statement characterizes toddlers' eating behavior?

They become fussy eaters. Toddlers have physiologic anorexia that contributes to fussy eating.

Michael, age 4 months, is brought to the clinic by his parents for a well-baby checkup. Which recommendation about injury prevention should the nurse include at this time?

When Michael learns to roll over you must supervise him whenever he is on a surface from which he might fall. Rolling over from abdomen to back occurs between 4 and 7 months. It is appropriate anticipatory guidance to teach parents to supervise Michael whenever he is on a surface from which he may fall.

The nurse observes that 13-year-old Mike has gynecomastia (breast enlargement). The nurse explains to Mike that this is:

a normal occurrence during puberty. Gynecomastia is common during mid-puberty in about one third of boys. For most, the breast enlargement disappears within 2 years.

Kristen is an 8-year-old child with moderate cerebral palsy (CP). Kristen recently began participation in a regular classroom for part of the day. Kristen's mother asked the school nurse about having Kristen join the after-school Girl Scout troop. The nurse's response should be based on knowledge that:

after-school activities often provide children with CP opportunities for socialization and recreation. Recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs.

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response is based on the knowledge that

bullies often have difficulties developing and maintaining relationships. Children who bully are defiant toward adults, antisocial, and likely to break school rules. They have little anxiety and strong self-esteem and may come from homes where physical punishment is used and there is a lack of parental involvement and warmth. In the long term, this negativity continues into adulthood, causing difficulties in developing and maintaining relationships.

Neat pincer grasp

characteristic of an 11-month-old infant.

The parents of 9-year-old twin children tell the nurse, "The twins have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this is:

characteristic of cognitive development at this age. Classification skills are developed during the school-age years. This age group enjoys sorting objects according to shared characteristics.

Chris, age 9 years, has several physical disabilities. His father explains to the nurse that his son concentrates on what he can, rather than cannot, do and is as independent as possible. The nurse's best interpretation of this is that the:

child is using an adaptive coping style. When a child concentrates on what he can do rather than what he cannot do and is as independent as possible, the child is using an adaptive coping style. The child learns to accept physical limitations but finds achievements in a variety of compensatory motor and intellectual pursuits.

A mother tells the nurse that her daughter's favorite toy is a large, empty box in which a stove was packaged. She plays "house" in it with her toddler brother. The nurse recognizes that this is:

creative play that should be encouraged. C Creative play should be encouraged. After children create something new, they can then transfer their new knowledge to other situations.

The parents of a child with fragile X syndrome want to have another baby. They tell the nurse that they worry another child might be similarly affected. The most appropriate nursing action is to:

ecommend genetic counseling because the syndrome is inherited.

The development of a 2-year-old child is characterized by:

engaging in parallel play. Two-year-olds typically play alongside each other.

A 2-year-old child has recently started having temper tantrums during which the child holds her breath and sometimes faints. The appropriate intervention by the nurse is to:

explain to the parents that this is not harmful. In a healthy child, the rising carbon dioxide levels stimulate breathing to reduce carbon dioxide. When she faints and is no longer able to exert control in this manner, her breathing will automatically resume.

By preschool age the child's body image has developed to include:

fear of intrusive procedures. Preschoolers fear that their insides will come out with intrusive procedures.