peds final pt 2&3

A parent of an 8-month-old infant expressed that the infant cannot walk even a few steps and is unable to sit without support. The nurse gave a toy to the infant and found that the infant was able to transfer the toy between the hands. What should be the most appropriate response of the nurse to the parent?

"At this age the babies do not walk; they may walk after a few months more."

A child has been diagnosed with scabies. Which statement by the parent indicates understanding of the nurse's teaching about scabies?

"Everyone who has been in close contact with my child will need to be treated." (Because of the length of time between infestation and physical symptoms (30 to 60 days), all persons who were in close contact with the affected child need treatment. Families need to know that although the mite will be killed, the rash and the itch will not be eliminated until the stratum corneum is replaced, which takes approximately 2 to 3 weeks. Aggressive housecleaning is not necessary, but surface vacuuming of heavily used rooms by a person with crusted scabies is recommended. The prescribed cream should be thoroughly and gently massaged into all skin surfaces (not just the areas that have a rash) from the head to the soles of the feet.)

The parent of a 12-month-old 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." What is the most appropriate response by the nurse?

"He's at the age when he should begin to feed himself. Let's think of ways to make the mess more tolerable."

The nurse finds that a toddler shows transductive reasoning of preoperational thoughts. Which statement made by the toddler supports the nurse's finding?

"I don't like this food, because the last time I ate something new, it wasn't good."

The nurse is teaching a nursing student about standard precautions. Which statement made by the student indicates a need for further teaching?

"I will use precautions when administering oral medications to a school-age child." (Standard precautions involve the use of barrier protection (personal protective equipment [PPE]), such as gloves, goggles, a gown, or a mask, to prevent contamination from (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood; (3) nonintact skin; and (4) mucous membranes. Precautions should be taken when giving oral care, when changing diapers, and when coming in contact with blood and body fluids. Further teaching is needed if the student indicates the need to use precautions when administering an oral medication to a school-age child.)

The mother of a 6-month old infant tells the nurse she is concerned about her son's nutrition because he pushes the spoonful of baby food away as soon as she brings it to his mouth. What is the most appropriate response to the mother's concern?

"Just keep presenting the spoon to him even though he pushes it away."

A parent has a 2-year old in the clinic for a well-child checkup. Which statement by the parent suggests the need for additional information about injury prevention in early childhood?

"Our 2-year-old toddler takes a bath with his sister while we cook dinner." PG 371

The parent of a 1½-year-old child asks the nurse whether meat and hot dogs can be included in the child's diet. How does the nurse respond?

"Slice the meat into small pieces before serving."

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 most appropriate explanation by the nurse is "This is unusual and requires further evaluation of your son." "This is unusual because the onset of pubescence is usually the same in siblings." "This is normal because the onset of pubescence is usually earlier in girls than it is in boys." "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."

"This is normal because the onset of pubescence is usually earlier in girls than it is in boys." Girls begin puberty on average approximately 2 years before boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, no further evaluation is necessary at this time. The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.

A parent brings a 2-year-old toddler to the clinic for a well-child visit. Which statement by the parent indicates to the nurse that the parent needs more instruction regarding accident prevention?

"We make sure we fasten the front seat bilt tightly." PG 361

A parent brings a 2-year-old to 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 locked all the medicines in the bathroom cabinet." "We turned the thermostat down on our hot water heater." "We placed gates at the top and bottom of the basement steps." "We stopped using the car seat and put our child in the seat belt now that he is older."

"We stopped using the car seat and put our child in the seat belt now that he is older." A car seat should be used until the child weighs 18 kilograms (40 pounds) and is approximately 4 years old. Locking up medicines and any other harmful household products is an appropriate action; therefore, there is no need for further instruction. Turning down the thermostat on the hot water heater is an appropriate action; therefore, there is no need for further instruction. Placing gates at the top and bottom of the basement stairs is an appropriate action; therefore, there is no need for further instruction.

The parents of a 4-month-old infant girl bring the infant to the clinic for a well-baby checkup. Which instruction about injury prevention should the nurse include at this time?

"When she learns to roll over, you'll need to continue to supervise whenever she's on a surface that she could fall from."

What are big signs of Hirschsprung Disease?

*Ribbon like, foul smell *Visible peristalsis *Palpable fecal mass *Looking like an anemic person

Iron Supplements

- give between meals for greater absorption - can stain teeth so administer with a dropper toward the back of the mouth

What are meds for UC?

-5 ASAs -Corticosteroids -Immunomodulators (if steroid resistant)

What are ingestion of injurious agent?

-< 6 years -Commonly ingested: cosmetics, medications, cleaning products, toys -90% occur at home

What is celiac crisis?

-Abd distention -Explosive diarrhea -Dehydration then electrolyte imbalance -Hypotensive shock

What is colic caused by?

-Abd pain and cramping w/ LOUD cry -Baby draws legs up to belly **#3

How to diagnose Hirschsprung Disease?

-Anorectal manometric exam: measures pressure of the sphincter muscles in rectum and all neural reflexes needed for normal bowel movement -Full thickness rectal biopsy: confirms absence of ganglions

What is hep C?

-Blood to blood -incubation is 2-24 weeks (~7-9 weeks) -Kids are asymptomatic -No vaccine -Leads to cirrhosis or hepatocellular carcinoma

What are the effects of lead poisoning?

-Blood: Anemia -Renal: impair calcium function -Neuro: ↑ICP

How to diagnose appendicitis?

-CBC + CRP -ALWAYS get a UA to rule out a UTI -ALWAYS get a US to rule out pregnancy - + if CT is + and enlarged

What is cleft palate?

-Can involve hard and soft -Midline fissure from failure of the two palatal processes to fuse -Repair @ 6-12 mos -Secondary surgery usually for speech

What is inflammatory bowel disease?

-Chronic inflammation of intestine -Causes ulceration -Two types: 1. CROHNS 2. ULCERATIVE COLITIS -No idea where it comes from -No cure - ↑ Risk of colorectal cancer

Attachment Process

-Differential crying, smiling, and vocalization (more to the mother than to anyone else) -Visual-motor orientation (looking more at the mother, even if she is not close) -Crying when the mother leaves the room -Approaching through locomotion (crawling, creeping, or walking) -Clinging (especially in the presence of a stranger) -Exploring away from the mother while using her as a secure base

Who are at most risk for Hep B?

-Disorders involving blood transfusion -IV drug use -Preschoolers -Heterosexual activity

What does a LOW DOSE of lead do to the neurological system?

-Distractibility, impulsivity, hyperactivity, hearing impairment, mild intellect deficit

How to manage GER?

-Don't treat a thriving baby -Small, less, frequent feedings (baby will be less full) -Thicken feedings with rice ceral -Sit upright (Supine) -HOB 30 degrees

How to manage acute diarrhea?

-Draw BMP to assess fluid and electrolyte imbalance -If patient AAO with ORT and ORS (KNOWN losses 1:1) -IV bolus to those with low BP or high HR -Babies can feed with replacement therapy just don't forget to make the appropriate adjustments

What is Hep A?

-Fecal oral route -Incubation 4 weeks (15-50 days) -Virus sheds in 2 weeks before and 1 week after -2 dose series vaccine @ 12 mos

What is lead poisoning?

-From chipping paint or old homes or lead in soil

How to manage lead poisoning?

-Goal: eliminate from the blood - BLL > 15 = lead hazard control initiated -BLL > 45 = chelation therapy

What are s/s of Hirschsprung Disease in an INFANT?

-Growth failure -Constipated -Distended belly -Enterocolitis (explosive diarrhea, fever, looks ill)

What are the meds for GER/GERD?

-H2 receptor antagonist -PPI 30 min before

Cardiovascular system in infant

-HR slows -Sinus arrhythmia

What is Hep B?

-Human to human (blood/semen/saliva) -Incubation 45-165 days (~120 days) -3 dose vaccine (1st @ 24 hours of birth)

What is Crohn's Disease?

-IBS involving ANY part of GI -Usually terminal ileum -Involved all layers and skip lesions* in a discontinuous fashion

What is Ulcerative colitis?

-IBS involving ONLY colon and rectum -Happens in continuous segments* and leads to bleeding and edema -May lead to strictures and shortening of the colon

Vaccine Information Statements (VIS)

-Information statements that must be given to parents before administration of vaccines -Provide updated information for parent or guardian of child being vaccinated

What is celiac disease?

-Intollerance to gluten (wheat, barley, rye, and oats) -Unknown cause -Protein gluten leads to atrophy in small bowel -That atrophy leads to malabsorption

What does a HIGH DOSE of lead do to the neurological system?

-Lead encephalopathy, cognitive impairment, paralysis, blindness, convulsions, coma, death

How does appendicitis occur?

-Lumen gets obstructed -Blocks the outflow of mucus -Causes pressure -Compresses the BV -Causes ischemia -Causes ulceration of lining -Bacteria gets in those ulcers -Necrosis or perforation occurs -Rupture of the appendix leads to bacteria being released all over

Reactive Attachment Disorder

-Maladaptive or absent attachment between the infant and parent -Not being cuddly with parents, failing to make eye contact with significant others, having poor impulse control, and being destructive to themselves and others. - Usually in victims of abuse or neglect, parental alcoholism, mental illness, and substance abuse

Where could celiac disease come from?

-Malnutrition -Steatorrhea (fatty, foul, frothy, bulky stool) -Abd distention -vit deficiency

What is cleft lip?

-Maxillary and median nose process DO NOT fuse -Usually corrected at 2 - 3 mos

What is Meckel Diverticulum?

-Most common GI congenital -Slight bulge of small intestine -Remnant of omphalomesenteric duct to dissolve in week 7-8 of gestation [yolk sac] -Involves the ileum and the ileocecal valve -If it's true, it'll have 3 layers

What is cleft lip/palate?

-Most common congenital deformity -Most common together but can occur separately -Present at birth

What are s/s of EA or TEF?

-Mucus comes from the nose and the mouth -Cough/choke -Cyanosis -Then apnea - ↑ RR distress -Constant regurgitation

What is pyloric Stenosis

-Muscle sphincter thickens or elongates, narrows causing obstruction -Genetic

What are the s/s of acute diarrhea?

-N/V/D -Abdominal pain -Weight loss -Fever -Electrolyte imbalance and dehydration

What is Hirschsprung Disease?

-No ganglion cells present -Loss of rectosphincteric reflex (relaxation of internal sphincter and contraction of external) -Congenital

What are risk factors of Lead poisoning?

-Poverty -<6 years -Urban area living -old home (<1978)

Parachute Reflex

-Protective response to falling -Appears at 7 months

How does giardia usually present?

-Protozoa causes cysts -Cysts survive on surfaces -Children usually pass cysts for months -Normally asymptomatic

What are s/s of appendicitis?

-RLQ pain -Fever -Rigid abdomen -Decreased or absent bowel sounds -Vomiting -Irritability -Stooped posture (guarding)

Respiratory in infant

-RR slows -abdominal breathing - prone to respiratory infections (b/c of lack of IgA in mucosal lining)

Prehension

-Reaching and grasping objects - occurs at 2-3 months - reflex to voluntary

What are s/s of Hirschsprung Disease in a NEWBORN?

-Refusal to pass meconium within 24-48 hours -No appetite -Bilious vomiting -Distended belly

What are s/s of intussusception?

-Sudden/acute abdominal pain -Screaming and drawing knees to chest -Child is okay during the rest period of episodes -Jelly-like stools -Distended belly

What happens if the meds do not work for GER?

-Surgery -Nissen Fundoplication: wrap stomach around esophagus so person can never throw up (Mikayla) -Irreversible

What is tx of Hirschsprung Disease?

-Surgical removal of aganglionic portion of bowel -DISTENDED BELLY: Temp colostomy then soave endorectal pull trough -NOT DISTENDED: Just soave pull through right away

Object Permanence- Piaget

-The understanding that objects continue to exist even when they cannot be observed (seen, heard, touched, smelled or sensed in any way) -Approximately 9 - 10 months

How to diagnose EA/TEF?

-Tube does not pass and it'll come right back up -Seen in X-Ray

What is EA/TEF associated with?

-VATER or VACTERL Vertebral defect Anal (imperforated) Cardiac TEF Radial or renal dysplasia Limb

What are s/s of pyloric stenosis?

-Vomit 30/60 after eating -Projectile -NONbilious -Dehydration -Metabolic Alkalosis (from the vomiting) -Growth failure

How to treat antibiotic associated diarrhea?

-With antibiotics! -Flagyl and vanco

How to diagnose celiac disease?

-blood test: Transglutaminase and antiendomysial antibodies -Drawn at 18 mos -If + get a GI biopsy to detect the atrophy (when the person eats gluten)

prevent spread of infection

-careful hand washing is important -use a tissue or arm to cover noses and mouths when coughing or sneezing -dispose of tissues properly -dont share drinking cups, eating utensils wash clothes or towels with others -do not touch eyes or nose with hands if sick remove affected children from contact with other children when possible - teach well children to stay away from sick children -

Pacifiers

-increase risk of otitis media -wean off after first 6 months

How is intussusception diagnoses?

-palpable sausage-shape mass in URQ -Dance sign is empty in RLQ

Avoid these two things to prevent cavities

-propping the bottle in bed -giving fruit juices in bottle

How to manage constipation?

-reg bowel movements -Try and get the child up early for school to use the restroom beforehand -Increase fiber and fluids -Miralax in juice

What is nursing care for those with GER or GERD?

-small frequent feedings -Positioning after feeding -Thicken feedings -Avoid the foods that are supposed to avoid

What is short bowel syndrome?

-↓ intestinal surface area and doesn't allow for absorption -Malabsorption disorder that results from bowel re-sectioning -That malabsorption tired from bacterial growth and dysmotility -Child may need an ostomy

Height increases by ______ per month for first 6 months

1 inch

How much rice cereal should be added to formulas?

1 tsp / 1 tbs per oz.

Can form 3-5 words with meaning by age

1 year

Triple birth weight by age

1 year

The hepatitis A vaccine is now recommended at which of the following ages?

1 year (Hepatitis A has been recognized as a significant child health problem, particularly in communities with unusually high infection rates. Hepatitis A virus is spread by the fecal-oral route and from person-to-person contact, by ingestion of contaminated food or water, and rarely by blood transfusion, so the immunization is recommended at 1 year of age.)

Lessons from peer group during middle years

1) appreciate different points of view 2) become increasingly sensitive to norms of peer groups 3) form intimate friendships

bike size and helmet recommendations

1) child able to sit on bike and place balls of feet on the ground 2) helmet positioned low on the forehead parallel to the ground 3) strap securely fastened under chin

According to Piaget, cognitive achievements in middle years

1) concrete operations: able to use thought processes to experience events and actions 2) conceptual thinking: able to make judgements based on what they reason 3) conservation: of mass first, then weight and volume last 4) classification skils 5) relational terms: bigger, smaller, etc.

Three physical changes that provide a clue to school age child's physical maturity and readiness for school

1) dec in head circumference in relation to height 2) dec in waist circumference in relation to height 3) inc. in leg length in relation to height

Effective forms of disciple in the middle years

1) reasoning 2) withholding priviledges 3) requiring compensation 4) imposing penalities 5) contracting 6) problem solving: include child in process of determing appropriate discipline

When does celiac disease normally occur?

1-5 years old

When defining the epidemiology triangle to a class, which is part of the definition? (Select all that apply.) 1. Agent 2. Environment 3. Host 4. Prevalence

1. Agent 2. Environment 3. Host Prevalence is not part of the epidemiology triangle; prevalence is defined as the measure of existing events in a population during a time period.

Community nursing involves community evaluation and planning. What is the first step in the community nursing process? 1. Assessment 2. Planning 3. Implementation 4. Evaluation

1. Assessment

The nurse is setting up a community safety program on car seats. What level of prevention is this? 1. Primary 2. Tertiary 3. Secondary 4. Environmental

1. Primary Car seat safety focuses on health promotion and the prevention of disease or injury, which is primary prevention. Tertiary prevention focuses on optimizing function for children with chronic illnesses and disabilities. Secondary prevention involves screening and the early diagnosis of diseases. Environmental is not a level of prevention.

The school nurse is working on a drug and alcohol education program with a sixth-grade class. This education program is an example of what type of community prevention? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Basic prevention

1. Primary prevention Primary prevention focuses on health promotion and prevention of disease or injury. Prevention of drug and alcohol use in school-age children and adolescents promotes healthy living. Secondary prevention focuses on screening and early diagnosis of disease. Tertiary prevention focuses on optimizing function for children with a disability or disease. Basic prevention is not defined.

Sensorimotor Phase

1. Reflex stage: birth-1 month - Sucking, rooting, grasping, crying 2. Reflex to voluntary acts - Association of an action with a response 3. Causality, deliberate intention (shaking rattle) - Imitation - Play

The nurse demonstrates understanding of family-centered care by 1. encouraging family visitation. 2. assuming total care for the child. 3. limiting visitation to three time periods per day. 4. expecting the child to perform self-care in activities of daily living.

1. encouraging family visitation. Family-centered care recognizes the family as the constant in a child's life and visitation supports this philosophy in addition to developing trusting relationships with families. Family-centered care does not assume total care for the child. Limiting visitation is the exact opposite of family-centered care. Family-centered care involves more than expectations for the child.

The nurse is providing education to a group of parents at a health fair in a local kindergarten school. The nurse describes the most common cause of death for children age 5 to 9 years is 1. inappropriate use of bike helmets and seat belts. 2. childhood immunizations. 3. lack of hand washing in the prevention of communicable diseases. 4. the obesity epidemic.

1. inappropriate use of bike helmets and seat belts. The most common cause of death in children age 5 to 9 years is accidents. Education on safety is important to help prevent accidental deaths. Accidents are the most common cause of death for children age 5 to 9 years, not childhood immunizations. Accidents are the most common cause of death for children age 5 to 9 years. Hand washing helps to prevent communicable diseases. Accidents are the most common cause of death for children 5 to 9 years, not obesity.

What is acute hepatitis?

1.Regenerates liver cells without scarring or 2.Can cause liver failure -Diagnoses based on + markers for Hep A, B, and C

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning?

10 months

Move from prone to sitting position occurs at

10 months

Pincer Grasp occurs at

10 months - replaces palmer grasp

Put in/Remove objects from a container occurs at

11 months

Build tower of two blocks occurs at

12 months

At what age is an infant expected to say three to five words besides "dada" and "mama"?

12 months PG 306

The nurse observes that an infant kisses the parent when the parent asks for it. The baby is able to sit down from standing position without help and tries to imitate animal sounds. The nurse tests the baby for Babinski reflex and finds that it has disappeared. What is the approximate age of this baby?

12 months PG 306

Anterior fontanel closing by

12 to 18 months of age (average is 14 months)

When does colic go away?

12-16 weeks

What is the normal age that the anterior fontanel closes?

14 months

the deltoid muscle may be used in kids __age

18mo or older

how much output is sufficient for a child who weighs less than 30kg

1ml/kg/hour

Nutrition

1st 6 months Human milk is most desirable with vitamin supplements Do not require additional fluids, especially water or juice Expressed breast milk may be stored in the freezer for up to 6 months Commercial iron-fortified formula No solid food before 4-6 months

Biologic Development

1st year growth is rapid, slows down during the second 6 months (breast-fed infants gain less weight in second 6 mos) Prone to respiratory infections Close proximity of trachea to bronchi transmits infections from one to the other Short, straight eustachian tube = more ear infections Immune system does not produce immunoglobulin A in the mucosal lining

How does Hep A go?

1st: Asymptomatic 2nd: Diarrhea 3rd: Gastroenteritis

MMR is given in how any doses? when?

2 doses (12-15 mo and again 4-6 yrs)

Single vowel sounds occur at

2 months

Pertussis vaccination should begin at which age?

2 months (The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The first dose is usually given at the 2-month well-child visit. Infants are highly susceptible to pertussis, which can be a life-threatening illness in this age group.)

Which is objective information that can be found in a community? 1. Individuals from the community who report on the level of food insecurity 2. A phone book detailing the community resources 3. The mayor's reports about the level of homelessness in the community 4. A family member's statements on the lack of resources available in the community

2. A phone book detailing the community resources Objective information is data that the nurse collects either by direct observation or through written sources. Individuals from the community reporting on the level of food insecurity is an example of subjective information. Mayor's reporting about the level of homelessness in the community is an example of subjective data. A family member's statements on the lack of resources available in the community would be an example of subjective data.

A camp nurse is assessing a group of children attending summer camp. Based on the nurse's knowledge of special parenting situations, which group of children is at risk for a sense of belonging? 1. Children adopted as infants 2. Children recently placed in foster care 3. Children whose parents recently divorced 4. Children who recently gained a step-parent

2. Children recently placed in foster care Children placed in foster care are at greater risk to have problems perceiving a sense of belonging. Children adopted at birth have fewer problems with acceptance when parents follow pre-adoption counseling about disclosure. Children of divorced parents often fear abandonment. Children who gain a stepparent are at risk for having trust problems with the new parent.

Which defines a group of people living in a specific geographic area? 1. Culture 2. Community 3. Target population 4. Individual countries and states

2. Community A group of people living in a specific geographic area is the definition of a community. Culture refers to a group of people who share a common language and traditions. A target population is a narrowly defined group toward which nurses can direct actions to improve health. Individual countries and states are geopolitical entities.

The role of the pediatric nurse is influenced by trends in health care. Which is an influential trend in pediatric health care? 1. Primary focus on treatment of disease or disability 2. Shift of focus to maintenance of health and illness prevention 3. National health care planning on a distributive or episodic basis 4. Accountability to professional codes and international standards

2. Shift of focus to maintenance of health and illness prevention Maintenance of health and illness prevention is the current focus of health care in which nursing plays a major role. Traditionally, the primary focus on treatment of disease or disability is the role of the physician. National health care planning on a distributive or episodic basis is not a major trend. Accountability to professional codes and international standards is an established responsibility, not a trend.

Studies of families with only one child indicate that only children 1. tend to be selfish. 2. are similar to firstborn children. 3. are less stimulated toward achievement. 4. grow up lonely and dependent on adults.

2. are similar to firstborn children. As only children, they have many of the characteristics of firstborn children. Selfishness is not associated with birth order. Being less stimulated toward achievement is characteristic of middle children. Loneliness and dependence on adults are not associated with birth order.

A 7-year-old child tells the nurse, "Grandpa, Mommy, Daddy, and my sister live at my house." Based on the nurse's knowledge of family structure and function, the nurse identifies this family structure as a 1. binuclear family. 2. extended family. 3. reconstituted family. 4. traditional nuclear family.

2. extended family. An extended family contains at least one parent, one or more children, and one or more members, related or unrelated, other than the parent or sibling such as grandparents. A binuclear family refers to parents continuing the parenting role while terminating the spousal unit. A reconstituted family, also called blended family, includes at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children.

A nurse is admitting a child, in foster care, to the hospital. The nurse recognizes that foster parents care for the child _____ hours a day. (Record your answer as a whole number.)

24 The term foster care is defined as 24-hour substitute care for children outside of their own homes.

How to diagnose GER?

24 hours intraesophageal study or barium swallow tests

In teaching prospective parents about the emergence of gender identity, the nurse should instruct them that this concept emerges at about 12 months of age. 24 months of age. at birth. at 3 years of age.

24 months of age. The concept of gender identity begins at about 2 years of age (24 months), at which children are able to label their own as well as other's genders. It is not inherent at birth or by 1 year of age.

When does meconium need to be passed?

24-36 hours

Nutrition

2nd six months Human milk or formula, primary source of nutrition Fluoride supplementation should begin Iron fortified infant cereal first New foods added one at a time (4-7 days) Fruit juice (from a cup) can be offered once a day (no more than 4-6 oz) Vegetables and fruits (1 tablespoon per year of life) Meats 8-9 months = introduce junior foods

a full series of hepB vaccine is how many doses?

3 (1,2 AND 6 MO)

Digestive processes do not begin functioning until age

3 months (vulnerable to diarrhea, vomiting, and dehydration)

Immunologic System

3 months = maternal IgG By 1 yr, has reached 40% of adult levels of IgG Thermoregulation Shiver Capillary changes Increased adipose tissue

when does infection rate increase?

3 to 6 months period between maternal antibody disappearance and the infants own antibody production.

A child is admitted to the hospital with a diagnosis of possible meningitis. Which information is the most important to ask at the time of admission? 1. "Are there any pets in the household?" 2. "Is anyone else in the household ill?" 3. "Are the immunizations up to date?" 4. "Has the child had a recent injury?"

3. "Are the immunizations up to date?" Immunizations are one of two public health interventions that have had the greatest impact on world health, with clean public drinking water being the other. Nurses should review individual immunization records at every clinical visit and/or hospitalization. In addition, nurses are responsible for keeping current in changes in immunization schedules, recommendations, and research related to childhood vaccines.

Nurses working in the community must be educated in epidemiology and statistics for population health. Which statistic below is an example of neonatal mortality rate? 1. Crude birth rate Incorrect 2. Cause-specific death rate 3. Age-specific death rate 4. Prevalence of disease

3. Age-specific death rate The neonatal mortality rate is the number of deaths in a population in a certain age group, (neonates); over the total population in that age group, (neonates). The crude birth rate is the number of childbirths per 1000 people per year. The cause-specific death rate is the number of deaths from a specified cause per 100,000 people per year. The prevalence of a disease is the number of cases of the specific disease in a population.

Which is appropriate advice for parents who are preparing to tell their children about their decision to divorce? 1. Avoid crying in front of children. 2. Avoid discussing the reason for the divorce. 3. Give reassurance that the divorce is not the children's fault. 4. Give reassurance that the divorce will not affect most aspects of the children's life.

3. Give reassurance that the divorce is not the children's fault. Parents, if able, should hold and touch children and reassure them that the children are not the cause of the divorce. Parents can cry in front of children; it may give the children permission to do the same. Parents should provide the reasons for the divorce in a manner the children will understand. Giving reassurance that the divorce will not affect most aspects of the children's life would most likely be false reassurance, since many aspects will change.

Nurses play an important role in current issues and trends in health care. Which is a current trend in pediatric nursing and health care today? 1. The patient is the unit of care for the health care provider. 2. Discharge planning begins when the physician writes the order. 3. Health promotion resources enable children to achieve their full potential. 4. The focus of pediatric health care is trending toward acute hospital care.

3. Health promotion resources enable children to achieve their full potential. Health promotion provides opportunities to reduce differences in current health status among members of different groups and provides a better chance to achieve the fullest health potential. The patient and family is the unit of care for the health care provider. Discharge planning begins when the patient is admitted. The focus of pediatric health care is trending away from acute hospital settings.

The nurse is teaching levels of prevention at a community health clinic. Which is considered tertiary prevention in community health? 1. Prenatal visits in a health clinic for teenagers 2. Pediculosis screening at an elementary school 3. Working with postoperative scoliosis patients in a rehabilitation clinic 4. Counseling for a recent divorce in the family

3. Working with postoperative scoliosis patients in a rehabilitation clinic Tertiary interventions include rehabilitation for children with a disability or a chronic disease. Prenatal visits in a health clinic for teenagers are primary prevention interventions. Pediculosis screening at an elementary school is a secondary prevention intervention. Counseling for a recent divorce in the family is a secondary prevention intervention.

Successful adaptation to the stress of transition to parenthood involves two types of family resources. These resources include (Select all that apply) 1. adaptation. 2. integration. 3. coping strategies. 4. internal resources 5. community resources.

3. coping strategies. 4. internal resources Coping strategies is the use of social support systems and community resources for dealing with the stressors of parenthood. Internal resources include adaptability and integration. Adaptation is part of internal resources. Adaptation is learning to be patient, becoming better organized, and more flexible. Integration is part of internal resources. Integration is the couple's attempt to continue some activities they engaged in prior to becoming parents. Community resources are part of coping strategies.

How many mLs are in one ounce?

30

Separation anxiety

4 and 8 months

By what age do the primitive reflexes disappear in an infant?

4 months

Give supplemental iron after

4 months

Infants laugh out loud by age

4 months

Gross Motor Development

4 months lift head 90 degrees 5 months abdomen to back 6 months back to abdomen 7 months can sit alone 9 months crawling to creeping 1 year walk with one hand held

polio is given in how many doses?

4 total (2, 4, 6-18 moths and 4-6 years)

Head control is well established at

4-6 months

Introduction of solid foods at

4-6 months (allow 4-7 days between each new food for identification of food allergies)

Which action would indicate a priority for the nurse in terms of health promotion safety? 8-year-old child uses helmet protection while riding a bicycle. 4-year-old child wears protective equipment while on a skateboard. School-age child uses car seat restraint system. Protective equipment is used while the 9-year-old child is riding a scooter.

4-year-old child wears protective equipment while on a skateboard. Skateboard use is not recommended for children aged 5 and younger regardless if they are wearing protective equipment. All of the other options indicate that attention has been placed on safety concerns and that the children are developmentally appropriate to handle the physical skill activity.

A community health nurse is focusing on secondary prevention in the community. Which is appropriate to include in secondary prevention planning? 1. Encouraging annual routine health physicals 2. Providing information to patients is an asthma clinic 3. Holding an immunization clinic for an underserved community 4. A lead screening program for children in a rural setting

4. A lead screening program for children in a rural setting Secondary prevention focuses on screening and early diagnosis of disease. Examples of secondary interventions include tuberculosis and lead screening programs and mental health counseling for stressful events such as separation, divorce, or community natural disasters. Encouraging annual routine health physicals is a form of primary prevention. Providing information to patients in an asthma clinic is a tertiary prevention intervention. Holding an immunization clinic for an underserved community is a primary prevention intervention.

Research notes that birth position of children affects their personalities. According to ordinal position, what is a characteristic of the youngest child? 1. Able to identify more with their parents than with their peers 2. Are expected to do more household chores 3. More dependent than firstborn children 4. Are more flexible in their thinking

4. Are more flexible in their thinking Youngest children develop interpersonal skills, the ability to negotiate, and accept less favorable outcomes better than older siblings; therefore, they are more flexible Firstborn and only children identify more with their parents than peers. Youngest children identify more with peers than parents and make friends more easily. Youngest children have fewer demands placed on them for household help Youngest children are less dependent than firstborn children

Which nursing intervention would be most effective in decreasing mortality from unintentional injury? 1. Teaching children the dangers of contact sports 2. Encouraging potential parents to obtain genetic counseling 3. Educating parents-caretakers about the benefits of immunizations 4. Teaching parents-caretakers about proper use of vehicle restraint seats

4. Teaching parents-caretakers about proper use of vehicle restraint seats The most common cause of death for the age group 1-19 years is unintentional injuries such as motor vehicle accidents, drowning, and firearms. Teaching the dangers of contact sports will not decrease mortality from unintentional injuries such as motor vehicle accidents. Genetic counseling does not decrease mortality from unintentional injuries. The most common cause of mortality in children is unintentional injuries. Immunization education is not most effective.

Which is descriptive of family system theory? 1. Family is viewed as the sum of individual members. 2. Change in one family member cannot create a change in other members. 3. Individual family members are readily identified as the source of a problem. 4. When the family system is disrupted, change can occur at any point in the system.

4. When the family system is disrupted, change can occur at any point in the system. Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. Change in any family member will affect other members of the family. The interactions are considered to be the problem, not the individual members.

A nurse is assessing a family for effective coping and defensive strategies. The family social system theory the nurse will use is the 1. family systems theory, as derived from general systems theory. 2. resiliency Model of Family Stress, Adjustment, and Adaptation. 3. family developmental theory. 4. family stress theory.

4. family stress theory. Family stress theory explains how families react to stressful events and suggest factors that promote adaptation to stress. When too many stresses occur in a short period of time for adaptation to occur, a state of crisis occurs. Family systems theory emphasizes the relationships among and between family members and the environment. The Resiliency Model of family Stress, Adjustment, and Adaptation demonstrates that the family is required to make adjustments and adaptations. Family developmental theory addresses family change over time.

The etiology component of the nursing diagnosis describes the 1. projected changes in an individual's health status, clinical conditions, or behavior. 2. individual's responses to health pattern deficits in the child, family, or community. 3. cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems. 4. physiologic, situational, and maturational factors that cause the problem or influence its development.

4. physiologic, situational, and maturational factors that cause the problem or influence its development. The etiology component of the nursing diagnosis, the second component of the nursing diagnosis, describes the physiologic, situational, and maturational factors that cause the problem or influence its development. Projected changes in an individual's health status, clinical conditions, or behavior are the outcomes or goals that are established. An individual's responses to health pattern deficits in the child, family, or community is the definition of the problem statement, the first component of the nursing diagnosis. The cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems is the third part of the nursing diagnosis, the signs and symptoms.

A nurse is preparing an educational workshop on atraumatic care in pediatric patient care. The most appropriate nursing intervention to include in the workshop is to 1. prepare the child that their parents will not be able stay during hospitalization by watching a video. 2. help the child to accept the pain associated with any treatments, procedures, or surgery. 3. tell the child that the loss of control and privacy in the hospital is temporary. 4. provide the child play activities for expression of fear and aggression

4. provide the child play activities for expression of fear and aggression Allowing the child play activities for the expression of fear and aggression are principles of atraumatic care. Atraumatic care is to prevent or minimize the child's separation from the family. Minimizing or preventing bodily injury and pain are principles of atraumatic care. Promoting a sense of control and privacy are components of atraumatic care.

The main objective of the nursing role in the community is to focus on 1. cost of health care. 2. emergency management. 3. population-based programs. 4. wellness and health promotion.

4. wellness and health promotion. The focus is on promoting and maintaining the health of individuals, families, and groups in a community setting. The cost of health care is not the main objective of the nursing role in the community. Emergency management is not the main objective of the nursing role in the community. Population-based programs do not make up the main objective of the nursing role in the community.

By what age would the nurse expect most children to use sentences of four or five words? 18 months 24 months 3 years 4½ years

4½ years Children ages 4 to 5 years use sentences of four or five words. An 18-month-old child has a vocabulary of approximately 10 words. A 24-month-old child uses two- or three-word phrases. A 3-year-old child uses sentences of three or four complete words.

Abdomen to back rolling over occurs at

5 months

Fetal hemoglobin (HgbF) is present in infant for the first ______

5 months

At what age do children begin smiling at their own mirror image?

5 months PG 303

What age is intussusception most common?

5 mos to 3 years

Decrease in iron in ______ to ______ months

5 to 6 months

by what age are viral respiratory tract infections less frequent?

5 years old but... incidence of Mycoplasma pneumoniae and GABHS infections increase.

Stranger anxiety

6 and 8 months

Back to abdomen rolling over occurs at

6 months

Double birth weight by age

6 months

Give fluoride in

6 months

Lower central incisors come in at

6 to 10 months of age (average is 8 months)

Posterior fontanel fusing by

6 to 8 weeks of age

Bionocularity (fixation of two ocular images into one cerebral picture) begins to develop at

6 weeks of age and is well established by age 4 months

Social Development

6-12 months = attached to parent 4 months = laugh aloud 6 months = very personable Separation anxiety Stranger fear Quality of personal interaction during play is most important Temperament - strong biologic component but can be modified by the environment (family)

At which age, is a strong preference exhibited for members of the same sex to engage in play activities rather than play with mixed groups? 7 6 8 9

7 At age 7, boys prefer to play with boys and girls prefer to play with girls. At age 6, play is considered to be more independent but showing some degree of socialization. Between the ages of 8 and 9, there is more interest in body-girl relationships and beginning to mix group play.

Transfer object between hands occurs at

7 months

On assessment, the nurse notices that the child is able to sit leaning forward on both hands and can transfer objects from one hand to another. The child can fixate on very small objects and produce vowel sounds and chained syllables. The child also seems fearful of strangers. What is the approximate age of the child?

7 months PG 304

Depth Perception (stereopsis) begins to develop by age

7 to 9 months, but not fully mature until 2-3 years of age

The nurse is assessing a healthy 6-month-old infant who weighed 3.5 kg at birth. Approximately how many kilograms does the nurse expect the infant to weigh now?

7.0

____% of body weight is water

75%

Imitate sounds occur at

8 months

Comprehend meaning of word "no" and obey simple commands by age

9 to 10 months

What is primary encopresis?

< 4 years old for a child who has NOT achieved fecal continence

What is a desired BLL?

< 5 mcg/dL

When is a lead screening on children usually done?

@ 1-2 years old or between 3 and 6 years

When does rotavirus hit the worst (age)?

@ 3-24 months old

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a A. spacer. B. nebulizer. C. peak expiratory flow meter. D. trial of chest physiotherapy.

A

A child has a chronic cough, no retractions but diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? A. Asthma B. Pneumonia C. Croup D. Foreign body aspiration

A

An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? A. Administration of antibiotic B. Frequent complete assessment of the infant C. Round-the-clock administration of antitussive agents

A

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to A. prevent respiratory syncytial virus (RSV) infection. B. make isolation of the infant with RSV unnecessary. C. prevent secondary bacterial infection. D .decrease toxicity of antiviral agents.

A

Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous (IV) fluids C. Foreign airway obstruction removal using the Heimlich maneuver D. Advice that the infant not be left with caretakers other than the parents

A

The most appropriate nursing intervention for a child following a tonsillectomy is to A. watch for continuous swallowing. B. encourage gargling to reduce discomfort. C. position the child on the back for sleeping. D. apply warm compresses to the throat.

A

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 A. pneumothorax. B. bronchodilation. C. carbon dioxide retention. D. increased viscosity of sputum.

A

Which of the following interventions would be an appropriate nursing intervention when caring for a child with pneumonia? A. Encourage rest B Instruct the child to avoid lying on the affected side c. Administer analgesics D. Place the child in the Trendelenburg position

A

Which statement best describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s)

A A child's temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contributes to the abusing situation. Socioeconomic status is an environmental characteristic. This child is less likely to be abused than one who is premature, disabled, or very young. The abused child does not in turn abuse his or her siblings.

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

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

In terms of cognitive development, the 5-year-old child would be expected to: a. Use magical thinking. b. Think abstractly. c. Understand conservation of matter. d. Be able to comprehend another person's perspective.

A Magical thinking is believing that thoughts can cause events. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children ages 5 to 7 years. Five-year-olds cannot understand another's perspective.

A common characteristic of those who sexually abuse children is that they: a. Pressure the victim into secrecy. b. Are usually unemployed and unmarried. c. Are unknown to victims and victims' families. d. Have many victims that are each abused only once.

A Sex offenders may pressure the victim into secrecy, regarding the activity as a "secret between us" that other people may take away if they find out. Abusers are often employed upstanding members of the community. Most sexual abuse is committed by men and persons who are well known to the child. Abuse is often repeated with the same child over time. The relationship may start insidiously without the child realizing that sexual activity is part of the offer.

A useful skill that the nurse should expect a 5-year-old child to be able to master is to: a. Tie shoelaces. b. Hammer a nail. c. Use a knife to cut meat. d. Make change from a quarter.

A Tying shoelaces is a fine motor task typical of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change from a quarter are fine motor tasks of an 8- to 9-year-old.

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

A Actively involving them in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away. DIF: Cognitive Level: Apply REF: p. 388 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

The nuclear family is composed of two parents and their children. The parent-child relationship may be biologic, step, half, or adoptive. The parents are not necessarily married.

A blended family or household, also called a reconstituted family, includes at least on stepparent, stepsibling, or half sibling.

For which child would fluoride supplementation be recommended?

A child 6 months or older whose drinking water is deficient in fluoride PG 369

A nurse is assessing a client who has pertussis. Which of the following are clinical manifestations of pertussis? (Select all that apply.)

A client who has pertussis has coldlike symptoms, including runny nose, congestion, and mild fever. A client who has pertussis will experience coughing fits and a whooping sound.

Rickett's

A deficiency of vitamin D causes ______.

D

A deficiency of vitamin _____ causes Rickett's.

The nurse is assessing a 6-month-old infant who smiles, coos, and exhibits a strong head lag. The nurse, drawing on knowledge of growth and development, recognizes which true statement?

A developmental and neurologic evaluation is needed.

The most common types of relationships are consanguineous, blood relationships; Affinal, marital relationships; and Family of origin.

A family can be defined as an institution in which individuals, related through biology or enduring commitments, and representing similar or different generations and genders, participate in roles involving mutual socialization, nurturance, and emotional commitment. To accommodate the different varieties of family styles, the descriptive term household is frequently used.

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain?

A topical anesthetic can be applied before injections are given. (To minimize the discomfort associated with intramuscular injections, a topical anesthetic agent can be used on the injection site. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. Infants have neural pathways that will indicate pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.)

Duvall's Developmental Stages of the Family, Stage 8 - Aging families. Shift from a work role to leisure and semi-retirement or full retirement, maintain couple and individual functioning while adapting to the aging process, and prepare for own death and dealing with the loss of spouse or siblings and other peers.

A traditional nuclear family consists of a married couple and their biologic children. Children in this type of family live with both biologic parents and, if siblings are present, only full brothers and sisters.

Strict isolation is required for a child who is hospitalized with (select all that apply): a. Mumps. b. Chickenpox. c. Exanthema subitum (roseola). d. Erythema infectiosum (fifth disease). e. Parvovirus B19.

A, B, C, D Childhood communicable diseases requiring strict transmission-based precautions (Contact, Airborne, and Droplet Precautions) include diphtheria, chickenpox, measles, mumps, tuberculosis, adenovirus, Haemophilus influenzae type B, mumps, pertussis, plague, streptococcal pharyngitis, and scarlet fever. Strict isolation is not required for parvovirus B19.

3. When parents consider genetic testing, especially after having a child born with an anomaly, which information could the nurse use to further instruct the family? Select all that apply. A. Genetic screening can provide early recognition of a disease, before signs and symptoms occur, for which effective intervention and therapy exists. B. Screening can occur at different times in a person's life: preconceptual, newborn screening, or maternal screening after delivery, depending on the circumstances. C. Genetic testing can help identify carriers of a genetic disease for the purpose of maximizing parenthood planning options. D. A thorough history by the nurse will include the parents' siblings, the parents, and the grandparents. E. Recognizing a genetic disorder can further facilitate a genetic evaluation by collecting pregnancy, labor and delivery, perinatal, medical, and developmental histories.

A, B, C, E

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

A, B, C, E 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. Structured play is typical of school-age children.

A pediatric oncology patient undergoing chemotherapy treatment is refusing to eat despite providing the child's "favorite foods" and allowing for alternate feeding patterns independent of meal time. What etiological theories might account for the child's loss of desire to eat? (Select all that apply.) A. The patient anticipates that he/she will be nauseous and/or vomit as part of the treatment sequence. B. The patient is refusing to eat in an attempt to gain control over his/her surroundings. C. The "correct" food has just not been found and more food selections should be offered. D. The patient is experiencing symptoms of depression. E. The patient is refusing to eat because his/her parents did not make the food.

A, B, D Anorexia and/or a refusal to eat sometimes accompanies chemotherapy interventions in patients. Thus, even in the context of being offered "favorite foods," the child may not want to eat. Theories proposed for this persistent anorexia and/or refusal include but are not limited to: possible depression, attempts at control, gaining control over one's environment, a conditioned response reflecting aversion during treatment and/or stress.

Which toys should a nurse provide to promote imaginative play for a 3-year-old hospitalized child (select all that apply)? a. Plastic telephone b. Hand puppets c. Jigsaw puzzle (100 pieces) d. Farm animals and equipment e. Jump rope

A, B, D To promote imaginative play for a 3-year-old child, the nurse should provide: dress-up clothes, dolls and dollhouses, housekeeping toys, play-store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, and medical kits. A 100-piece jigsaw puzzle and a jump rope would be appropriate for a young, school-age child but not a 3-year-old child.

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

A, B, E

You tell the parent of a 4-year-old patient being admitted that you need to ask some questions. She asks, "Why do you have to ask so many questions?" Which explanations should you offer? Select all that apply. A. "It is something we are required to do for every child who is hospitalized." B. "By learning about your child's routines, we can try to minimize some of the changes he will be going through." C. "Knowing more about your child can help predict how the hospital stay will go and will also help us choose a good roommate for him when more children arrive at the hospital." D. "Gaining more information about your child, such as current medications she is taking, will help us provide the best care." E. "This will give you an opportunity to ask questions as well."

A, B, E

When discharging the pediatric patient from the outpatient setting, the nurse knows which of the following responses indicate a need for more teaching? Select all that apply. A. "The physician said my son can have clear liquids when we return home, which would include Jello, pudding, and apple juice." B. "The other nurse explained that I can use other things to help with the pain, such as distraction (reading a book, music, or a movie), after the pain medication is given." C. "I can get my child's prescription tomorrow, so I can go to my regular pharmacy where they can explain the medication to me." D. "I am waiting for my husband to come so he can drive us, and I can watch my son in the car on the way home." E. "I understand that I will be contacted tomorrow for follow-up on my child but that I should not hesitate to call if I have any concerns before then."

A, C

An adolescent is admitted to the hospital for a fractured femur. The most appropriate nursing intervention(s) in caring for this adolescent is/are to (Select all that apply.) A. provide written material about the hospital. B. provide an opportunity for the adolescent to try on surgical attire. C. explain the upcoming surgery to the adolescent using anatomically correct models. D. provide an opportunity for the adolescent to talk with peers who have had a similar experience. E. provide education for the parents of what to teach so they can

A, C, D A. provide written material about the hospital. C. explain the upcoming surgery to the adolescent using anatomically correct models. D. provide an opportunity for the adolescent to talk with peers who have had a similar experience. Adolescents benefit from written material about hospitalization. This material offers information and services provided in the hospital that the adolescent can access that gives a sense of control. The use of anatomically correct models to explain surgical procedures offers the adolescent opportunities to ask questions and decrease fear and anxiety. The opportunity for the adolescent to talk with peers who have had a similar experience to facilitate communication on their level. Dressing up in surgical attire is appropriate for the younger child, not the adolescent. The adolescent should be taught firsthand about the hospitalization and what to expect.

Which gross motor milestones should the nurse assess in an 18-month-old child? (Select all that apply.) a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily

A, C, D An 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily is not acquired until 30 months of age. DIF: Cognitive Level: Understand REF: p. 355 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) A. Vital signs B. Throat culture C. Medical history D. Assessment of breath sounds E. Emergency airway equipment readily available

A, C, D, E

Play is children's work, even in the hospital. Which of the following are functions of play? Select all that apply. A. Provides diversion and brings about relaxation B. Keeps the child occupied and directs concerns away from himself or herself C. Helps the child feel more secure in a strange environment D. Lessens the stress of separation and the feeling of homesickness E. Provides a means for release of tension and expression of feelings F. Allows the parents to have a break from the unit for a respite period

A, C, D, E

A newborn has antibiotics ordered for possible sepsis. Which nursing intervention would the nurse prepare to implement? (Select all that apply) A. obtain blood cultures B. restrict parental visits. C. monitor temperature. D. monitor oxygen levels. E. monitor blood sugars for signs of hypoglycemia.

A, C, D, E A. obtain blood cultures C. monitor temperature. D. monitor oxygen levels. E. monitor blood sugars for signs of hypoglycemia. Blood cultures should be obtained prior to the initiation of antibiotic for accurate results. The nurse should monitor the newborn's temperature for instability, which is a possible sign of sepsis. The nurse should implement continuous monitoring of oxygen levels and observe for any signs of respiratory distress, which is associated with sepsis. The nurse should implement close monitoring of blood sugars. Low blood sugars can be a sign of possible sepsis. The nurse should encourage the parents to visit at frequent intervals for bonding and attachment.

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

A, C, E

Based on the nurse's knowledge of wounds and wound healing, what are factors that can delay or cause dysfunctional wound healing? (Select all that apply) A. Overweight B. Hypoxemia C. Hypervolemia D. Prolonged infection E. Corticosteroid therapy

A, C, E A. Overweight C. Hypervolemia E. Corticosteroid therapy Poor nutrition without proper protein and calorie intake affects healing more than being overweight itself. Hypovolemia, not hypervolemia, inhibits wound healing due to low circulating blood volume and oxygenation of tissues. Corticosteroid therapy or other immunocompromising therapy prevents macrophages from migrating to the site of injury, thus suppressing epithelialization. Hypoxemia makes tissues more susceptible to infection due to insufficient oxygenation. Prolonged infection affects the healing process and causes increased scarring.

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (Select all that apply) A. lung function. B. associated allergies. C. frequency of symptoms. D. frequency and severity of exacerbations.

A, D

A parent is concerned as her 6-year-old child "cheats" when playing games with other children. The parent is concerned that this behavior will affect future behaviors as the child gets older. The nurse understands the parent's anxiety about the described behavior and provides the following assurance A. this type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose. B. this is a prompted behavior that occurs intermittently at this age. C. you are right to be concerned about this type of behavior. D. it is best to ignore the behavior as it will stop eventually.

A. Cheating as a behavior occurs primarily between the ages of 5 and 6. It is almost at times displayed as an automatic behavior as the child does not understand about winning and losing. The behavior typically goes away as the child matures. Ignoring the behavior without some direction is not advised as it is best to address the situation and help the child to begin understanding of the concept.

The best explanation for using pulse oximetry on young children is that it A. Is noninvasive. B. Is better than capnography. C. Is more accurate than arterial blood gas measurements. D. Provides intermittent measurements of oxygen.

A. Pulse oximetry is a noninvasive method for determining oxygen saturation. Capnography measures carbon dioxide exhalation. It does not reflect oxygen perfusion. Pulse oximetry is less invasive and easier to test than arterial blood gases. Pulse oximetry provides continuous or intermittent measurements of oxygen saturation.

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of infection? A. Absolute neutrophil count of 250 mm3 B. Temperature of 99.2 degrees Fahrenheit C. White blood cell count 7,000 mm3 D. Platelet count 100,000 mm3

A. An absolute neutrophil count of less than 500 mm3 is of critical concern as it indicates the potential for overwhelming infection. None of the other measurement parameters are reflective of this fact.

The pediatric nurse is performing a well child assessment. Which finding if noted would require further investigation? A. Palpation of an abdominal mass without pain expression. B. No report of pain or tenderness in arms or legs. C. Buccal mucosa pink and intact. D. Grey appearance of tympanic membrane on otoscopic exam.

A. In a pediatric patient detection of an abdominal mass, regardless of pain expression requires further diagnostic work up as it may be evidence of Wilm's tumor. All of the other findings represent normal variations and as such do not require further investigation.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) infusion site with streaking along the vein. The nurse's priority action is to A. immediately stop the infusion. B. check for a good blood return. C. ask another nurse to check the IV site. D. increase IV drip with normal saline for 1 minute and recheck.

A. Erythema, pain, and edema at an IV site describe an extravasation or infiltration. The IV must be stopped to prevent further damage to the child. Blood return suggests that the IV catheter is still in the vein, but this does not address the immediacy of the assessment findings. Reassessment of the IV site by another nurse can be done once the IV has been stopped, which is the priority based on the assessment findings. The IV infusion should not be increased. It will add additional fluid to the child's tissue and could cause further damage.

A 10-year-old child requires daily medications for a chronic illness. The mother tells the nurse that she is always nagging the child to take the medicine before school. The most appropriate nursing intervention to promote the child's compliance is to A. establish a contract with the child, including rewards. B. suggest time-outs when the child forgets her medicine. C. discuss with the child's mother the damaging effects of nagging. D. ask the child to bring her medicine containers to each appointment so that the pills can be counted.

A. For school-age children, behavior contracting with desirable rewards is an effective method of encouraging compliance. Any forms of negative consequences, such as time-outs, should only be used if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem solving. The technique of counting pills may be tried if the contracting is not successful, but it sends a punitive signal to the child that may make the situation worse.

A child, age 7 years, is being treated at home and has a fever associated with a viral illness. The principal reason for treating the child's fever is A. relief of discomfort. B. reassurance that illness is temporary. C. prevention of secondary bacterial infection. D. prevention of life-threatening complications.

A. The primary reason for treating a fever with pharmacologic (acetaminophen and ibuprofen) or environmental interventions is to relieve discomfort in a child with a viral illness. Fever management does not provide reassurance that the illness is temporary. Fever-reducing medications do not have antibacterial actions and may inhibit the fever-enhancing effects on the immune system. Fever-reducing medications do not prevent life-threatening complications of viral illnesses.

It is time to give a 3-year-old medication. What approach is most likely to receive a positive response from the child? A. It's time for your medication now. Would you like water or apple juice afterward?" B. "Wouldn't you like to take your medicine now?" C. "You must take your medicine because the doctor says it will make you better." D. "See how nicely your roommate took medicine? Now take yours."

A. This statement provides the child with a structured choice with two acceptable options, which is important for preschoolers. As a question, it allows the child the option of saying no and therefore should be avoided. The statement "you must" can elicit negative behavior from the child. The nurse is also abdicating responsibility to the physician by telling the child, "The doctor said...." Competition is not appropriate for this age group. What one child does or how one child acts should not be used to entice another child to do something, such as taking a medication.

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the nurse's best reply? A. "Mommy will be here after lunch." B. "Mommy always comes back to see you." C. "Your Mommy told me yesterday that she would be here today about noon." D. "Mommy had to go home for a while, but she will be here today."

A. "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 to a familiar activity that takes place at that time. Telling the child that his mother always comes back to see him does not give the child any meaningful information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Stating that his mother had to go home but will be back today does not provide the child with any meaningful information related to when she will actually visit.

Which characterizes the development of a 2-year-old child? A. Engages in parallel play B. Fully dresses self with supervision C. Has a vocabulary of at least 500 words D. Has attained one third of his or her adult height

A. Engages in parallel play Two-year-olds play alongside each other, otherwise known as parallel play. Toddlers need help with dressing because this is a task they are just beginning to learn; learning this extends into the preschool years. A toddler commonly has a vocabulary of 300 words. A toddler has attained one half of his or her adult height.

What should the nurse recommend to the parents to help a toddler cope with the birth of a new sibling? A. Give the toddler a doll with which he or she can imitate the parents. B. Discourage the toddler from helping with care of the new sibling until the baby is much older. C. Prepare the toddler about 1 to 2 weeks before the birth of a new sibling. D. Explain to the toddler that a new playmate will soon come home.

A. Give the toddler a doll with which he or she can imitate the parents. The toddler can participate in the activity of caring for a new family member, which will make him or her feel included and important. The child should be encouraged to participate within his or her capabilities. The toddler should never be discouraged, because this will make him or her feel isolated and left out. Preparation should begin when obvious changes begin to happen to the mother's body and at home. This will establish unrealistic expectations for the toddler. Toddlers take language literally, and therefore will be disappointed when the new baby cannot play when he or she arrives home.

The nurse receives a report about a newborn stating that the mother has type O+ blood and the infant has type B+ blood. The infant is at highest risk for developing: A. Hyperbilirubinemia B. Hypoglycemia C. Erythema toxicum D. Phenylketonuria

A. Hyperbilirubinemia There is an ABO incompatibility between the mother and the newborn. This puts the infant at increased risk for hyperbilirubinemia. Hypoglycemia, in which serum glucose levels are low, may appear a short time after birth. It often occurs in infants of diabetic mothers. Erythema toxicum is a newborn rash of small, yellow-to-white colored papules surrounded by red skin. Phenylketonuria is an inborn error of metabolism caused by a deficiency of the enzyme needed to metabolize the essential amino acid phenylalanine.

The nurse is concerned with the prevention of communicable disease. Primary prevention results from: A. Immunizations B. Early diagnosis C. Strict isolation D. Treatment of disease

A. Immunizations Communicable diseases are prevented through immunizations, which constitute primary prevention. Early diagnosis can prevent the spread of communicable disease by initiating treatment and isolation if necessary; this would be considered secondary prevention. Strict isolation would be considered part of the treatment regimen and would constitute tertiary prevention, which is the prevention of complications or sequelae. Treatment of disease would not prevent communicable disease

The nurse is caring for a 12-year-old who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action related to this? A. Request a psychological consultation. B. Ask the child why the child does not have pain. C. Praise the child for the ability to withstand pain. D. Encourage continued bravery as a coping strategy.

A. Request a psychological consultation. A psychological consultation will assist the child in verbalizing fears. This age group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying his or her fears and pain. If the child is feeling pain, the nurse should not praise the child for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.

The parents of a ventilator-dependent child tell the nurse that their insurance company wants the child discharged. The child's parents explain that they do not want the child home "under any circumstances." What should the nurse consider when working with this family? A. The parents' desire to have the child home is essential to effective home care. B. Parents should not be expected to care for a technology-dependent child. C. Parents' role in the decision-making process is limited when compared with that of the insurance company because of the costs of hospitalization. D. Having a technology-dependent child at home is better for both the child and the family.

A. The parents' desire to have the child home is essential to effective home care. To provide high-quality home care for children, parental desire and ability are essential. The community must have adequate resources for the child and parent, including capable professional support. Most parents can learn how to manage the care of the technology-dependent child, thus enhancing their desire to have their child at home. The child's psychosocial care will be improved if the child is in a home where the parents are comfortable with the care and grow to see their life as a family as becoming "normal." Parents need to be included in the decision-making process related to all aspects of their child's care, both in the health care setting and at home. Placement of the child at home will not be effective without parental participation. Insurance companies should never dictate or have complete authority over any decisions relative to children and their health care. Whether having a technology-dependent child at home is better for the child and family depends on the family. Parental comfort, community support, and available resources are critical to the care provided and to the family structure and relationships.

The nurse preparing a nutritional teaching plan for the parents of a preschool child should include which information? A. The quality of the food consumed is more important than the quantity. B. Nutrition requirements for preschoolers are very different from requirements for toddlers. C. Requirement for calories per unit of body weight increases slightly during the preschool period. D. Average daily intake of preschoolers should be about 3000 calories.

A. 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; the amount of food is less important than the quality of the food. Requirements are similar for both toddlers and preschoolers. The caloric requirement decreases slightly for preschoolers. The average intake is about 1800 calories each day for preschoolers.

Which statement is correct about young children who report sexual abuse? A. They may exhibit various behavioral manifestations. B. In most cases the child has fabricated the story. C. Their stories are not believed unless other evidence is apparent. D. They should be able to retell the story the same way to another person.

A. They may exhibit various behavioral manifestations.

Which statement is correct about young children who report sexual abuse by one of their parents? A. They may exhibit various behavioral manifestations. B. In most cases, the child has fabricated the story. C. Their stories are not believed unless other evidence is apparent. D. They should be able to retell the story the same way to another person.

A. They may exhibit various behavioral manifestations. There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.

Which is an appropriate nursing intervention when caring for an infant with narcotic abstinence syndrome (NAS)? A. Wrap the infant snugly. B. Initiate an early stimulation program. C. Place the infant in an infant seat for feedings. D. Teach the mother how to provide tactile stimulation.

A. Wrap the infant snugly. Infants with narcotic abstinence syndrome who are irritable respond to physical comforting and close contact. Wrapping the infant snugly minimizes self-stimulation, thereby decreasing stimulation. Infants with narcotic abstinence syndrome require less stimulation. It is suggested that infants with narcotic abstinence syndrome be breastfed if the mother is negative for human immunodeficiency virus (HIV) and is not using illicit substances; therefore, feeding in an infant seat may be inappropriate. Infants with narcotic abstinence syndrome require less stimulation; therefore, the mother should be taught to limit tactile stimulation, not increase it.

The primary reason for universal screening of young children for lead poisoning is that: A. children with lead poisoning rarely have symptoms. B. water and food in the United States are usually contaminated with lead. C. most children are exposed to lead through herbal products. D. most children in the United States are exposed to toxic amounts of lead.

A. children with lead poisoning rarely have symptoms. In the early stages of lead poisoning, children are asymptomatic. Water and food in the United States are not highly contaminated. Risks are homes painted before 1978, when painting products still had high lead levels. Universal screening will identify children who may receive lead via herbal supplements, if applicable. Universal screening will identify children who may receive lead via environmental exposure, if applicable.

The nurse is assessing a preschool age child who is stuttering when answering the nurse's questions. The nurse should offer alternate methods of responding to the stuttering when observing the parent: A. completing the child's sentences. B. listening attentively. C. encouraging the child to speak slowly. D. helping the child relax.

A. completing the child's sentences.

Guidelines for a nurse using an interpreter in developing a care plan for an 8-year-old admitted to rule out epilepsy include: A. explaining to the interpreter what information is necessary to obtain from the patient and family. B. encouraging the interpreter to ask several questions at a time to make the best use of time. C. not giving the interpreter too much information so that the interview evolves. D. discouraging the interpreter and client from discussing topics that are deemed irrelevant to the original intent of the interview.

A. explaining to the interpreter what information is necessary to obtain from the patient and family. The interpreter should be given guidance as to what information is necessary to obtain during the interview. One question should be asked at a time, leaving sufficient time for the family to ANS. The interpreter should not have to guess what to ask and what information to obtain during the interview. The interpreter should gain as much information from the family as they are willing to share based on the questions posed. Limits should not be placed on the interview.

An important nursing intervention in the care of a child with bacterial conjunctivitis is: A. intermittent warm, moist compresses to remove crusts on the eye area. B. oral antihistamines to minimize itching. C. continuous warm compresses to relieve discomfort. D. application of optic corticosteroids to reduce inflammation.

A. intermittent warm, moist compresses to remove crusts on the eye area. The eye should be kept clean. Intermittent warm, moist compresses can soften the crusting for easier removal, maintaining the cleanliness of the eye. Antihistamines are not usually necessary for bacterial conjunctivitis. Continuous warm compresses would promote bacterial growth. Antibiotics are the treatment of choice for bacterial infections; optic corticosteroids are not warranted.

For a toddler with sleep problems, the nurse should suggest that the parents A. use a transitional object at bedtime. B. vary the bedtime ritual. C. restrict stimulating activities throughout the day. D. explain away their fears.

A. use a transitional object at bedtime. Transitional objects may help ease the toddler's anxiety and facilitate sleep. A consistent set of bedtime rituals will facilitate a toddler's sleep. Toddlers should have stimulating physical activity during the daytime in order for them to sleep at night. Toddlers do not understand verbal explanations, so parents cannot explain away their fears.

Which statement is not accurate regarding the roles and responsibilities of a school nurse? A. They are responsible for development and implementation of plans of care for all children within the designated school. B. All school nurses are registered nurses. C. They are responsible for medical needs of the children within the designated school. D. They evaluate implementation of care delivered to children within the designated school setting.

ANS B Not all schools have a school nurse but may have unlicensed assistive personnel that work within the school setting that have received training to provide routine standardized care under the supervision of a school nurse. The other options are all within the roles and responsibilities of a school nurse.

An important consideration in preventing injuries during middle childhood is that A. peer pressure is not strong enough to affect risk-taking behavior. B. most injuries occur in or near school or home. C. injuries from burns are the highest at this age because of fascination with fire. D. lack of muscular coordination and control results in an increased incidence of injuries.

ANS B. Most children in the middle years spend the majority of their time in and around school or home; therefore, the risk for injuries is increased in and around these areas. Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence. Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, either as a pedestrian or passenger, account for the majority of severe accidents in the middle years. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscular coordination and control leading to injuries occurs in younger children.

A 10-year-old child is riding a bicycle on the grounds of the school. Which finding if observed by the school nurse would require intervention? A. Child is seen walking the bicycle through the crosswalk. B. Child is riding close to the curb. C. Child's shoes are ill fitting. D. Child is riding single file.

ANS C. Shoes that are ill fitting can result in potential injury as they can get caught up in gears and affect the ability of the child to navigate. All of the other observed behaviors are consistent with safe practice.

At which age, is a strong preference exhibited for members of the same sex to engage in play activities rather than play with mixed groups? A. 7 B. 6 C. 8 D. 9

ANS. A At age 7, boys prefer to play with boys and girls prefer to play with girls. At age 6, play is considered to be more independent but showing some degree of socialization. Between the ages of 8 and 9, there is more interest in body-girl relationships and beginning to mix group play.

A child has sustained an injury and lost a primary tooth. Which priority action should be taken by the nurse at this time? A. Provide comfort measures and assess for bleeding. B. Referral to the dentist for immediate consultation. C. Recover the tooth and prepare for reimplantation. D. If the tooth is dirty, rinse it off and cover in gauze until needed for reimplantation.

ANS. A Avulsed primary teeth are usually not reimplanted. Therefore the nurse should focus on assessment of the site and comfort measures. All of the other options would be indicated if an avulsed tooth were to be reimplanted.

A finding that is consistent with prepubescence is: A. variation in physical appearance between boys and girls. B. age of onset of physical signs is the same for both boys and girls. C. does not occur during the preadolescence period. D. appearance of secondary sex characteristics is the same for both boys and girls.

ANS. A During the period of prepubescence there is a variation in physical appearance between boys and girls. The age of onset of these appearances also varies with girls exhibiting changes earlier than their male counterparts. The changes occur during the preadolescence period. Secondary sex characteristics also present at different times for boys and girls.

Which benchmark serves as the ending period for the middle year period of development? A. Beginning school B. Onset of puberty C. Wisdom teeth appearing D. Loss of deciduous teeth

ANS. B The onset of puberty signals the end of the middle year period. Beginning school and loss of deciduous teeth are associated with the beginning of the middle year period. Appearance of wisdom teeth occurs later on in life.

Which behavior is most characteristic of the concrete operations stage of cognitive development? A. Progression from reflex activity to imitative behavior B. Inability to put oneself in another's place C. Increasingly logical and coherent thought processes D. Ability to think in abstract terms and draw logical conclusions

ANS. C Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? A. Changing self-esteem is difficult after about age 5 years. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of lowered self-esteem are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

ANS. C Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.

The estimated average requirement of calcium for an adolescent is _____ milligrams. (Record your answer in a whole number.)

ANS: 1100 The EAR (estimated average requirement) for calcium in adolescents 14 to 18 years of age is 1100 mg. DIF: Cognitive Level: Understand REF: p. 459 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

The recommendation for calcium for children 1 to 3 years of age is _____ milligrams. (Record your answer in a whole number.)

ANS: 500 While limiting fat consumption, it is important to ensure diets contain adequate nutrients such as calcium. The recommendation for daily calcium intake for children 1 to 3 years of age is 500 mg, and the recommendation for children 4 to 8 years of age is 800 mg. DIF: Cognitive Level: Remember REF: p. 389 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Place in order the correct sequence for emergency treatment of poisoning in a child. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d). a. Locate the poison. b. Assess the child. c. Prevent absorption of poison. d. Terminate exposure to the toxic substance.

ANS: b, d, a, c The initial step in treating poisonings is to assess the child, treat immediate life-threatening conditions, and initiate cardiopulmonary resuscitation (CPR) if indicated. Terminating the exposure to the toxic substance is the second step. Locating the poison for identification is the third step. Preventing absorption of poison is the fourth step. DIF: Cognitive Level: Apply REF: p. 416 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity

A nurse is formulating a clinical question for evidence-based practice. Place in order the steps the nurse should use to clarify the scope of the problem and clinical topic of interest. Begin with the first step of the process and proceed ordering the steps ending with the final step of the process. Provide answer as lowercase letters separated by commas (e.g., a, b, c, d, e). a. Intervention b. Outcome c. Population d. Time e. Control

ANS: c, a, e, b, d When formulating a clinical question for evidence-based practice, the nurse should follow a concise, organized way that allows for clear answers. Good clinical questions should be asked in the PICOT (population, intervention, control, outcome, time) format to assist with clarity and literature searching. PICOT questions assist with clarifying the scope of the problem and clinical topic of interest. DIF: Cognitive Level: Understand REF: p. 10 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Place in order the sequence of maturational changes for girls. Begin with the first change seen, sequencing to the last change. Provide answer in using lowercase letters, separated by commas (e.g., a, b, c, d, e). a. Growth of pubic hair b. Rapid increase in height and weight c. Breast changes d. Menstruation e. Appearance of axillary hair

ANS: c, b, a, e, d The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs. DIF: Cognitive Level: Analyze REF: p. 450 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance

An infant is having an anaphylactic reaction, and the nurse is preparing to administer epinephrine 0.001 mg/kg. The child weighs 22 pounds. What is the epinephrine dose the nurse should administer? (Record your answer using two decimal places.)

ANS: 0.01 Convert the 22 pounds to kilograms by dividing 22 by 2.2 = 10. Multiply the 10 by 0.001 mg of epinephrine = 0.01 mg as the dose to be given.

A nurse is interpreting the results of a child's peak expiratory flow rate. Which percentage, either at this number or less than this number, is considered to be a red zone? (Record your answer in a whole number.)

ANS: 50 A peak expiratory flow rate of red (<50% of personal best) signals a medical alert. Severe airway narrowing may be occurring. A short-acting bronchodilator should be administered. Notify the practitioner if the peak expiratory flow rate does not return immediately and stay in yellow or green zones.

Place in order the expected sequence of fine motor developmental milestones for an infant beginning with the first milestone achieved and ending with the last milestone achieved. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e). a. Voluntary palmar grasp b. Reflex palmar grasp c. Puts objects into a container d. Neat pincer grasp e. Builds a tower of two blocks, but fails

ANS: b, a, d, c, e Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 5 months, infants are able to voluntarily grasp objects. Gradually, the palmar grasp (using the whole hand) is replaced by a pincer grasp (using the thumb and index finger). By 8 to 10 months of age, infants use a crude pincer grasp, and by 11 months, they have progressed to a neat pincer grasp. By 11 months, they put objects into containers and like to remove them. By age 1 year, infants try to build towers of two blocks but fail.

ESSAY 1. Place in order the expected sequence of fine motor developmental milestones for an infant beginning with the first milestone achieved and ending with the last milestone achieved. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e). a. Voluntary palmar grasp b. Reflex palmar grasp c. Puts objects into a container d. Neat pincer grasp e. Builds a tower of two blocks, but fails

ANS: b, a, d, c, e Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 5 months, infants are able to voluntarily grasp objects. Gradually, the palmar grasp (using the whole hand) is replaced by a pincer grasp (using the thumb and index finger). By 8 to 10 months of age, infants use a crude pincer grasp, and by 11 months, they have progressed to a neat pincer grasp. By 11 months, they put objects into containers and like to remove them. By age 1 year, infants try to build towers of two blocks but fail.

Place in order the correct sequence for emergency treatment of poisoning in a child. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d). a. Locate the poison. b. Assess the child. c. Prevent absorption of poison. d. Terminate exposure to the toxic substance.

ANS: b, d, a, c The initial step in treating poisonings is to assess the child, treat immediate life-threatening conditions, and initiate cardiopulmonary resuscitation (CPR) if indicated. Terminating the exposure to the toxic substance is the second step. Locating the poison for identification is the third step. Preventing absorption of poison is the fourth step.

A parent of a newborn is expressing concern about returning to work after taking time off under the Family and Medical Leave Act (FMLA). The nurse understands that the Act allows a new parent to take off from work for _____ weeks. (Record your answer as a whole number.) a. 6 b. 12 c. 18 d. 24

ANS: 12 The passage of the Family and Medical Leave Act (FMLA) in 1993 set the stage for a greater focus on the issues of contemporary families. FMLA allows eligible employees to take up to 12 weeks of unpaid leave each year to care for newborn or newly adopted children, parents, or spouses who have serious health conditions or to recover from their own serious health condition.

A parent of a 12-year-old child states to the nurse, My 12-year-old watches TV constantly while at homeis this OK? The nurse should recommend to the parent that television viewing should be limited to _____ hours a day? (Record your answer in a whole number.)

ANS: 2 Children may identify closely with people or characters portrayed in reading materials, movies, and television programs and commercials. Pediatric nurses can educate and support parents on the effects of mass media on their children by recommending that television viewing should be limited to 2 hours a day or less.

A nurse is admitting a child, in foster care, to the hospital. The nurse recognizes that foster parents care for the child _____ hours a day. (Record your answer as a whole number.) a. 12 b. 24 c. 36 d. 48

ANS: 24 The term foster care is defined as 24-hour substitute care for children outside of their own homes.

The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which statement by a parent indicates a correct understanding of the teaching? a. I should expect my 24-month-old child to express some signs of readiness for toilet training. b. I should be firm and structured when disciplining my 18-month-old child. c. I should expect my 12-month-old child to start to develop a fear of darkness and to need a security blanket. d. I should expect my 36-month-old child to understand time and proximity of events.

ANS: A A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline because the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot hurry up or we will be late.

The school nurse needs to obtain authorization for a child who requires medications while at school. From whom does the nurse obtain the authorization? a. The parents b. The pharmacist c. The school administrator d. The prescribing practitioner

ANS: A A child who requires medication during the school day requires written authorization from the parent or guardian. Most schools also require that the medication be in the original container appropriately labeled by the pharmacist or physician. Some schools allow children to receive over-the-counter medications with parental permission. The pharmacist may be asked to appropriately label the medication for use at the school, but authorization is not required. The school administration should have a policy in place that facilitates the administration of medications for children who need them. The prescribing practitioner is responsible for ensuring that the medication is appropriate for the child. Because the child is a minor, parental consent is required.

In teaching parents about appropriate pacifier selection, the nurse should recommend which characteristic? a. Easily grasped handle b. Detachable shield for cleaning c. Soft, pliable material d. Ribbon or string to secure to clothing

ANS: A A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate, posing a risk for aspiration. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks.

The nurse is collecting a stool sample from an infant with lactose intolerance. Which fecal pH should the nurse expect as the result? a. 5.5 b. 7.0 c. 7.5 d. 8

ANS: A An acidic pH (5.5) indicates malabsorption, which occurs with lactose intolerance. The normal pH of the stool is 7.0 to 7.5. A finding of 8 would be alkaline.

A child has an evulsed (knocked-out) tooth. Which medium should the nurse instruct the parents to place the tooth in for transport to the dentist? a. In cold milk b. In cold water c. In warm salt water d. In a dry, clean jar

ANS: A An evulsed tooth should be placed in a suitable medium for transplant, either cold milk or saliva (under the child or parent's tongue). Cold milk is a more suitable medium for transport than cold water, warm salt water, or a dry, clean jar.

Steven, 16 months old, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. Steven is acting in an age-appropriate manner.

An infant has been diagnosed with an allergy to milk. In teaching the parent how to meet the infants nutritional needs, the nurse states that a. Most children will grow out of the allergy. b. All dairy products must be eliminated from the childs diet. c. It is important to have the entire family follow the special diet. d. Antihistamines can be used so the child can have milk products.

ANS: A Approximately 80% of children with cows milk allergy develop tolerance by the fifth birthday. The child can have eggs. Any food that has milk as a component or filler is eliminated. These foods include processed meats, salad dressings, soups, and milk chocolate. Having the entire family follow the special diet would provide support for the child, but the nutritional needs of other family members must be addressed. Antihistamines are not used for food allergies.

An infant, age 5 months, is brought to the clinic by his parents for a well-baby checkup. What is the best advice that the nurse should include at this time about injury prevention? a. Keep buttons, beads, and other small objects out of his reach. b. Do not permit him to chew paint from window ledges because he might absorb too much lead. c. When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall. d. Lock the crib sides securely because he may stand and lean against them and fall out of bed.

ANS: A Aspiration of foreign objects is a great risk at this age. Parents are instructed to keep small objects out of the infants reach. At this age, the child is not mobile enough to reach window sills. If window sills have cracked or chipped paint, it needs to be removed before he is a toddler. This child should already be rolling over. This information is reinforced but should have been taught earlier. Pulling to a stand occurs between 8 and 12 months of age.

Which is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Pat-a-cake and showing how to clap hands will help with kinetic stimulation. Imitating animal sounds will help with auditory stimulation.

According to Piaget, magical thinking is the belief of which? a. Thoughts are all powerful. b. God is an imaginary friend. c. Events have cause and effect. d. If the skin is broken, the insides will come out.

ANS: A Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all powerful. Believing God is an imaginary friend is an example of concrete thinking in a preschoolers spiritual development. Cause-and-effect implies logical thought, not magical thinking. Believing that if the skin is broken, the insides will come out is an example of concrete thinking in development of body image.

The nurse is teaching a parent with a 2-month-old infant who has been diagnosed with colic about ways to relieve colic. Which statement by the parent indicates the need for additional teaching? a. I should let my infant cry for at least 30 minutes before I respond. b. I will swaddle my infant tightly with a soft blanket. c. I should massage my infants abdomen whenever possible. d. I will place my infant in an upright seat after feeding.

ANS: A Because the infant has been diagnosed with colic, the parent should respond to the infant immediately or any type of interventions to relieve colic may not be effective. Also, the infant may develop a mistrust of the world if his or her needs are not met. The parent should swaddle the baby tightly with a soft blanket, massage the babys abdomen, and place the infant in an upright seat after a feeding to help relieve colic.

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What should the nurse recommend? a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave bottle top uncovered to allow heat to escape. d. Shake bottle vigorously for at least 30 seconds after heating.

ANS: A Bottles cannot be heated safely in microwave ovens even if safe guidelines are followed and regardless of the amount to be heated due to uneven heating and possible burns.

In terms of fine motor development, what should the infant of 7 months be able to do? a. Transfer objects from one hand to the other and bang cubes on a table. b. Use thumb and index finger in crude pincer grasp and release an object at will. c. Hold a crayon between the fingers and make a mark on paper. d. Release cubes into a cup and build a tower of two blocks.

ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline, and bang objects on a hard surface. The crude pincer grasp is apparent at about age 9 months, and releasing an object at will is seen around 8 months. The child can scribble spontaneously at age 15 months. At age 12 months, the child can release cubes into a cup and build a small tower.

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: 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 Children at this age may view illness or injury as a punishment for a real or imagined misdeed. The belief in divine punishment is common for an 8-year-old child.

A parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." The nurse's best action is: a. encourage parent to verbalize feelings. b. encourage parent not to worry so much. c. assess parent for other signs of inadequate parenting. d. reassure parent that colic rarely lasts past age 9 months.

ANS: A Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxieties. The nurse should reassure the parent that he or she is not doing anything wrong. Colic is multifactorial. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

Which is the most descriptive of kwashiorkor? A. Kwashiorkor has a multifactorial etiology. B. Kwashiorkor occurs primarily in breastfed infants. C. Kwashiorkor results from excessive amounts of vitamin K. D. Kwashiorkor is related to inadequate calories, not adequate protein.

ANS: A Cultural, environmental, and infectious components contribute to kwashiorkor, a deficiency of protein with an adequate supply of calories. Kwashiorkor occurs in infants and children who are beyond the age of breastfeeding. There is no correlation between excessive amounts of vitamin K and kwashiorkor. Kwashiorkor is a disorder in which there are adequate calories but a deficiency of protein.

What is the most fatal type of burn in the toddler age group? 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 electric outlets

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

Which food combination will generally provide the appropriate amounts of essential amino acids for an individual who is a vegetarian? A. Grains and legumes B. Grains and vegetables C. Legumes and vegetables D. Milk products and fruit

ANS: A Grains and legumes form complete proteins when eaten together, providing appropriate amounts of essential amino acids. Grains should be eaten with milk products or legumes to provide appropriate amounts of essential amino acids. Legumes should be eaten with grains or seeds to provide appropriate amounts of essential amino acids. Milk products should be eaten with grains to provide appropriate amounts of essential amino acids.

The nurse is guiding parents in selecting a daycare facility for their infant. Which is especially important to consider when making the selection? a. Health practices of facility b. Structured learning environment c. Socioeconomic status of children d. Cultural similarities of children

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

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. How should the nurse interpret this action? a. Normal development b. Significant developmental lag c. Slightly delayed development due to prematurity d. Suggestive of a neurologic disorder such as cerebral palsy

ANS: A Holding a rattle but not voluntarily grasping it is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. 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 and the behavior is age appropriate. No evidence of neurologic dysfunction is present.

The primary reason for universal screening of young children for lead poisoning is that A. children with lead poisoning rarely have symptoms. B. water and food in the United States are usually contaminated with lead. C. most children are exposed to lead through herbal products. D. most children in the United States are exposed to toxic amounts of lead.

ANS: A In the early stages of lead poisoning, children are asymptomatic. Water and food in the United States are not highly contaminated. Risks are homes painted before 1978, when painting products still had high lead levels. Universal screening will identify children who may receive lead via herbal supplements, if applicable. Universal screening will identify children who may receive lead via environmental exposure, if applicable.

A 4-month-old was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. What should the nurse's explanation include? a. Infants' temperaments are part of their unique characteristics. b. Infants become less difficult if they are not kept on scheduled feedings and structured routines. c. The infant's behavior is suggestive of failure to bond completely with her parents. d. The infant's difficult temperament is the result of painful experiences in the neonatal period.

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

The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What should the nurse tell her? a. Fluids in addition to breast milk are not needed. b. Water should be given if the infant seems to nurse longer than usual. c. Clear juices are better than water to promote adequate fluid intake. d. Water once or twice a day will make up for losses resulting from environmental temperature.

ANS: A Infants who are breastfed or bottle fed do not need additional water during the first 4 months of life. Excessive intake of water can create problems such as water intoxication, hyponatremia, or failure to thrive. Juices provide empty calories for infants.

Which is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Congenital disorders d. Childhood diseases

ANS: A Injuries are the single most common cause of death in children ages 1 through 4 years. This represents the highest rate of death from injuries of any childhood age group except adolescence. Infectious diseases and childhood diseases are less common causes of deaths in this age group. Congenital disorders are the second leading cause of death in this age group.

A nurse is preparing to administer an oral iron supplement to a hospitalized infant. Which should not be given simultaneously with the iron supplement? a. Milk b. Multivitamin c. Fruit juice d. Meat, fish, poultry

ANS: A Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Multivitamins may contain iron; no contraindication exists to taking the two together. Vitamin C-containing juices enhance the absorption of iron. Meat, fish, and poultry do not have an effect on absorption.

A nurse is preparing to accompany a medical mission's team to a third world country. Marasmus is seen frequently in children 6 months to 2 years in this country. Which symptoms should the nurse expect for this condition? a. Loose, wrinkled skin b. Edematous skin c. Depigmentation of the skin d. Dermatoses

ANS: A Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears to be very old, with loose and wrinkled skin, unlike the child with kwashiorkor, who appears more rounded from the edema. Fat metabolism is less impaired than in kwashiorkor; thus, deficiency of fat-soluble vitamins is usually minimal or absent. In general, the clinical manifestations of marasmus are similar to those seen in kwashiorkor with the following exceptions: With marasmus, there is no edema from hypoalbuminemia or sodium retention, which contributes to a severely emaciated appearance; no dermatoses caused by vitamin deficiencies; little or no depigmentation of hair or skin; moderately normal fat metabolism and lipid absorption; and a smaller head size and slower recovery after treatment.

Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." Which intervention should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should help the child develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response.

Which statement characterizes moral development in the older school-age child? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them.

ANS: A Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. The situation and the morality of the rule itself influence reactions.

What may a clinical manifestations of failure to thrive (FTT) in a 13-month-old include? a. Irregularity in activities of daily living b. Preferring solid food to milk or formula c. Weight that is at or below the 10th percentile d. Appropriate achievement of developmental landmarks

ANS: A One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the fifth percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.

Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include: a. avoidance of eye contact. b. an associated malabsorption defect. c. weight that falls below the 15th percentile. d. normal achievement of developmental landmarks.

ANS: A One of the clinical manifestations of nonorganic failure to thrive is the child's avoidance of eye contact with the health professional. A malabsorption defect would result in a physiologic problem, not behavioral. Weight (but not height) below the 5th percentile is indicative of failure to thrive. Developmental delays, including social, motor, adaptive, and language, exist.

To prevent plagiocephaly, the nurse should teach parents to: a. place infant prone for 30 to 60 minutes per day. b. buy a soft mattress. c. allow infant to nap in the car safety seat. d. have infant sleep with the parents.

ANS: A Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or "tummy time" for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.

At a well-child check-up, the nurse notes that an infant with a previous diagnosis of failure to thrive (FTT) is now steadily gaining weight. The nurse should recommend that fruit juice intake be limited to no more than how much? a. 4 oz/day b. 6 oz/day c. 8 oz/day d. 12 oz/day

ANS: A Restrict juice intake in children with FTT until adequate weight gain has been achieved with appropriate milk sources; thereafter, give no more than 4 oz/day of juice.

The nurse is planning care for a hospitalized toddler. What is the rationale for planning to continue the toddlers rituals while hospitalized? a. To provide security b. To prevent regression c. To prevent dependency d. To decrease negativism

ANS: A Ritualism, the need to maintain sameness and reliability, provides a sense of security and comfort. It will not prevent regression or dependency or decrease negativism.

What is an important consideration in preventing injuries during middle childhood? a. Achieving social acceptance is a primary objective. b. The incidence of injuries in girls is significantly higher than it is in boys. c. Injuries from burns are the highest at this age because of fascination with fire. d. Lack of muscular coordination and control results in an increased incidence of injuries.

ANS: A School-age children often participate in dangerous activities in an attempt to prove themselves worthy of acceptance. The incidence of injury during middle childhood is significantly higher in boys compared with girls. Motor vehicle collisions are the most common cause of severe injuries in children. Children have increasing muscular coordination. Children who are risk takers may have inadequate self-regulatory behavior.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her school work satisfactorily but lately 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 Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. This child is exhibiting signs of stress.

A breastfed infant is being seen in the clinic for a 6-month checkup. The mother tells the nurse that the infant recently began to suck her thumb. Which is the best nursing intervention? a. Reassure the mother that this is normal at this age. b. Recommend the mother substitute a pacifier for her thumb. c. Assess the infant for other signs of sensory deprivation. d. Suggest the mother breastfeed the infant more often to satisfy her sucking needs.

ANS: A Sucking is an infants chief pleasure, and the infant may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. The nurse should explore with the mother her feelings about a pacifier versus the thumb. No data support that the child has sensory deprivation.

Teasing can be common during the school-age years. The nurse should recognize that which applies to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased

ANS: A Teasing in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

Which information could be given to the parents of a 12-month-old child regarding appropriate play activities? a. Give large push-pull toys for kinetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.

ANS: A The 12-month-old child is able to pull to standing and walk holding on or independently. Appropriate toys for a child this age include large pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.

The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend which intervention? a. Ignore the "baby talk." b. Explain to the toddler that "baby talk" is for babies. c. Tell the toddler frequently, "You are a big kid now." d. Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

A nurse is assessing a 6-month-old infant. The nurse recognizes the posterior fontanel usually closes at which age? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months

ANS: A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks; 10 to 12 weeks, 4 to 6 months, and 8 to 10 months are too late. The posterior fontanel is usually closed by age 8 weeks.

Which technique is best for dealing with the negativism of the toddler? a. Offer the child choices. b. Remain serious and intent. c. Provide few or no choices for child. d. Quietly and calmly ask the child to comply.

ANS: A The child should have few opportunities to respond in a negative manner. Questions and requests should provide choices. This allows the child to be in control and reduces opportunities for negativism. The child will continue trying to assert control. The toddler is too young for verbal explanations. The negativism is the child testing limits. These should be clearly defined by structured choices.

A nurse is assessing a child with kwashiorkor disease. Which assessment findings should the nurse expect? a. Thin wasted extremities with a prominent abdomen b. Constipation c. Elevated hemoglobin d. High levels of protein

ANS: A The child with kwashiorkor has thin, wasted extremities and a prominent abdomen from edema (ascites). Diarrhea (persistent diarrhea malnutrition syndrome) not constipation commonly occurs from a lowered resistance to infection and further complicates the electrolyte imbalance. Anemia and protein deficiency is a common finding in malnourished children with kwashiorkor.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend? a. Determine whether the water supply is fluoridated. b. Use fluoridated mouth rinses in children older than 1 year. c. Give fluoride supplements to infants beginning at age 2 months. d. Brush teeth with fluoridated toothpaste unless the fluoride content of water supply is adequate.

ANS: A The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used.

Which would be the best play activity for a 6-month-old infant to provide tactile stimulation? a. Allow to splash in bath. b. Give various colored blocks. c. Play music box, tapes, or CDs. d. Use infant swing or stroller.

ANS: A The feel of the water while the infant is splashing will provide tactile stimulation. Various colored blocks would provide visual stimulation for a 4- to 6-month-old infant. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation.

Which is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine and follow it consistently. b. Maintain a nondistracting environment by not speaking to child during feeding. c. Place child in an infant seat during feedings to prevent overstimulation. d. Limit sensory stimulation and play activities to alleviate fatigue.

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

The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that: a. soft and flexible shoes are generally better. b. high-top shoes are necessary for support. c. inflexible shoes are necessary to prevent in-toeing and out-toeing. d. this type of shoe will encourage the infant to walk sooner.

ANS: A The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may help to keep the child's foot in the shoe. Inflexible shoes can delay walking and can aggravate in-toeing and out-toeing and impede development of the supportive foot muscles.

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

ANS: 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. Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize as dangerous all the different forms of medications that may be available in the home. It is not feasible to not keep medicines in the homes of small children. Many parents require medications for chronic illnesses. Parents must be taught safe storage for their home and when they visit other homes.

A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddler's preoperational thinking is the nurse using? a. Inability to conserve b. Magical thinking c. Centration d. Irreversibility

ANS: A The nurse is using the toddler's inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told.

The nurse is teaching parents about avoiding accidental burns with their toddler. What water heater setting should the nurse recommend to the parents? a. 120 F b. 130 F c. 140 F d. 150 F

ANS: A The water heater should be set to limit household water temperatures to less than 49 C (120 F). At this temperature, it takes 10 minutes for exposure to the water to cause a full-thickness burn. Conversely, water temperatures of 54 C (130 F), the usual setting of most water heaters, expose household members to the risk of full-thickness burns within 30 seconds.

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurses response should be based on remembering what? a. This is acceptable to encourage head control and turning over. b. This is acceptable to encourage fine motor development. c. This is unacceptable because of the risk of sudden infant death syndrome (SIDS). d. This is unacceptable because it does not encourage achievement of developmental milestones.

ANS: A These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs to reduce the risk of SIDS and then be placed on their abdomens when awake to enhance achievement of milestones such as head control. These position changes encourage gross motor, not fine motor, development.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. How should the nurse interpret this finding? a. Normal finding b. Finding requiring a referral c. Abnormal finding d. Normal finding, but requires rechecking in 1 month

ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. No further intervention is required.

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is included in which statement? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old. Having a rapid mood swing is an expected behavior for a toddler.

Cow's milk allergy (CMA) is diagnosed in a 6-month-old infant. Which should the nurse recommend as a substitute formula? a. Nutramigen b. Goat's milk c. Similac d. Enfamil

ANS: A Treatment of CMA is elimination of cow's milk-based formula and all other dairy products. For infants fed cow's milk formula, this primarily involves changing the formula to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum). Goat's milk (raw) is not an acceptable substitute because it cross-reacts with cow's milk protein, is deficient in folic acid, has a high sodium and protein content, and is unsuitable as the only source of calories

Which characterizes the development of a 2-year-old child? A. Engages in parallel play B. Fully dresses self with supervision C. Has a vocabulary of at least 500 words D. Has attained one third of his or her adult height

ANS: A Two-year-olds play alongside each other, otherwise known as parallel play. Toddlers need help with dressing because this is a task they are just beginning to learn; learning this extends into the preschool years. A toddler commonly has a vocabulary of 300 words. A toddler has attained one half of his or her adult height.

Recent studies indicate that a deficiency of which vitamin correlates with increased morbidity and mortality in children with measles? a. A b. C c. Niacin d. Folic acid

ANS: A Vitamin A deficiency is correlated with increased morbidity and mortality in children with measles. This vitamin deficiency also is associated with complications from diarrhea, and infections are often increased in infants and children with vitamin A deficiency. No correlation exists between vitamins C, niacin, or folic acid and measles.

The nurse is checking reflexes on a 7-month-old infant. When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended. Which reflex is this? a. Landau b. Parachute c. Body righting d. Labyrinth righting

ANS: A When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended; this describes the Landau reflex. It appears at 6 to 8 months and persists until 12 to 24 months. The parachute reflex occurs when the infant is suspended in a horizontal prone position and suddenly thrust downward; the infant extends the hands and fingers forward as if to protect against falling. This appears at age 7 to 9 months and lasts indefinitely. Body righting occurs when turning the hips and shoulders to one side causes all other body parts to follow. It appears at 6 months of age and persists until 24 to 36 months. The labyrinth-righting reflex appears at 2 months and is strongest at 10 months. This reflex involves holding infants in the prone or supine position. They are able to raise their heads.

Lactose intolerance is diagnosed in an 11-month-old infant. Which should the nurse recommend as a milk substitute? a. Yogurt b. Ice cream c. Fortified cereal d. Cows milkbased formula

ANS: A Yogurt contains the inactive lactase enzyme, which is activated by the temperature and pH of the duodenum. This lactase activity substitutes for the lack of endogenous lactase. Ice cream and cows milkbased formula contain lactose, which will probably not be tolerated by the child. Fortified cereal does not have the nutritional equivalents of milk.

A nurse is assessing a familys structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extended

ANS: A A blended family contains at least one step-parent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling.

A nurse is assessing a family's structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extended

ANS: A A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling.

25. During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which of the following? a. Normal finding b. Sign of possible visual defect and a need for vision screening c. Abnormal finding; requiring referral to ophthalmologist d. Sign of small hemorrhages, which usually resolve spontaneously

ANS: A A brilliant, uniform red reflex is an important normal finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber. DIF: Cognitive Level: Knowledge REF: p. 155 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A young child from Mexico is hospitalized for a serious illness. The father tells the nurse that the child is being punished by God for being bad. The nurse should recognize that this is a(n): a. health belief common in this culture. b. early indication of potential child abuse. c. misunderstanding of the familys common beliefs. d. belief common when fortune tellers have been used.

ANS: A A common health belief in the Mexican-American cultural group is that health is controlled by the environment, fate, and the will of God. The fathers comment has no relation to child abuse. The father would not misunderstand the familys beliefs. It is a cultural belief that health is controlled by the environment, fate, and the will of God. Mexicans may use the services of curandero (healers), not fortune tellers.

The home health nurse is planning care for a 3-year-old boy who has Down syndrome and is receiving continuous oxygen. He recently began walking around furniture. He is spoon-fed by his parents and eats some finger foods. Which is the most appropriate goal to promote normal development? a. Encourage mobility. b. Encourage assistance in self-care. c. Promote oral-motor development. d. Provide opportunities for socialization.

ANS: A A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual child's abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to provide activities that encourage mobility, for example, longer oxygen tubing. Parents should provide decreasing amounts of assistance with self-care as he is able to develop these skills. He is receiving oral foods and is eating finger foods. He has acquired oral-motor development. Mobility is a new developmental task. Opportunities for socialization should be ongoing. DIF: Cognitive Level: Apply REF: p. 403 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

The home health nurse is planning care for a 3-year-old boy who has Down syndrome and is receiving continuous oxygen. He recently began walking around furniture. He is spoon-fed by his parents and eats some finger foods. Which is the most appropriate goal to promote normal development? a. Encourage mobility. b. Encourage assistance in self-care. c. Promote oral-motor development. d. Provide opportunities for socialization.

ANS: A A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual child's abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to provide activities that encourage mobility, for example, longer oxygen tubing. Parents should provide decreasing amounts of assistance with self-care as he is able to develop these skills. He is receiving oral foods and is eating finger foods. He has acquired oral-motor development. Mobility is a new developmental task. Opportunities for socialization should be ongoing.

The nurse is taking care of a 7-year-old child with a skin rash called a papule. Which clinical finding should the nurse expect to assess with this type of skin rash? a. A lesion that is elevated, palpable, firm, and circumscribed; less than 1 cm in diameter b. A lesion that is elevated, flat-topped, firm, rough, and superficial; greater than 1 cm in diameter c. An elevated lesion, firm, circumscribed, palpable; 1 to 2 cm in diameter d. An elevated lesion, circumscribed, filled with serous fluid; less than 1 cm in diameter

ANS: A A papule is elevated; palpable; firm; circumscribed; less than 1 cm in diameter; and brown, red, pink, tan, or bluish red. A plaque is an elevated, flat-topped, firm, rough, superficial papule greater than 1 cm in diameter. It may be coalesced papules. A nodule is elevated, 1 to 2 cm in diameter, firm, circumscribed, palpable, and deeper in the dermis than a papule. A vesicle is elevated, circumscribed, superficial, less than 1 cm in diameter, and filled with serous fluid.

A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sitting comfortably on a parent's lap. The parents state they will need to leave for a brief period. Which type of nursing diagnosis should the nurse formulate for this child? a. Risk for anxiety b. Anxiety c. Readiness for enhanced coping d. Ineffective coping

ANS: A A potential problem is categorized as a risk. The toddler has a risk to become anxious when the parents leave. Nursing interventions will be geared toward reducing the risk. The child is not showing current anxiety or ineffective coping. The child is not at a point for readiness for enhanced coping, especially because the parents will be leaving. DIF: Cognitive Level: Remember REF: p. 11 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance

10. Which of the following data would be included in a health history? a. Review of systems b. Physical assessment c. Growth measurements d. Record of vital signs

ANS: A A review of systems is done to elicit information concerning any potential health problems. This further guides the interview process. Physical assessment, growth measurements, and a record of vital signs are components of the physical examination. DIF: Cognitive Level: Knowledge REF: p. 127 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool test for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Gastric contents contain hydrochloride normally; it is not diagnostic. Bronchoscopy and duodenal fluid are not diagnostic. Stool test for trypsin and intestinal biopsy are not helpful in diagnosing CF.

When minority groups immigrate to another country, a certain degree of cultural or ethnic blending occurs through the involuntary process of: a. acculturation. b. ethnocentrism. c. culture shock. d. cultural sensitivity.

ANS: A Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Ethnocentrism is the belief that ones way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of ones ethnic group are superior to those of others. This would limit the blending. Culture shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. This would limit the blending. Cultural sensitivity is an awareness of cultural similarities and differences. The nurse should develop the dynamics of cultural sensitivity to provide culturally competent care.

Which aspect of cognition develops during adolescence? a. Capability to use a future time perspective b. Ability to place things in a sensible and logical order c. Ability to see things from the point of view of another d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: A Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit these characteristic thought processes. DIF: Cognitive Level: Remember REF: p. 449 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which is most suggestive that a nurse has a nontherapeutic relationship witha patient and family? a. Staff is concerned about the nurse's actions with the patient and family. b. Staff assignments allow the nurse to care for same patient and family over an extended time. c. Nurse is able to withdraw emotionally when emotional overload occurs but still remains committed. d. Nurse uses teaching skills to instruct patient and family rather than doing everything for them.

ANS: A An clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowing the nurse to care for the same patient over time would be therapeutic for the patient and family. Nurses who are able to somewhat withdraw emotionally can protect themselves while providing therapeutic care. Nurses using teaching skills to instruct patient and family will assist in transitioning the child and family to self-care. DIF: Cognitive Level: Analyze REF: p. 8 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity

A child has an evulsed (knocked-out) tooth. Which medium should the nurse instruct the parents to place the tooth in for transport to the dentist? a. In cold milk b. In cold water c. In warm salt water d. In a dry, clean jar

ANS: A An evulsed tooth should be placed in a suitable medium for transplant, either cold milk or saliva (under the child or parent's tongue). Cold milk is a more suitable medium for transport than cold water, warm salt water, or a dry, clean jar.

Steven, 16 months old, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. Steven is acting in an age-appropriate manner. DIF: Cognitive Level: Understand REF: p. 357 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

An 18-month-old child is seen in the clinic with AOM. Trimethoprim- sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a. "I should administer all the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

ANS: A Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of AOM. Antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside. It should be continued. DIF: Cognitive Level: Apply REF: p. 645 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a. "I should administer all the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

ANS: A Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of AOM. Antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside. It should be continued.

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

ANS: A Asthma presents with a nonproductive cough and wheezing. Pneumonia appears with an acute onset, fever, and general malaise. A productive cough and rales would be indicative of pneumonia. Stridor and substernal retractions are indicative of croup. DIF: Cognitive Level: Understand REF: p. 664 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

ANS: A Asthma presents with a nonproductive cough and wheezing. Pneumonia appears with an acute onset, fever, and general malaise. A productive cough and rales would be indicative of pneumonia. Stridor and substernal retractions are indicative of croup.

4. Because children younger than 5 years are egocentric, the nurse should do which of the following when communicating with them? a. Focus communication on the child. b. Use easy analogies when possible. c. Explain experiences of others to the child. d. Assure child that communication is private.

ANS: A Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding. DIF: Cognitive Level: Comprehension REF: p. 123 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

18. Which is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Pat-a-cake and showing how to clap hands will help with kinetic stimulation. Imitating animal sounds will help with auditory stimulation.

A 35-year-old client is currently on fertility treatments. When responding to a question from the client about multiple births, which statement by the nurse is accurate? a. Use of fertility treatments has been associated with an increase in multiple births. b. Your chance of having multiple births is at the same rate as all women of childbearing age. c. There is not enough evidence about the use of fertility treatments increasing the rate of multiple births. d. Because of your age and the fertility treatments, you have almost a 100% chance of a multiple birth.

ANS: A Because women in their thirties are almost 2.5 times as likely as women in their twenties to have higher-order plural births, increased childbearing among older women and the expanded use of fertility drugs have been associated with an increase in the multiple-birth ratio. The rate of having a multiple birth for this client is not the same for all women of childbearing age. There are data indicating that fertility treatments increase the rate of multiple births, but fertility treatments do not have a 100% rate of multiple births.

30. The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What should the nurse recommend? a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave bottle top uncovered to allow heat to escape. d. Shake bottle vigorously for at least 30 seconds after heating.

ANS: A Bottles cannot be heated safely in microwave ovens even if safe guidelines are followed and regardless of the amount to be heated due to uneven heating and possible burns.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which diagnosis? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

ANS: A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years of age. DIF: Cognitive Level: Understand REF: p. 650 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which diagnosis? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

ANS: A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years of age.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. Before chest physiotherapy (CPT) b. After CPT c. Before receiving 100% oxygen d. After receiving 100% oxygen

ANS: A Bronchodilators should be given before CPT to open bronchi and make expectoration easier. Aerosolized bronchodilator medications are not helpful when used after CPT. Oxygen administration is necessary only in acute episodes with caution because of chronic carbon dioxide retention.

Bullying can be common during the school-age years. The nurse should recognize that which applies to bullying? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being bullied

ANS: A Bullying in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

37. Which figure depicts an expected developmental milestone for a 7-month-old infant?

ANS: A By 6 to 7 months of age, infants are able to bear all their weight on their legs with assistance. Infants can stand holding on to furniture at 9 months. While standing, the infant takes a deliberate step at 10 months. Crawling (propelling forward with the belly on the floor) progresses to creeping on hands and knees (with the belly off of the floor) by 9 months.

Which figure depicts an expected developmental milestone for a 7-month-old infant? a. able to bear own weight b. stand holding on to furniture at 9 months c. deliberate steps at 10 months crawling on hands and knees

ANS: A By 6 to 7 months of age, infants are able to bear all their weight on their legs with assistance. Infants can stand holding on to furniture at 9 months. While standing, the infant takes a deliberate step at 10 months. Crawling (propelling forward with the belly on the floor) progresses to creeping on hands and knees (with the belly off of the floor) by 9 months.

14. The nurse is interviewing the father of a 10-month-old infant. She is playing on the floor when she notices an electric outlet and reaches up to touch it. Her father says "no" firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that the infant: a. is old enough to understand the word "no." b. is too young to understand the word "no." c. should already know that electric outlets are dangerous. d. will learn safety issues better if she is spanked.

ANS: A By age 10 months, children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. The child should be old enough to understand the word "no." The 10-month-old is too young to understand the purpose of an electric outlet. The father is using both verbal and physical cues to teach safety measures. Physical discipline should be avoided.

7. In terms of fine motor development, what should the infant of 7 months be able to do? a. Transfer objects from one hand to the other and bang cubes on a table. b. Use thumb and index finger in crude pincer grasp and release an object at will. c. Hold a crayon between the fingers and make a mark on paper. d. Release cubes into a cup and build a tower of two blocks.

ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline, and bang objects on a hard surface. The crude pincer grasp is apparent at about age 9 months, and releasing an object at will is seen around 8 months. The child can scribble spontaneously at age 15 months. At age 12 months, the child can release cubes into a cup and build a small tower.

Parents of a child with cystic fibrosis ask the nurse about genetic implications of the disorder. Which statement, made by the nurse, expresses accurately the genetic implications? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected.

ANS: A CF is an autosomal recessive gene inherited from both parents and is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier. DIF: Cognitive Level: Understand REF: p. 673 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Parents of a child with cystic fibrosis ask the nurse about genetic implications of the disorder. Which statement, made by the nurse, expresses accurately the genetic implications? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected.

ANS: A CF is an autosomal recessive gene inherited from both parents and is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

Which describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s)

ANS: A Child's temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contribute to the abusing situation. Abuse occurs among all socioeconomic levels. Children who are ill or have additional physical needs are more likely to be abused. The abused child may not abuse siblings. DIF: Cognitive Level: Understand REF: p. 418 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity

Which describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s)

ANS: A Child's temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contribute to the abusing situation. Abuse occurs among all socioeconomic levels. Children who are ill or have additional physical needs are more likely to be abused. The abused child may not abuse siblings.

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. How should the nurse interpret this statement? a. A common belief 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 Children at this age may view illness or injury as a punishment for a real or imagined misdeed. The belief in divine punishment is common for an 8-year-old child.

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein b. Diet should be high in easily digested carbohydrates and fats c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

ANS: A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48 to 72 hours after the test? a. ≥5 mm b. ≥10 mm c. ≥15 mm d. ≥20 mm

ANS: A Clinical evidence of a positive TST in children receiving immunosuppressive therapy, including immunosuppressive doses of steroids or who have immunosuppressive conditions, including HIV infection is an induration of ≥5 mm. Children younger than 4 years of age: (a) with other medical risk conditions, including Hodgkin disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition; (b) born or whose parents were born in high-prevalence (TB) regions of the world; (c) frequently exposed to adults who are HIV infected, homeless, users of illicit drugs, residents of nursing homes, incarcerated or institutionalized, or migrant farm workers; and (d) who travel to high-prevalence (TB) regions of the world are positive when the induration is ≥10 mm. Children 4 years of age or older without any risk factors are positive when the induration is ≥20 mm.

A nurse is planning a teaching session for a group of adolescents. The nurse understands that by adolescence the individual is in which stage of cognitive development? a. Formal operations b. Concrete operations c. Conventional thought d. Post-conventional thought

ANS: A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. Concrete operations usually occur between ages 7 and 11 years. Conventional and postconventional thought refers to Kohlberg's stages of moral development. DIF: Cognitive Level: Understand REF: p. 453 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

A parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." What is the nurse's best action? a. Encourage parent to verbalize feelings. b. Encourage parent not to worry so much. c. Assess parent for other signs of inadequate parenting. d. Reassure parent that colic rarely lasts past age 9 months.

ANS: A Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxieties. The nurse should reassure the parent that he or she is not doing anything wrong. Colic is multifactorial. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

Which is the leading cause of death in infants younger than 1 year? a. Congenital anomalies b. Sudden infant death syndrome c. Respiratory distress syndrome d. Bacterial sepsis of the newborn

ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group. DIF: Cognitive Level: Remember REF: p. 6 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced.

ANS: A Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but cool-mist vaporizers present decreased risk for burns and growth of organisms.

Which accurately describes the speech of the preschool child? a. Dysfluency in speech patterns is normal. b. Sentence structure and grammatic usage are limited. c. By age 5 years, child can be expected to have a ] vocabulary of about 1000 words. d. Rate of vocabulary acquisition keeps pace with the degree of comprehension of speech.

ANS: A Dysfluency includes stuttering and stammering, a normal characteristic of language development. Children speak in sentences of three or four words at age 3 to 4 years and eight words by age 5 years. At 5 years, children have a vocabulary of 2100 words. Children often gain vocabulary beyond degree of comprehension. DIF: Cognitive Level: Understand REF: p. 389 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing? a. Dyspnea b. Tachypnea c. Hypopnea d. Orthopnea

ANS: A Dyspnea is labored breathing. Tachypnea is rapid breathing. Hypopnea is breathing that is too shallow. Orthopnea is difficulty breathing except in an upright position.

An infant's parents ask the nurse about preventing OM. Which should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in a supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI) symptoms. Children should be fed in an upright position to prevent OM. DIF: Cognitive Level: Apply REF: p. 645 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

An infant's parents ask the nurse about preventing OM. Which should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in a supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

What is the most fatal type of burn in the toddler age group? 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 electric outlets

ANS: A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group. High-temperature tap water, hot objects, and electrical outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. DIF: Cognitive Level: Understand REF: p. 375 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment

A young adolescent boy tells the nurse he "feels gawky." How should the nurse explain why this occurs in adolescents? a. Growth of the extremities and neck precedes growth in other areas b. Growth is in the trunk and chest c. The hip and chest breadth increases d. The growth spurt occurs earlier in boys than it does in girls

ANS: A Growth in length of the extremities and neck precedes growth in other areas, and, because these parts are the first to reach adult length, the hands and feet appear larger than normal during adolescence. Increases in hip and chest breadth take place in a few months followed several months later by an increase in shoulder width. These changes are followed by increases in length of the trunk and depth of the chest. This sequence of changes is responsible for the characteristic long-legged, gawky appearance of early adolescent children. The growth spurt occurs earlier in girls than in boys. DIF: Cognitive Level: Apply REF: p. 450 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

23. The nurse is guiding parents in selecting a daycare facility for their infant. Which is especially important to consider when making the selection? a. Health practices of facility b. Structured learning environment c. Socioeconomic status of children d. Cultural similarities of children

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

6. 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 due to prematurity. d. suggestive of a neurologic disorder such as cerebral palsy.

ANS: A Holding a rattle but not voluntarily grasping it is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. 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 and the behavior is age appropriate. No evidence of neurologic dysfunction is present.

Currently, the fastest-growing segment of the homeless population in the United States consists of: a. families. b. runaway adolescents. c. migrant farm workers. d. individuals with mental disorders.

ANS: A Homeless individuals lack resources and community ties necessary to provide for their own adequate shelter. One of the most pressing problems in the United States is the rapidly growing number of homeless families, which currently account for 50% of the nations homeless. Runaway (or throwaway) adolescents are often victims of physical and social abuse. Although it is a significant issue, this is not the fastest-growing segment of the homeless population. Migrant farm workers form one of the most severely disadvantaged groups in the United States. They have a mobile existence, which is detrimental for children. They do not constitute the fastest-growing segment of the homeless population. Individuals with mental disorders may be homeless. They do not constitute the fastest-growing segment of the homeless population.

The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching? a. "My marital relationship can have a positive or negative effect on the role transition." b. "If an infant has special care needs, the parents' sense of confidence in their new role is strengthened." c. "Young parents can adjust to the new role easier than older parents." d. "A parent's previous experience with children makes the role transition more difficult."

ANS: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development.

The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching? a. My marital relationship can have a positive or negative effect on the role transition. b. If an infant has special care needs, the parents sense of confidence in their new role is strengthened. c. Young parents can adjust to the new role easier than older parents. d. A parents previous experience with children makes the role transition more difficult.

ANS: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development.

The nurse is caring for a 5-year-old child with impetigo contagiosa. The parents ask the nurse what will happen to their child's skin after the infection has subsided and healed. Which answer should the nurse give? a. There will be no scarring. b. There may be some pigmented spots. c. It is likely there will be some slightly depressed scars. d. There will be some atrophic white scars.

ANS: A Impetigo contagiosa tends to heal without scarring unless a secondary infection occurs.

In which cultural group is good health considered to be a balance between yin and yang? a. Asians b. Australian aborigines c. Native Americans d. African-Americans

ANS: A In Chinese health beliefs, the forces termed yin and yang must be kept in balance to maintain health. The belief in this balance is not consistent with Australian aborigines, Native Americans, or African-Americans.

A 14-year-old boy seems to be always eating, although his weight is appropriate for his height. What is the best explanation for this? 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 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. Seemingly always eating describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. DIF: Cognitive Level: Understand REF: p. 459 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

ANS: A In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. In bronchial asthma, there is increased resistance in the airway. There are multiple causes of asthma, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors. Atopy or development of an immunoglobulin E (IgE)-mediated response is inherited but is not the only cause of asthma. DIF: Cognitive Level: Understand REF: p. 664 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

ANS: A In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. In bronchial asthma, there is increased resistance in the airway. There are multiple causes of asthma, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors. Atopy or development of an immunoglobulin E (IgE)-mediated response is inherited but is not the only cause of asthma.

15. A 4-month-old was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that: a. infants' temperaments are part of their unique characteristics. b. infants become less difficult if they are not kept on scheduled feedings and structured routines. c. the infant's behavior is suggestive of failure to bond completely with her parents. d. the infant's difficult temperament is the result of painful experiences in the neonatal period.

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

Which is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Congenital disorders d. Childhood diseases

ANS: A Injuries are the single most common cause of death in children ages 1 through 4 years. This represents the highest rate of death from injuries of any childhood age group except adolescence. Infectious diseases and childhood diseases are less common causes of deaths in this age group. Congenital disorders are the second leading cause of death in this age group. DIF: Cognitive Level: Understand REF: p. 370 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Safe and Effective Care Environment

17. The nurse is preparing to perform a physical assessment on a girl age 10 years. The nurse gives her the option of her mother staying in the room or leaving. This action should be considered which of the following? a. Appropriate, because of child's age b. Appropriate, because mother would be uncomfortable making decision for child c. Inappropriate, because of child's age d. Inappropriate, because child is same sex as mother

ANS: A It is appropriate to give the older school-age child the option of having the parent present or not. During the examination the nurse should respect the child's need for privacy. Children age 10 are minors, and parents are responsible for health care decisions. If the parent is uncomfortable, part of the nurse's role is to assist the parent by providing information. The child should help determine who is present during the examination. DIF: Cognitive Level: Comprehension REF: p. 140 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The father of a hospitalized child tells the nurse, He cant have meat. We are Buddhist and vegetarians. The nurses best intervention is to: a. order the child a meatless tray. b. ask a Buddhist priest to visit. c. explain that hospital patients are exempt from dietary rules. d. help the parent understand that meat provides protein needed for healing.

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

A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guidelines concerning adoption should the nurse use in planning a response? a. Telling the child is an important aspect of their parental responsibilities. b. The best time to tell the child is between ages 7 and 10 years. c. It is not necessary to tell the child who was adopted so young. d. It is best to wait until the child asks about it.

ANS: A It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child's identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity.

A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guidelines concerning adoption should the nurse use in planning a response? a. Telling the child is an important aspect of their parental responsibilities. b. The best time to tell the child is between ages 7 and 10 years. c. It is not necessary to tell the child who was adopted so young. d. It is best to wait until the child asks about it.

ANS: A It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the childs identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity.

Which is usually the only symptom of pediculosis capitis (head lice)? a. Itching b. Vesicles c. Scalp rash d. Localized inflammatory response

ANS: A Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft. Vesicles, scalp rash, and localized inflammatory response are not symptoms of head lice.

Effective lone-rescuer CPR on a 5-year-old child should include a. two breaths to every 30 chest compressions. b. two breaths to every 15 chest compressions. c. reassessment of the child after 50 cycles of compression and ventilation. d. reassessment of the child every 10 minutes that CPR continues.

ANS: A Lone-rescuer CPR is two breaths to 30 compressions for all ages until signs of recovery occur. Reassessment of the child should take place after 20 cycles or 1 minute.

The nurse is conducting a staff in-service on appearance of childhood skin conditions. Lymphangitis ("streaking") is frequently seen in which condition? a. Cellulitis b. Folliculitis c. Impetigo contagiosa d. Staphylococcal scalded skin

ANS: A Lymphangitis is frequently seen in cellulitis. If it is present, hospitalization is usually required for parenteral antibiotics. Lymphangitis is not associated with folliculitis, impetigo, or staphylococcal scalded skin.

A nurse is preparing to administer an oral iron supplement to a hospitalized infant. Which should not be given simultaneously with the iron supplement? a. Milk b. Multivitamin c. Fruit juice d. Meat, fish, poultry

ANS: A Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Multivitamins may contain iron; no contraindication exists to taking the two together. Vitamin C-containing juices enhance the absorption of iron. Meat, fish, and poultry do not have an effect on absorption.

A nurse is preparing to accompany a medical mission's team to a third world country. Marasmus is seen frequently in children 6 months to 2 years in this country. Which symptoms should the nurse expect for this condition? a. Loose, wrinkled skin b. Edematous skin c. Depigmentation of the skin d. Dermatoses

ANS: A Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears to be very old, with loose and wrinkled skin, unlike the child with kwashiorkor, who appears more rounded from the edema. Fat metabolism is less impaired than in kwashiorkor; thus, deficiency of fat-soluble vitamins is usually minimal or absent. In general, the clinical manifestations of marasmus are similar to those seen in kwashiorkor with the following exceptions: With marasmus, there is no edema from hypoalbuminemia or sodium retention, which contributes to a severely emaciated appearance; no dermatoses caused by vitamin deficiencies; little or no depigmentation of hair or skin; moderately normal fat metabolism and lipid absorption; and a smaller head size and slower recovery after treatment.

Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." Which intervention should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should help the child develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response. DIF: Cognitive Level: Apply REF: p. 366 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

17. A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers

ANS: A Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over appropriate use of car seat restraints. DIF: Cognitive Level: Apply REF: p. 3 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

Which statement characterizes moral development in the older school-age child? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them.

ANS: A Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. The situation and the morality of the rule itself influence reactions.

Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include: a. avoidance of eye contact. b. an associated malabsorption defect. c. weight that falls below the 15th percentile. d. normal achievement of developmental landmarks.

ANS: A One of the clinical manifestations of nonorganic failure to thrive is the child's avoidance of eye contact with the health professional. A malabsorption defect would result in a physiologic problem, not behavioral. Weight (but not height) below the 5th percentile is indicative of failure to thrive. Developmental delays, including social, motor, adaptive, and language, exist.

7. The nurse must assess 10-month-old Chad. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which of the following initial actions by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask father to place Chad on the examination table. c. Talk softly to Chad while taking him from his father. d. Undress Chad while he is still sitting on his father's lap.

ANS: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done with the child on the father's lap. The nurse should have the father undress the child as needed during the examination. DIF: Cognitive Level: Application REF: p. 126 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

When assessing a family, the nurse determines that the parents exert little or no control over their children. What is this style of parenting called? a. Permissive b. Dictatorial c. Democratic d. Authoritarian

ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children's actions. Dictatorial or authoritarian parents attempt to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children's behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the child's individual nature.

When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called: a. permissive. b. dictatorial. c. democratic. d. authoritarian.

ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their childrens actions. Dictatorial or authoritarian parents attempt to control their childrens behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their childrens behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the childs individual nature.

To prevent plagiocephaly, the nurse should teach parents to: a. place infant prone for 30 to 60 minutes per day. b. buy a soft mattress. c. allow infant to nap in the car safety seat. d. have infant sleep with the parents.

ANS: A Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or "tummy time" for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.

Which is a common characteristic of those who sexually abuse children? a. Pressure victim into secrecy b. Are usually unemployed and unmarried c. Are unknown to victims and victims' families d. Have many victims that are each abused once only

ANS: A Sex offenders may pressure the victim into secrecy regarding the activity as a "secret between us" that other people may take away if they find out. The offender may be anyone, including family members and persons from any level of society. Sex offenders are usually trusted acquaintances of the victims and victims' families. Many victims are abused many times over a long period. DIF: Cognitive Level: Understand REF: p. 422 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity

Which is a common characteristic of those who sexually abuse children? a. Pressure victim into secrecy b. Are usually unemployed and unmarried c. Are unknown to victims and victims' families d. Have many victims that are each abused once only

ANS: A Sex offenders may pressure the victim into secrecy regarding the activity as a "secret between us" that other people may take away if they find out. The offender may be anyone, including family members and persons from any level of society. Sex offenders are usually trusted acquaintances of the victims and victims' families. Many victims are abused many times over a long period.

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 has been somewhat aggressive and stubborn in the classroom. How should the nurse interpret this behavior? a. A sign of stress b. A developmental delay c. A physical problem d. A lack of adjustment to school

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

20. Parents are concerned that their child is showing aggressive behaviors. Which suggestion should the nurse make to the parents? a. Supervise television viewing. b. Ignore the behavior. c. Punish the child for the behavior. d. Accept the behavior if the child is male.

ANS: A Television is also a significant source for modeling at this impressionable age. Research indicates there is a direct correlation between media exposure, both violent and educational media, and preschoolers exhibiting physical and relational aggression (Ostrov, Gentile, and Crick, 2006). Therefore, parents should be encouraged to supervise television viewing. The behavior should not be ignored because it can escalate to hyperaggression. The child should not be punished because it may reinforce the behavior if the child is seeking attention. For example, children who are ignored by a parent until they hit a sibling or the parent learn that this act garners attention. The behavior should not be accepted from a male child; this is using a "double standard" and aggression should not be equated with masculinity. DIF: Cognitive Level: Apply REF: p. 383 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

16. Which information could be given to the parents of a 12-month-old child regarding appropriate play activities? a. Give large push-pull toys for kinetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger-paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.

ANS: A The 12-month-old child is able to pull to standing and walk holding on or independently. Appropriate toys for a child this age include large pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger-paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.

The Heimlich maneuver is recommended for airway obstruction in children older than _____ year(s). a. 1 b. 4 c. 8 d. 12

ANS: A The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. In children younger than 1 year, back blows and chest thrusts are administered. The Heimlich maneuver can be used in children older than 1 year.

27. What is the most frequently used test for measuring visual acuity? a. Snellen letter chart b. Ishihara vision test c. Allen picture card test d. Denver eye screening test

ANS: A The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. The Ishihara Vision Test is used for color vision. The Allen picture card test and Denver eye screening test involve single cards for children ages 2 years and older who are unable to use the Snellen letter chart. DIF: Cognitive Level: Comprehension REF: p. 156 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend which intervention? a. Ignore the "baby talk." b. Explain to the toddler that "baby talk" is for babies. c. Tell the toddler frequently, "You are a big kid now." d. Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism. DIF: Cognitive Level: Apply REF: p. 364 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

4. A nurse is assessing a 6-month-old infant. The nurse recognizes the posterior fontanel usually closes at which age? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months

ANS: A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks; 10 to 12 weeks, 4 to 6 months, and 8 to 10 months are too late. The posterior fontanel is usually closed by age 8 weeks.

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status? a. Continuous b. Every 30 minutes c. Every hour d. Every 2 hours

ANS: A The child on supplemental oxygen requires intermittent or continuous oxygenation monitoring, depending on severity of respiratory compromise and initial oxygenation status. The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring. DIF: Cognitive Level: Apply REF: p. 664 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status? a. Continuous b. Every 30 minutes c. Every hour d. Every 2 hours

ANS: A The child on supplemental oxygen requires intermittent or continuous oxygenation monitoring, depending on severity of respiratory compromise and initial oxygenation status. The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring.

Which technique is best for dealing with the negativism of the toddler? a. Offer the child choices. b. Remain serious and intent. c. Provide few or no choices for child. d. Quietly and calmly ask the child to comply.

ANS: A The child should have few opportunities to respond in a negative manner. Questions and requests should provide choices. This allows the child to be in control and reduces opportunities for negativism. The child will continue trying to assert control. The toddler is too young for verbal explanations. The negativism is the child testing limits. These should be clearly defined by structured choices. DIF: Cognitive Level: Understand REF: p. 364 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is assessing a child with kwashiorkor disease. Which assessment findings should the nurse expect? a. Thin wasted extremities with a prominent abdomen b. Constipation c. Elevated hemoglobin d. High levels of protein

ANS: A The child with kwashiorkor has thin, wasted extremities and a prominent abdomen from edema (ascites). Diarrhea (persistent diarrhea malnutrition syndrome) not constipation commonly occurs from a lowered resistance to infection and further complicates the electrolyte imbalance. Anemia and protein deficiency are common findings in malnourished children with kwashiorkor.

A nurse is admitting a child to the hospital with a diagnosis of giardiasis. Which medication should the nurse expect to be prescribed? a. Metronidazole (Flagyl) b. Amoxicillin clavulanate (Augmentin) c. Clarithromycin (Biaxin) d. Prednisone (Orapred)

ANS: A The drugs of choice for treatment of giardiasis are metronidazole (Flagyl), tinidazole (Tindamax), and nitazoxanide (Alinia). These are classified as antifungals. Amoxicillin and clarithromycin are antibiotics that treat bacterial infections. Prednisone is a steroid and is used as an anti-inflammatory medication.

A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools are a later manifestation of CF. Recurrent respiratory tract infections are a later sign of CF. DIF: Cognitive Level: Understand REF: p. 674 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools are a later manifestation of CF. Recurrent respiratory tract infections are a later sign of CF.

19. Which would be the best play activity for a 6-month-old infant to provide tactile stimulation? a. Allow to splash in bath. b. Give various colored blocks. c. Play music box, tapes, or CDs. d. Use infant swing or stroller.

ANS: A The feel of the water while the infant is splashing will provide tactile stimulation. Various colored blocks would provide visual stimulation for a 4- to 6-month-old infant. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation.

1. The nurse is seeing an adolescent boy and his parents in the clinic for the first time. Which of the following should the nurse do first? a. Introduce self. b. Make family comfortable. c. Give assurance of privacy. d. Explain purpose of interview.

ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. Clarification of the purpose of the interview and the nurse's role is the second thing that should be done. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. The interview also should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality. DIF: Cognitive Level: Application REF: p. 118 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

13. Where in the health history does a record of immunizations belong? a. History b. Present illness c. Review of systems d. Physical assessment

ANS: A The history contains information relating to all previous aspects of the child's health status. The immunizations are appropriately included in the history. The present illness, review of systems, and physical assessment are not appropriate places to record the immunization status. DIF: Cognitive Level: Comprehension REF: p. 127 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

12. The nurse is interviewing the mother of an infant. The mother reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which of the following headings? a. History b. Present illness c. Chief complaint d. Review of systems

ANS: A The history refers to information that relates to previous aspects of the child's health, not to the current problem. The mother's difficult delivery and prematurity are important parts of the infant's history. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth, but might include sequelae such as pulmonary dysfunction. DIF: Cognitive Level: Comprehension REF: p. 127 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

Which is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine and follow it consistently. b. Maintain a nondistracting environment by not speaking to child during feeding. c. Place child in an infant seat during feedings to prevent overstimulation. d. Limit sensory stimulation and play activities to alleviate fatigue.

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

25. The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that: a. soft and flexible shoes are generally better. b. high-top shoes are necessary for support. c. inflexible shoes are necessary to prevent in-toeing and out-toeing. d. this type of shoe will encourage the infant to walk sooner.

ANS: A The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may help to keep the child's foot in the shoe. Inflexible shoes can delay walking and can aggravate in-toeing and out-toeing and impede development of the supportive foot muscles.

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

ANS: 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. Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize as dangerous all the different forms of medications that may be available in the home. It is not feasible to not keep medicines in the homes of small children. Many parents require medications for chronic illnesses. Parents must be taught safe storage for their home and when they visit other homes. DIF: Cognitive Level: Apply REF: p. 376 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Safe and Effective Care Environment

A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddler's preoperational thinking is the nurse using? a. Inability to conserve b. Magical thinking c. Centration d. Irreversibility

ANS: A The nurse is using the toddler's inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told. DIF: Cognitive Level: Apply REF: p. 357 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

What is the earliest age at which puberty begins? a. 9 b. 10 c. 11 d. 12

ANS: A There is no universal age at which children assume the characteristics of prepubescence. The first physiologic signs appear at about 9 years of age (particularly in girls) and are usually clearly evident in 11- to 12-year-old children.

3. The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. The nurse should interpret this as a(n): a. normal finding. b. finding requiring a referral. c. abnormal finding. d. normal finding, but requires rechecking in 1 month.

ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. No further intervention is required.

34. What type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular b. Bronchial c. Adventitious d. Bronchovesicular

ANS: A This is the definition of vesicular breath sounds. They are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions, where trachea and bronchi bifurcate. DIF: Cognitive Level: Comprehension REF: p. 166 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is included in which statement? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old. Having a rapid mood swing is an expected behavior for a toddler. DIF: Cognitive Level: Understand REF: p. 358 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

Which is an important nursing consideration when caring for a child with herpetic gingivostomatitis (HGS)? a. Apply topical anesthetics before eating. b. Drink from a cup, not a straw. c. Wait to brush teeth until lesions are sufficiently healed. d. Explain to parents how this is sexually transmitted.

ANS: A Treatment for HGS is aimed at relief of pain. Drinking bland fluids through a straw helps avoid painful lesions. Mouth care is encouraged with a soft toothbrush. HGS is usually caused by herpes simplex virus type 1, which is not associated with sexual transmission.

Cow's milk allergy (CMA) is diagnosed in a 6-month-old infant. Which should the nurse recommend as a substitute formula? a. Nutramigen b. Goat's milk c. Similac d. Enfamil

ANS: A Treatment of CMA is elimination of cow's milk-based formula and all other dairy products. For infants fed cow's milk formula, this primarily involves changing the formula to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum). Goat's milk (raw) is not an acceptable substitute because it cross-reacts with cow's milk protein, is deficient in folic acid, has a high sodium and protein content, and is unsuitable as the only source of calories. Cow's milk protein is contained in both Enfamil and Similac.

The nurse is caring for a school-age child with a tinea capitis (ringworm) infection. What should the nurse expect the therapeutic management of this child to include? a. Administering oral griseofulvin b. Administering topical or oral antibiotics c. Applying topical sulfonamides d. Applying Burow solution compresses to affected area

ANS: A Treatment with the antifungal agent griseofulvin is part of the treatment for the fungal disease ringworm. Oral griseofulvin therapy frequently continues for weeks or months. Antibiotics, sulfonamides, and Burow solution are not effective in fungal infections.

Nicole and Kelly, age 5 years, are identical twins. Their parents tell the nurse that the girls always want to be together. The nurses suggestions should be based on which statement? a. Some twins thrive best when they are constantly together. b. Individuation cannot occur if twins are together too much. c. Separating twins at an early age helps them develop mentally. d. When twins are constantly together, pathologic bonding occurs.

ANS: A Twins work out a relationship that is reasonably satisfactory to both. They develop a remarkable capacity for cooperative play and considerable loyalty and generosity toward each other. Parents should foster individual differences and allow the children to follow their natural inclinations. Individuation does occur. In twinship, one member of the pair is more dominant, outgoing, and assertive than the other. Early separation may produce unnecessary stresses for the children. There is no evidence that pathologic bonding occurs when twins are constantly together.

Which is a useful skill that the nurse should expect a 5-year-old child to be able to master? a. Tie shoelaces b. Use knife to cut meat c. Hammer a nail d. Make change out of a quarter

ANS: A Tying shoelaces is a fine motor task of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change out of a quarter are fine motor and cognitive tasks of an 8- to 9-year-old. DIF: Cognitive Level: Understand REF: p. 386 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime.

ANS: A Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

Recent studies indicate that a deficiency of which vitamin correlates with increased morbidity and mortality in children with measles? a.A b.C c.Niacin d.Folic acid

ANS: A Vitamin A deficiency is correlated with increased morbidity and mortality in children with measles. This vitamin deficiency also is associated with complications from diarrhea, and infections are often increased in infants and children with vitamin A deficiency. No correlation exists between vitamin C, niacin, or folic acid and measles.

5. The nurse's approach when introducing hospital equipment to a preschooler who seems afraid should be based on which one of the following principles? a. The child may think the equipment is alive. b. Explaining the equipment will only increase the child's fear. c. One brief explanation will be enough to reduce the child's fear. d. The child is too young to understand what the equipment does.

ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. Simple, concrete explanations about what the equipment does and how it will feel will help alleviate the child's fear. The preschooler needs repeated explanations as reassurance. DIF: Cognitive Level: Analysis REF: p. 123 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

2. In terms of gross motor development, which should the nurse expect a 5-month-old infant to do? (Select all that apply.) a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position. f. Adjust posture to reach an object.

ANS: A, B Rolling from abdomen and to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position. The 8-month-old infant adjusts posture to reach an object.

In terms of gross motor development, which should the nurse expect a 5-month-old infant to do? (Select all that apply.) a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position. f. Adjust posture to reach an object.

ANS: A, B Rolling from abdomen and to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position. The 8-month-old infant adjusts posture to reach an object.

What are the goals of organized athletics for preadolescent children? (Select all that apply.) a. Physical fitness b. Basic motor skills c. A positive self-image d. Commitment to winning

ANS: A, B, C The goals of organized athletics for preadolescent children include physical fitness, basic motor skills, and a positive self-image. The commitment is to the values of teamwork, fair play, and sportsmanship, not to winning.

The primary goals in the nutritional management of children with failure to thrive (FTT) are Select all that apply. A. allow for catch-up growth. B. correct nutritional deficiencies. C. achieve ideal weight for height. D. restore optimum body composition. E. educate the parents or primary caregivers on child's nutritional requirements.

ANS: A, B, C, D, E The goal is to provide sufficient calories to support "catch-up" growth, which is a rate of growth greater than the expected rate for age. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating any coexisting medical problems. Accurate assessment of the child's initial weight and height are important as well as the daily recording of weight, food intake, and feeding behavior. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating coexisting medical problems to optimize body composition.

Which herbal therapies are associated with increased milk production? Select all that apply. A. Blessed thistle B. Fennel C. St. John's Wort D Fenugreek E. Echinacea

ANS: A, B, D These herbal preparations are known as galactgogoues and are thought to increase milk production. St. John's Wort and echinacea are not reported to increase milk production.

The nurse is planning play activities for a 2-month-old hospitalized infant to stimulate the auditory sense. Which activities should the nurse implement? (Select all that apply.) a. Talk to the infant. b. Play a music box. c. Place a squeaky doll in the crib. d. Give the infant a small-handled clear rattle.

ANS: A, B, D Auditory stimulation appropriate for a 2-month-old infant includes talking to the infant, playing a music box, and giving the infant a small-handled clear rattle. Placing a squeaky doll in the crib is appropriate for an infant 6 months of age or older.

The nurse is preparing to feed a 10-month-old child diagnosed with failure to thrive (FTT). Which actions should the nurse plan to implement? (Select all that apply.) a. Be persistent. b. Introduce new foods slowly. c. Provide a stimulating atmosphere. d. Maintain a calm, even temperament. e. Feed the infant only when signs of hunger are exhibited.

ANS: A, B, D Feeding strategies for children with FTT should include persistence; introducing new foods slowly; and maintaining a calm, even temperament. The environment should be unstimulating, and a structured routine should be developed with regard to feeding, not just when the infant shows signs of hunger.

A nurse is caring for an African-American child recently admitted to the hospital. The nurse should be aware of which broad cultural characteristics for this child when planning care? (Select all that apply.) a. Silence may indicate a lack of trust. b. Maintaining constant eye contact may be viewed as aggressive. c. Self-care and folk medicine do not play a role in healthcare. d. Illness may be seen as the will of God. e. No importance is attached to nonverbal behavior.

ANS: A, B, D A nurse should be aware of the African-American broad cultural characteristics, which include: initial eye contact to show respect; maintaining eye contact can be viewed as aggressive, silence may indicate a lack of trust, and illness may be seen as the will of God. Self-care and folk medicine are prevalent in this culture, and importance is placed on nonverbal behavior.

Which toys should a nurse provide to promote imaginative play for a 3-year- old hospitalized child? (Select all that apply.) a. Plastic telephone b. Hand puppets c. Jigsaw puzzle (100 pieces) d. Farm animals and equipment e. Jump rope

ANS: A, B, D To promote imaginative play for a 3-year-old child, the nurse should provide: dress-up clothes, dolls, housekeeping toys, dollhouses, play-store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, or medical kits. A 100-piece jigsaw puzzle and a jump rope would be appropriate for a young, school-age child but not a 3-year-old child. DIF: Cognitive Level: Apply REF: p. 383 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is preparing to admit a 2-year-old child with rubella (German measles). Which clinical manifestations of rubella should the nurse expect to observe? (Select all that apply.) a. Sore throat b. Conjunctivitis c. Koplik spots d. Lymphadenopathy e. Discrete, pinkish red maculopapular exanthema

ANS: A, B, D, E The clinical manifestations of rubella include a sore throat; conjunctivitis; lymphadenopathy; and a discrete, pinkish red maculopapular exanthema. Koplik spots occur in measles but not rubella.

The nurse is evaluating a 7-month-old infants cognitive development. Which behaviors should the nurse anticipate evaluating? (Select all that apply.) a. Imitates sounds b. Shows interest in a mirror image c. Comprehends simple commands d. Actively searches for a hidden object e. Attracts attention by methods other than crying

ANS: A, B, E A 7-month-old infant is in the secondary circular reactions (48 months) stage of cognitive development. Behaviors in this stage include imitating sounds, showing interest in a mirror image, and attracting attention by methods other than crying. Comprehending simple commands and actively searching for a hidden object are behaviors seen in the coordination of secondary schemas (912 months).

Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which types of behaviors? (Select all that apply.) a. Displaying fears of abandonment b. Verbalizing that he or she "is the reason for the divorce" c. Displaying fear regarding the future d. Ability to disengage from the divorce proceedings e. Engaging in fantasy to understand the divorce

ANS: A, B, E A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. He or she would not be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent.

The nurse is providing anticipatory guidance to parents of a 4-month-old infant on preventing an aspiration injury. What should the nurse include in the teaching? (Select all that apply.) a. Keep baby powder out of reach. b. Inspect toys for removable parts. c. Allow the infant to take a bottle to bed. d. Teething biscuits can be used for teething discomfort. e. The infant should not be fed hard candy, nuts, or foods with pits.

ANS: A, B, E Anticipatory guidance to prevent aspiration for a 4-month-old infant takes into account that the infant will begin to be more active and place objects in the mouth. Toys should be checked for removable parts; baby powder should be kept out of reach; and hard candy, nuts, and foods with pits should be avoided. The infant should not go to bed with a bottle. Teething biscuits should be used with caution because large chunks may be broken off and aspirated.

What preventive measures should the nurse teach parents of toddlers to prevent early childhood caries? (Select all that apply.) a. Avoid using a bottle as a pacifier. b. Eliminate bedtime bottles completely. c. Place juice in a bottle for the child to drink. d. Wean from the bottle by 18 months of age. e. Avoid coating pacifiers in a sweet substance.

ANS: A, B, E Prevention of dental caries involves eliminating the bedtime bottle completely, feeding the last bottle before bedtime, substituting a bottle of water for milk or juice, not using the bottle as a pacifier, and never coating pacifiers in sweet substances. Juice in bottles, especially commercially available ready-to-use bottles, is discouraged; these beverages are especially damaging because the sugar is more readily converted to acid. Juice should always be offered in a cup to avoid prolonging the bottle-feeding habit. Toddlers should be encouraged to drink from a cup at the first birthday and weaned from a bottle by 14 months of age, not 18 months.

A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.) a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games

ANS: A, B, E School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child.

Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which type of behaviors? (Select all that apply.) a. Displaying fears of abandonment b. Verbalizing that he or she is the reason for the divorce c. Displaying fear regarding the future d. Ability to disengage from the divorce proceedings e. Engaging in fantasy to understand the divorce

ANS: A, B, E A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. They would not be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent.

MULTIPLE RESPONSE 1. The nurse is teaching parents about appropriate pacifier selection. Which characteristics should the pacifier have? (Select all that apply.) a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material

ANS: A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks.

The nurse is teaching parents about appropriate pacifier selection. Which characteristics should the pacifier have? (Select all that apply.) a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material

ANS: A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks.

A nurse is teaching parents methods to reduce lead levels in their home. Which should the nurse include in the teaching? (Select all that apply.) a. Plant bushes around the outside of the house. b. Ensure your child eats frequent meals. c. Use hot water from the tap when boiling vegetables. d. Food can be stored in ceramic in the refrigerator. e. Ensure that your child's diet contains sufficient iron and calcium.

ANS: A, B, E Methods to reduce lead levels in homes include: planting bushes around the outside of the house if soil is contaminated with lead, so children cannot play there; ensuring that children eat regular meals because more lead is absorbed on an empty stomach; and ensuring that children's diets contain sufficient iron and calcium. Cold water should only be used for drinking, cooking, and reconstituting powder infant formula. Hot water dissolves lead more quickly than cold water and thus contains higher levels of lead. Do not use pottery or ceramic ware that was inadequately fired or is meant for decorative use for food storage or service. DIF: Cognitive Level: Apply REF: p. 418 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is teaching parents methods to reduce lead levels in their home. Which should the nurse include in the teaching? (Select all that apply.) a. Plant bushes around the outside of the house. b. Ensure your child eats frequent meals. c. Use hot water from the tap when boiling vegetables. d. Food can be stored in ceramic in the refrigerator. e. Ensure that your child's diet contains sufficient iron and calcium.

ANS: A, B, E Methods to reduce lead levels in homes include: planting bushes around the outside of the house if soil is contaminated with lead, so children cannot play there; ensuring that children eat regular meals because more lead is absorbed on an empty stomach; and ensuring that children's diets contain sufficient iron and calcium. Cold water should only be used for drinking, cooking, and reconstituting powder infant formula. Hot water dissolves lead more quickly than cold water and thus contains higher levels of lead. Do not use pottery or ceramic ware that was inadequately fired or is meant for decorative use for food storage or service.

A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.) a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games

ANS: A, B, E School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child.

The nurse is planning care for an infant with eczema. Which interventions should the nurse include in the care plan? (Select all that apply.) a. Avoid giving the infant a bubble bath. b. Avoid the use of a humidifier in the infants room. c. Avoid overdressing the infant. d. Avoid the use of topical steroids on the infants skin. e. Avoid wet compresses on the infants most affected areas.

ANS: A, C Guidelines for care of an infant with eczema include avoiding a bubble bath and harsh soaps and avoiding overdressing the infant to prevent perspiration, which can cause a flare-up. The care plan should include using a humidifier in the infants room, topical steroids, and wet compresses on the most affected areas.

In order for an infant/child to formulate an attachment with another human being, they must Select all that apply. A. discriminate self between individuals. B. understand moral principles of right versus wrong. C. achieve object permanence. D. understand principles of time. E. recognize themselves in the mirror.

ANS: A, C In order to form attachments, the infant/child must be able to discriminate themselves from others as separate human beings. They also must understand the concept of object permanence. Attachment is not based on understanding of moral principles, time or self-recognition of their image in a mirror.

The nurse is planning to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reactions from the vaccines? (Select all that apply.) a. Select a needle length of 1 inch. b. Administer in the deltoid muscle. c. Inject the vaccine into the vastus lateralis. d. Draw the vaccine up from a vial with a filter needle. e. Change the needle on the syringe after drawing up the vaccine and before injecting.

ANS: A, C To minimize local reactions from vaccines, the nurse should select a needle of adequate length (25 mm [1 inch] in infants) to deposit the antigen deep in the muscle mass and inject it into the vastus lateralis muscle. The deltoid may be used in children 18 months of age or older but not in a 6-month-old infant. A filter needle is not needed to draw the vaccine from a vial. Changing the needle on the syringe after drawing up the vaccine before injecting it has not been shown to decrease local reactions.

The nurse is providing education to a parent of a 10-month-old infant with the diagnosis of cow's milk allergy. What will be included in the teaching? Select all that apply. A. Reading of all food labels to avoid products with milk. B. Use of milk to desensitize the child. C. Introduction of soy-based products to replace milk. D. Signs and symptoms associated with potential accidental ingestion of milk.

ANS: A, C, D Reading of all food labels to avoid products with milk will be included in the teaching. This infant will not be desensitized to milk. Milk and milk-based products should be avoided with this child. Introduction of soy-based products to replace milk will be included in the teaching. Signs and symptoms associated with potential accidental ingestion of milk will be included in the teaching.

The nurse is teaching parents of a toddler how to handle temper tantrums. What should the nurse include in the teaching? (Select all that apply.) a. Provide realistic expectations. b. Avoid using rewards for good behavior. c. Ensure consistency among all caregivers in expectations. d. During tantrums, ignore the behavior and continue to be present. e. Use time-outs for managing temper tantrums, starting at 12 months.

ANS: A, C, D The best approach toward tapering temper tantrums requires consistency and developmentally appropriate expectations and rewards. Ensuring consistency among all caregivers in expectations, prioritizing what rules are important, and developing consequences that are reasonable for the childs level of development help manage the behavior. During tantrums, ignore the behavior, provided the behavior is not injurious to the child, such as violently banging the head on the floor. Continue to be present to provide a feeling of control and security to the child after the tantrum has subsided. Starting at 18 months, time-outs work well for managing temper tantrums, but not at 12 months.

A school-age child has been a victim of bullying. What characteristics does the nurse assess for in this child? (Select all that apply.) a. Anxiety b. Outgoing c. Low self-esteem d. Psychosomatic complaints e. Good academic performance

ANS: A, C, D Victims of bullying are at increased risk for low self-esteem; anxiety; depression; feelings of insecurity and loneliness; poor academic performance; and psychosomatic complaints such as feeling tense, tired, or dizzy.

Which gross motor milestones should the nurse assess in an 18-month-old child? (Select all that apply.) a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily

ANS: A, C, D An 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily is not acquired until 30 months of age.

Children are taught the values of their culture through observation and feedback, relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor(s) may be culturally determined? (Select all that apply.) a. Degree of competition b. Racial variation c. Determination of status d. Social roles e. Geographic boundaries

ANS: A, C, D Degree of competition, determination of status, and social roles are all factors that are determined by the assumptions, beliefs, and practices of the members of the culture. In cultures that value individual resourcefulness, competition would be acceptable. Status is culturally determined and varies according to each culture. Some will ascribe higher status to age or socioeconomic status. Social roles also are influenced by the culture. Race and culture are two distinct attributes. The racial grouping describes transmissible traits, whereas the culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries. It is not the boundaries that are culturally determined.

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

ANS: A, C, D Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. An ice collar should be used after surgery. Frequent coughing and nose blowing should be avoided. DIF: Cognitive Level: Apply REF: p. 643 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

ANS: A, C, D Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. An ice collar should be used after surgery. Frequent coughing and nose blowing should be avoided.

5. A nurse is preparing to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reaction and reduce pain? (Select all that apply.) a. Select a needle of adequate length (1 inch). b. Inject into the deltoid muscle. c. Apply a vapocoolant spray directly to the skin, 15 seconds before administration. d. Apply a topical anesthetic LMX4 (4% lidocaine) 10 minutes before administration.

ANS: A, C, D To minimize local reaction and reduce pain when administering an immunization, select a needle of adequate length (25 mm [1 inch] in infants) to deposit the antigen deep in the muscle mass. Apply a vapocoolant spray (e.g., ethyl chloride or Fluori-Methane) directly to the skin or to a cotton ball, which is placed on the skin for 15 seconds immediately before the injection. Inject into the vastus lateralis or ventrogluteal muscle; the deltoid may be used in children 18 months of age and older. Apply the topical anesthetic LMX4 (4% lidocaine) to the injection site 30 minutes before the injection. Ten minutes does not allow the anesthetic to be effective.

The nurse is providing anticipatory guidance to parents of an 8-month-old infant on preventing a drowning injury. Which should the nurse include in the teaching? (Select all that apply.) a. Fence swimming pools. b. Keep bathroom doors open. c. Eliminate unnecessary pools of water. d. Keep one hand on the child while in the tub. e. Supervise the child when near any source of water.

ANS: A, C, D, E Anticipatory guidance to prevent drowning for an 8-month-old infant takes into account that the child will begin to crawl, cruise around furniture, walk, and climb. Fences should be placed around swimming pools, unnecessary pools of water should be eliminated, one hand should be kept on the child when bathing, and the child should be supervised when near any source of water. The bathroom doors should be kept closed.

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.) a. Allow parents to say goodbye to their infant. b. Once parents leave the hospital, no further follow-up is required. c. Arrange for someone to take the parents home from the hospital. d. Avoid requesting an autopsy of the deceased infant. e. Conduct a debriefing session with the parents before they leave the hospital.

ANS: A, C, E An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents' last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.

The nurse is providing anticipatory guidance to the parents of a 1-month-old infant on preventing a suffocation injury. Which should the nurse include in the teaching? (Select all that apply.) a. Do not place pillows in the infants crib. b. Crib slats should be 4 inches or less apart. c. Keep all plastic bags stored out of the infants reach. d. Plastic over the mattress is acceptable if it is covered with a sheet. e. A pacifier should not be tied on a string around the infants neck.

ANS: A, C, E Anticipatory guidance for a 1-month-old infant to prevent a suffocation injury takes into account that the infant will have increased eyehand coordination and a voluntary grasp reflex as well as a crawling reflex that may propel the infant forward or backward. Pillows should not be placed in the infants crib, plastic bags should be kept out of reach, and a pacifier should not be tied on a string around the neck. Crib slats should be 2.4 inches apart (4 inches is too wide), and the mattress should not be covered with plastic even if a sheet is used to cover it.

Infants in the first few days of life are expected to have a weight loss between 5 and 10% based on the following principles Select all that apply. A. increased renal tubular function. B. enlargement of ECF compartment. C. increased glomerular filtration rate. D. shivering thermogenesis. E. decrease in percentage of body water.

ANS: A, C, E Expected weight loss in the first few days of life is associated with contraction of ECF compartment resulting in decrease in percentage of body water, increased tubular function and increased glomerular filtration rate. Shivering thermogenesis is the mechanism whereby the infant seeks to maintain body temperature.

Which food activities would be considered to be normal adaptations for toddlers? Select all that apply. A. They often pick up many types of foods, preferring snacking rather than eating just at mealtimes. B. Appetite and food choices exhibit a consistent pattern. C. Toddlers often exhibit "picky" eating behaviors which is considered to be a normal abnormal. D. Children tend to eat more when they are growing. E. Foods should not be given to children during playtime.

ANS: A, C, E Toddlers exhibit grazing or nibbling behaviors and sometimes prefer to snack throughout the day. Toddlers often exhibit "picky" preferential behaviors in their food choices. Foods should not be given to children during playtime as a safety measure to prevent possible choking or aspiration. Appetite and food choices are inconsistent during this time frame. Toddlers will eat more during growth spurt periods.

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.) a. Allow parents to say goodbye to their infant. b. Once parents leave the hospital, no further follow-up is required. c. Arrange for someone to take the parents home from the hospital. d. Avoid requesting an autopsy of the deceased infant. e. Conduct a debriefing session with the parents before they leave the hospital.

ANS: A, C, E An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents' last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.

3. A nurse is teaching a parent about administration of iron supplements to a 7-month-old infant. Which should the nurse include in the teaching session? (Select all that apply.) a. Administer the iron supplement with a dropper toward the side and to the back of the mouth b. Administer the iron supplement with feedings. c. Your infant's stools may look tarry green. d. Your infant may have some diarrhea initially. e. Follow the iron supplement with 4 ounces of juice.

ANS: A, C, E Liquid iron supplements may stain the teeth; therefore, administer them with a dropper toward the back of the mouth (side). Ideally, iron supplements should be administered between meals for greater absorption. Avoid administration of liquid iron supplements with whole cow's milk or milk products because they bind free iron and prevent absorption. Educate parents that iron supplements will turn stools black or tarry green. Iron supplements may cause transient constipation, not diarrhea. In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz).

A nurse is teaching a parent about administration of iron supplements to a 7-month-old infant. Which should the nurse include in the teaching session? (Select all that apply.) a. Administer the iron supplement with a dropper toward the side and to the back of the mouth b. Administer the iron supplement with feedings. c. Your infant's stools may look tarry green. d. Your infant may have some diarrhea initially. e. Follow the iron supplement with 4 ounces of juice.

ANS: A, C, E Liquid iron supplements may stain the teeth; therefore, administer them with a dropper toward the back of the mouth (side). Ideally, iron supplements should be administered between meals for greater absorption. Avoid administration of liquid iron supplements with whole cow's milk or milk products because they bind free iron and prevent absorption. Educate parents that iron supplements will turn stools black or tarry green. Iron supplements may cause transient constipation, not diarrhea. In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz).

The nurse should teach the adolescent that the long-term effects of tanning can cause which conditions? (Select all that apply.) a. Phototoxic reactions b. Increased number of moles c. Premature aging d. Striae e. Increased risk of skin cancer

ANS: A, C, E Long-term effects of tanning include premature aging of the skin, increased risk of skin cancer, and, in susceptible individuals, phototoxic reactions. There has been no correlation to an increase in moles or striae (streaks or stripes on the skin, usually on the abdomen) development. DIF: Cognitive Level: Apply REF: p. 463 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

Where do the lesions of atopic dermatitis (eczema) most commonly occur in the infant? (Select all that apply.) a. Cheeks b. Buttocks c. Extensor surfaces of arms and legs d. Back e. Trunk f. Scalp

ANS: A, C, E, F The lesions of atopic dermatitis are generalized in the infant. They are most commonly on the cheeks, scalp, trunk, and extensor surfaces of the extremities. The buttocks and back are not common locations for the lesions of atopic dermatitis in infants.

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.) a. Cluster care to conserve energy b. Round-the-clock administration of antitussive agents c. Strict intake and output to avoid congestive heart failure d. Administration of antibiotics

ANS: A, D Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine? (Select all that apply.) a. The hepatitis B vaccination series should be begun at birth. b. The adolescent not vaccinated at birth does not have a need to be vaccinated. c. Any child not vaccinated at birth should receive two doses at least 4 months apart. d. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart.

ANS: A, D Current immunization guidelines for hepatitis B vaccination recommend beginning the hepatitis B vaccine series at birth or, in unimmunized children, as soon as possible. Children younger than 11 years of age may be vaccinated with a three-dose series, administered 4 weeks apart. Children 11 years and older may receive the two-dose adult formulation given at least 4 months apart.

The nurse is teaching parents about foods that are hyperallergenic. Which foods should the nurse include? (Select all that apply.) a. Peanuts b. Bananas c. Potatoes d. Egg noodles e. Tomato juice

ANS: A, D, E Hyperallergenic foods include peanuts, egg noodles, and tomato juice. Bananas and potatoes are not hyperallergenic.

The nurse is teaching parents about potential causes of colic in infancy. Which should the nurse include in the teaching session? (Select all that apply.) a. Overeating b. Understimulation c. Frequent burping d. Parental smoking e. Swallowing excessive air

ANS: A, D, E Potential causes of colic include too rapid feeding, overeating, swallowing excessive air, improper feeding technique (especially in positioning and burping), emotional stress or tension between the parent and child, parental smoking, and overstimulation.

The nurse is planning strategies to assist a slow-to-warm child to try new experiences. What strategies should the nurse plan? (Select all that apply.) a. Attend after-school activities with a friend. b. Suggest the child move quickly into a new situation. c. Avoid trying new experiences until the child is ready. d. Allow the child to adapt to the experience at his or her own pace. e. Contract for permission to withdraw after a trial of the experience.

ANS: A, D, E The nurse should encourage slow-to-warm children to try new experiences but allow them to adapt to their surroundings at their own speed. Pressure to move quickly into new situations only strengthens their tendency to withdraw. After-school activities can be a cause for reaction, but attending with a friend or contracting for permission to withdraw after a trial of a specified number of times may provide them with sufficient incentive to try.

A 13-year-old is being seen in the clinic for a routine health check. The adolescent has not been in the clinic for 3 years but was up to date on immunizations at that time. Which immunizations should the adolescent receive? (Select all that apply.) a. DTaP (tetanus, diphtheria, acellular pertussis) b. MMR (measles, mumps, rubella) c. Hepatitis B d. Influenza e. MCV4 (meningococcal)

ANS: A, D, E The DTaP (tetanus, diphtheria, acellular pertussis) vaccine is recommended for adolescents 11 to 18 years old who have not received a tetanus booster (Td) or DTaP dose and have completed the childhood DTaP/DTP series. Meningococcal vaccine (MCV4) should be given to adolescents 11 to 12 years of age with a booster dose at age 16 years. Annual influenza vaccination with either the live attenuated influenza vaccine or trivalent influenza vaccine is recommended for all children and adolescents. The adolescent, previously up to date on vaccinations, would have received the MMR and hepatitis B as a child. DIF: Cognitive Level: Apply REF: p. 462 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

The community health nurse is teaching parents about prevention of the spread and reoccurrence of pediculosis (head lice). Which should the nurse include in the teaching session? (Select all that apply.) a. Dryclean nonwashable items. b. Spray the environment with an insecticide. c. Seal nonwashable items in a plastic bag for 5 days. d. Boil combs and brushes for 10 minutes. e. Discourage sharing of personal items.

ANS: A, D, E To prevent the spread and reoccurrence of pediculosis the nurse should teach the parents to: dryclean nonwashable items, boil combs and brushes for 10 minutes or soak for 1 hour in a pediculicide, and discourage the sharing of personal items, such as combs, hats, scarves and other headgear. Spraying with insecticide is not recommended because of the danger to children and animals. Nonwashable items should be sealed for 14 days in a plastic bag.

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? a. Discourage the parents from making a last visit with the infant. b. Make a follow-up home visit to the parents as soon as possible after the childs death. c. Explain how SIDS could have been predicted and prevented. d. Interview the parents in depth concerning the circumstances surrounding the childs death.

ANS: B A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months, the infant can enjoy social interactions.

Which is descriptive of a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time, such as "just a minute" and "in an hour"

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

A male school-age student asks the school nurse, How much with my height increase in a year? The nurse should give which response? a. Your height will increase on average 1 inch a year. b. Your height will increase on average 2 inches a year. c. Your height will increase on average 3 inches a year. d. Your height will increase on average 4 inches a year.

ANS: B Between the ages of 6 and 12 years, children grow an average of 5 cm (2 inches) per year.

The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately how many pounds? a. 10 b. 15 c. 20 d. 25

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7 pounds at birth would weigh approximately 15 pounds; 10 pounds is too little. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 20 to 25 pounds is too much. The infant would have tripled the birth weight at 6 months.

The nurse is interviewing the father of a 10-month-old girl. The child is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says no firmly and moves her away from the outlet. The nurse should use this opportunity to teach the father what? a. That the child should be given a time-out b. That the child is old enough to understand the word no c. That the child will learn safety issues better if she is spanked d. That the child should already know that electrical outlets are dangerous

ANS: B By age 10 months, children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. A time-out is not appropriate. The child is just learning about the environment. Physical discipline should be avoided. The 10-month-old child is too young to understand the purpose of an electrical outlet.

The school nurse is providing guidance to families of children who are entering elementary school. What is essential information to include? a. Meet with teachers only at scheduled conferences. b. Encourage growth of a sense of responsibility in children. c. Provide tutoring for children to ensure mastery of material. d. Homework should be done as soon as child comes home from school.

ANS: B By being responsible for school work, children learn to keep promises, meet deadlines, and succeed in their jobs as adults. Parents should meet with the teachers at the beginning of the school year, for scheduled conferences, and whenever information about the child or parental concerns needs to be shared. Tutoring should be provided only in special circumstances in elementary school, such as in response to prolonged absence. The parent should not dictate the study time but should establish guidelines to ensure that homework is done.

Macrominerals refer to those minerals with daily intake requirements greater than 100 mg. Which is a macromineral? A. Iron B. Calcium C. Fluoride D. Selenium

ANS: B Calcium is a macromineral. Iron, fluoride, and selenium are microminerals.

Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake? a. Vary the schedule for routine activities on a daily basis. b. Be persistent through 10 to 15 minutes of food refusal. c. Avoid solids until after the bottle is well accepted. d. Use developmental stimulation by a specialist during feedings.

ANS: B Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during mealtimes to maintain the focus on eating.

Parents are switching their toddler, who has met the weight requirement, from a rear-facing car seat to a forward-facing seat. The nurse should recommend the parents place the seat where in the car? a. In the front passenger seat b. In the middle of the rear seat c. In the rear seat behind the driver d. In the rear seat behind the passenger

ANS: B Children 0 to 3 years of age riding properly restrained in the middle of the backseat have a 43% lower risk of injury than children riding in the outboard (window) seat during a crash.

Which statement best describes fear in the school-age child? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years, children experience a wide variety of fears, but new fears relate predominantly to school and family. During the middle-school years, children become less fearful for body safety than they were as preschoolers. Parents and other persons involved with children should discuss children's fears with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding their fears does not end them and may lead to phobias.

Which should the nurse expect for a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of holophrases d. Approximately one third of speech understandable

ANS: B During the second year of life, level of comprehension and understanding of speech increases and is far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old child has a vocabulary of 10 or more words. At this age, the child does not use the one-word sentences that are characteristic of the 1-year-old child. The child has a limited vocabulary of single words that are comprehensible.

The clinic nurse is teaching parents about physiologic anemia that occurs in infants. What statement should the nurse include about the cause of physiologic anemia? a. Maternally derived iron stores are depleted in the first 2 months. b. Fetal hemoglobin results in a shortened survival of red blood cells. c. The production of adult hemoglobin decreases in the first year of life. d. Low levels of fetal hemoglobin depress the production of erythropoietin.

ANS: B Fetal hemoglobin results in a shortened survival of red blood cells (RBCs) and thus a decreased number of RBCs. Maternally derived iron stores are present for the first 5 to 6 months results in a shortened survival of RBCs and thus a decreased number of RBCs. High levels of fetal hemoglobin depress the production of erythropoietin, a hormone released by the kidney that stimulates RBC production.

A child relates that every time he eats a certain food, he gets a stomachache. No other discernable physical symptoms have been correlated with the food intake. Based on this information, the nurse would suspect that the child may be exhibiting? A. Food refusal behavior B. Food intolerance C. Food allergy D. Food preference

ANS: B Food intolerance occurs when a food substance elicits a reproducible reaction without an immunological basis. Food allergies would have discernable symptoms accompanying the food intake due to an immunological response. There is no information to suspect that the child is exhibiting a food preference or food refusal behavior as the description of the food event is noted as being the same each time.

What is the most effective way to clean a toddler's teeth? a. Child to brush regularly with a toothpaste of his or her choice b. Parent to stabilize the chin with one hand and brush with the other c. Parent to brush the mandibular occlusive surfaces, leaving the rest for the child d. Parent to brush the front labial surfaces, leaving the rest for the child

ANS: B For young children, the most effective cleaning of teeth is by the parents. Different positions can be used if the child's back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child's teeth. The child can participate in brushing, but for a thorough cleaning, adult intervention is necessary.

Which statement is most characteristic of the motor skills of a 24-month-old child? A. The toddler walks alone but falls easily. B. The toddler's activities begin to produce purposeful results. C. The toddler is able to grasp small objects but cannot release them at will. D. The toddler's motor skills are fully developed but occur in isolation from the environment.

ANS: B Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new toy. By 2 years of age, children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is a task of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

What is descriptive of the social development of school-age children? a. Identification with peers is minimum. b. Children frequently have best friends. c. Boys and girls play equally with each other. d. Peer approval is not yet an influence for the child to conform.

ANS: B Identification with peers is a strong influence in childrens gaining independence from parents. Interaction among peers leads to the formation of close friendships with same-sex peersbest friends. Daily relationships with age mates in the school setting provide important social interactions for school-age children. During the later school years, groups are composed predominantly of children of the same sex. Conforming to the rules of the peer group provides children with a sense of security and relieves them of the responsibility of making decisions.

The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which statement made by a participant, indicates the correct understanding of the teaching? a. "My body weight will be almost triple in the next few years." b. "I will grow an average of 2 inches per year from this point on." c. "There are not that many physical differences among school-age children." d. "I will have a gradual increase in fat, which may contribute to a heavier appearance."

ANS: B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, children's weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

Kimberly's parents have been using a rearward-facing, convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child reaches which age? a. 1 b. 2 c. 3 d. 4

ANS: B It is now recommended that all infants and toddlers ride in rear-facing car safety seats until they reach the age of 2 years or height recommended by the car seat manufacturer. Children 2 years old and older who have outgrown the rear-facing height or weight limit for their car safety seat should use a forward-facing car safety seat with a harness up to the maximum height or weight recommended by the manufacturer. One year is too young to switch to a forward-facing position.

The nurse is discussing development and play activities with the parent of a 2-month-old. Recommendations should include giving a first rattle at about which age? a. 2 months b. 4 months c. 7 months d. 9 months

ANS: B It is recommended that a brightly colored toy or rattle be given to the child at age 4 months. Grasping has begun as a deliberate act, and the infant grasps, holds, and begins shaking to hear a noise; 2 months is too young. The infant still has primarily reflex grips; 7 to 9 months is too old for the first rattle. The child should be given toys that provide for further exploration.

Which describes marasmus? a. Deficiency of protein with an adequate supply of calories b. Not confined to geographic areas where food supplies are inadequate c. Syndrome that results solely from vitamin deficiencies d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)

ANS: B Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is a deficiency of both protein and calories. It is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears very old, with flabby and wrinkled skin.

The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching? a. I can give my baby a ball of yarn to pull apart or different textured fabrics to feel. b. I can use a music box and soft mobiles as appropriate play activities for my baby. c. I should introduce a cup and spoon or pushpull toys for my baby at this age. d. I do not have to worry about appropriate play activities at this age.

ANS: B Music boxes and soft mobiles are appropriate play activities for a 2-month-old infant. A ball of yarn to pull apart or different textured fabrics are appropriate for an infant at 6 to 9 months. A cup and spoon or pushpull toys are appropriate for an older infant. Infants of all ages should be exposed to appropriate types of stimulation.

Which information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.

ANS: B One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months. Mixing solid foods in a bottle has no effect on the transition to solid food. Iron-fortified cereal should be the first solid food introduced into the infant's diet.

A 1-month-old infant is admitted to the hospital for failure to thrive (FTT) secondary to a cardiac condition. Based on the nurse's knowledge of the different types of FTT, this type of FTT is categorized as A. nonorganic. B. organic. C. idiopathic. D. generalized.

ANS: B Organic FTT is the result of a physical cause, such as a cardiac condition, neurologic condition, renal failure, endocrine system disorder, or other possible chronic or acute disease process. Nonorganic FTT is most often the result of psychosocial factors, such as inadequate nutritional information by the parent. Idiopathic FTT is unexplained by the usual organic and environmental etiologies. Generalized FTT is not a recognized term.

The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. What is the nurses best response? a. Allow him to cry for no longer than 15 minutes and then pick him up. b. Babies need comforting and cuddling. Meeting these needs will not spoil him. c. Babies this young cry when they are hungry. Try feeding him when he cries. d. If he isnt soiled or wet, leave him, and hell cry himself to sleep.

ANS: B Parents need to learn that a spoiled child is a response to inconsistent discipline and limit setting. It is important to meet the infants developmental needs, including comforting and cuddling. The data suggest that responding to a childs crying can actually decrease the overall crying time. Allowing him to cry for no longer than 15 minutes and then picking him up will reinforce prolonged crying. Infants at this age have other needs besides feeding. The parents should be taught to identify their infants cues. Counseling parents on letting the baby cry himself to sleep when not soiled or wet refers to sleep issues, not general infant behavior.

What is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

ANS: B Physiologically and developmentally, the 4-6 month-old infant is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding; 2 to 3 months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. Infant birth weight triples at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which pediatric issues? a. Sudden infant death syndrome (SIDS) b. Plagiocephaly c. Failure to thrive d. Apnea of infancy

ANS: B Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.

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

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

A school nurse observes school-age children playing at recess. Which is descriptive of the play the nurse expects to observe? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States.

Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Lego b. Set of large plastic building blocks c. Brightly colored balloon d. Coloring book and crayons

ANS: B Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Large plastic blocks are appropriate for a toddler in isolation. Small plastic toys such as Lego can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler. DIF: Cognitive Level: Apply REF: p. 355 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment

Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Lego b. Set of large plastic building blocks c. Brightly colored balloon d. Coloring book and crayons

ANS: B Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Large plastic blocks are appropriate for a toddler in isolation. Small plastic toys such as Lego can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler.

Which is an appropriate recommendation for preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

ANS: B Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

Parents of a twelve-year-old child ask the clinic nurse, "How many hours of sleep should our child get?' The nurse should respond that 12-year-old children need how many hours of sleep at night? a. 8 b. 9 c. 10 d. 11

ANS: B School-age children usually do not require naps, but they do need to sleep approximately 11 hours at age 5 years and 9 hours at age 12 years each night.

A school-age child has begun to sleepwalk. What does the nurse advise the parents to perform? a. Wake the child and help determine what is wrong. b. Leave the child alone unless he or she is in danger of harming him- or herself or others. c. Arrange for psychologic evaluation to identify the cause of stress. d. Keep the child awake later in the evening to ensure sufficient tiredness for a full night of sleep.

ANS: B Sleepwalking is usually self-limiting and requires no treatment. The child usually moves about restlessly and then returns to bed. Usually the actions are repetitive and clumsy. The child should not be awakened unless in danger. If there is a need to awaken the child, it should be done by calling the childs name to gradually bring to a state of alertness. Some children, who are usually well behaved and tend to repress feelings, may sleepwalk because of strong emotions. These children usually respond to relaxation techniques before bedtime. If a child is overly fatigued, sleepwalking can increase.

A parent asks the nurse "when will my infant start to teethe?" The nurse responds that the earliest age at which an infant begins teething with eruption of lower central incisors is _____ months. a. 4 b. 6 c. 8 d. 12

ANS: B Teething usually begins at age 6 months with the eruption of the lower central incisors; 4 months is too early for teething. By age 8 months, the infant has the upper and lower central incisors. At age 12 months, the infant has six to eight deciduous teeth.

The American Academy of Pediatrics (AAP) recommends that children younger than the age of 16 years be prohibited from participating in what? a. Skateboarding b. Snowmobiling c. Trampoline use d. Horseback riding

ANS: B The AAP views the use of snowmobiles and all-terrain vehicles as major health hazards for children. This group opposes the use of these vehicles by children younger than 16 years of age. The AAP recommends that children younger than the age of 10 years not use skateboards without parental supervision. Protective gear is always suggested. Trampoline use has increased along with injuries. Adults should supervise use. Horseback riding injuries are also a source of concern. Parents should determine the instructors safety record with students.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? A. Vitamin B B. Vitamin D C. Vitamin C D. Vitamin K

ANS: B The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 400 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency. Vitamins B, C, and K are not needed.

A hospitalized toddler clings to a worn, tattered blanket. The toddler screams when anyone tries to take it away. Which is the best explanation for the toddler's attachment to the blanket? A. The blanket encourages immature behavior. B. The blanket is an important transitional object. C. The developmental task of individuation-separation has not been mastered. D. The child and mother have inadequate bonding.

ANS: B The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are important to help toddlers separate, and attachment to them does not indicate immature behavior. Transitional objects are helpful when a toddler experiences increased stress such as hospitalization. The attachment to the blanket does not reflect inadequate bonding with the mother.

In teaching prospective parents about the emergence of gender identity, the nurse should instruct them that this concept emerges at about A. 12 months of age. B. 24 months of age. C. at birth. D. at 3 years of age.

ANS: B The concept of gender identity begins at about 2 years of age (24 months), at which children are able to label their own as well as other's genders. It is not inherent at birth or by 1 year of age.

The nurse is discussing the management of atopic dermatitis (eczema) with a parent. What should be included? a. Dress infant warmly to prevent chilling. b. Keep the infants fingernails and toenails cut short and clean. c. Give bubble baths instead of washing lesions with soap. d. Launder clothes in mild detergent; use fabric softener in the rinse.

ANS: B The infants nails should be kept short and clean and have no sharp edges. Gloves or cotton socks can be placed over the childs hands and pinned to the shirt sleeves. Heat and humidity increase perspiration, which can exacerbate the eczema. The child should be dressed properly for the climate. Synthetic material (not wool) should be used for the childs clothing during cold months. Baths are given as prescribed with tepid water, and emollients such as Aquaphor, Cetaphil, and Eucerin are applied within 3 minutes. Soap (except as indicated), bubble bath oils, and powders are avoided. Fabric softener should be avoided because of the irritant effects of some of its components.

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

ANS: 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. Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. Children should not ride double unless it is a tandem bike (built for two).

The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: a. front facing in back seat. b. rear facing in back seat. c. front facing in front seat with air bag on passenger side. d. rear facing in front seat if an air bag is on the passenger side.

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

The nurse understands that which guideline should be followed to determine serving sizes for toddlers? a. 1/2 tbsp of solid food per year of age b. 1 tbsp of solid food per year of age c. 2 tbsp of solid food per year of age d. 2 1/2 tbsp of solid food per year of age

ANS: B To determine serving sizes for young children, the guideline to follow is 1 tbsp of solid food per year of age. One-half tbsp per year of age would not be adequate. Two or 2 1/2 tbsp per year of age would be excessive.

A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan? a. Avoid use of pacifiers. b. Eliminate all second-hand smoke contact. c. Lay infant flat after feeding. d. Avoid swaddling the infant.

ANS: B To prevent and treat colic, teach parents that if household members smoke, avoid smoking near infant; preferably confine smoking activity to outside of home. A pacifier can be introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy blanket and placed in an upright seat after feedings.

The mother of a 6-month-old infant has returned to work and is expressing breast milk to be frozen. She asks for directions on how to safely thaw the breast milk in the microwave. What should the nurse recommend? a. Heat only 10 oz or more. b. Do not thaw or heat breast milk in a microwave oven. c. Always leave the bottle top uncovered to allow heat to escape. d. Shake the bottle vigorously for at least 30 seconds after heating.

ANS: B Using a microwave oven to thaw or heat breast milk decreases the anti-infective properties of the breast milk, lowers the vitamin C content, and changes the fat content. Breast milk should be thawed overnight in a refrigerator or in a warm water bath. A microwave should not be used. If steam is created, the milk is too hot. The bottle should be inverted several times after defrosting or warming.

The nurse is assessing a toddlers visual acuity. Which visual acuity is considered acceptable during the toddler years? a. 20/20 b. 20/40 c. 20/50 d. 20/60

ANS: B Visual acuity of 20/40 is considered acceptable during the toddler years.

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 Voluntary control of the anal and urethral sphincters is achieved sometime 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 parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

When teaching injury prevention during the school-age years, what should the nurse include? a. Teach children to fear strangers. b. Teach basic rules of water safety. c. Avoid letting child cook in microwave ovens. d. Caution child against engaging in competitive sports.

ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check for sufficient water depth before diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes instructing children to not go with strangers, not wear personalized clothing in public places, tell parents if anyone makes child feel uncomfortable, and say "no" in uncomfortable situations. Teach child safe cooking. Caution against engaging in hazardous sports such as those involving trampolines.

To avoid a fall from a crib, the nurse recommends to parents that their toddler should sleep in a bed rather than a crib when reaching what height? a. 30 in b. 35 in c. 40 in d. 45 in

ANS: B When children reach a height of 89 cm (35 in), they should sleep in a bed rather than a crib.

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse that they will be back to visit at 6 PM. When the child asks the nurse when his parents are coming, the nurse's best response is a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be."

ANS: B A 4-year-old child understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. I will tell you every time I see you how much longer it will be assumes the child understands the concepts of hours and minutes, which are not developed until age 5 or 6 years. DIF: Cognitive Level: Apply REF: p. 385 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

The parent of a 4-year-old boy tells the nurse that the child believes that monsters and boogeymen are in his bedroom at night. What is the nurse's best suggestion for coping with this problem? a. Let the child sleep with his parents. b. Keep a night-light on in the child's bedroom. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and boogeymen do not exist.

ANS: B A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old child is in the preconceptual age and cannot understand logical thought. DIF: Cognitive Level: Apply REF: p. 388 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

Acyclovir (Zovirax) is given to children with chickenpox to: a. minimize scarring. b. decrease the number of lesions. c. prevent aplastic anemia. d. prevent spread of the disease.

ANS: B Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia. Treating pruritus and discouraging itching minimize scarring. Aplastic anemia is not a complication of chickenpox. Strict isolation until vesicles are dried prevents spread of disease.

6. When the nurse interviews an adolescent, which of the following is especially important? a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Use the same type of language as the adolescent. d. Emphasize that confidentiality will always be maintained.

ANS: B Adolescents, like all children, need an opportunity to express their feelings. Often they interject feelings into their words. The nurse must be alert to the words and feelings expressed. The nurse should maintain a professional relationship with adolescents. To avoid misunderstanding or misinterpretation of words and phrases used, the nurse should clarify the terms used, what information will be shared with other members of the health care team, and any limits to confidentiality. Although the peer group is important to this age-group, the interview should focus on the adolescent. DIF: Cognitive Level: Comprehension REF: p. 124 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

A 14-year-old adolescent never had chickenpox as a child. What should the nurse expect the health care provider to recommend? a. One dose of the varicella vaccination b. Two doses of the varicella vaccination 4 weeks apart c. One dose of the varicella immune globulin d. No vaccinations—the child is past the age to receive it

ANS: B All adolescents should also be assessed for previous history of varicella infection or vaccination. Vaccination with the varicella vaccine is recommended for those with no previous history; for those with no previous infection or history, the varicella vaccine may be given in two doses 4 or more weeks apart to adolescents 13 years or older. The varicella immune globulin is given to immunosuppressed children exposed to chickenpox to boost immunity; it is only temporary. The varicella vaccination should be given to adolescents, no matter the age, who have not had chickenpox as a child. DIF: Cognitive Level: Apply REF: p. 462 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

A child has been admitted to the emergency department with an acetaminophen (Tylenol) poisoning. An antidote is being prescribed by the health care provider. Which antidote should the nurse prepare to administer? a. Naloxone (Narcan) b. N-acetylcysteine (Mucomyst) c. Flumazenil (Romazicon) d. Digoxin immune Fab (Digibind)

ANS: B Antidotes available to treat toxin ingestion include N-acetylcysteine for acetaminophen poisoning, naloxone for opioid overdose, flumazenil (Romazicon) for benzodiazepine (diazepam [Valium], midazolam [Versed]) overdose, and digoxin immune Fab (Digibind) for digoxin toxicity. DIF: Cognitive Level: Apply REF: p. 409 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity

A child has been admitted to the emergency department with an acetaminophen (Tylenol) poisoning. An antidote is being prescribed by the health care provider. Which antidote should the nurse prepare to administer? a. Naloxone (Narcan) b. N-acetylcysteine (Mucomyst) c. Flumazenil (Romazicon) d. Digoxin immune Fab (Digibind)

ANS: B Antidotes available to treat toxin ingestion include N-acetylcysteine for acetaminophen poisoning, naloxone for opioid overdose, flumazenil (Romazicon) for benzodiazepine (diazepam [Valium], midazolam [Versed]) overdose, and digoxin immune Fab (Digibind) for digoxin toxicity.

The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry red.

ANS: B Arterial blood gases are the best way to monitor carbon monoxide poisoning. Pulse oximetry is contraindicated in the case of carbon monoxide poisoning because the PaO2 may be normal. The child should receive 100% oxygen as quickly as possible, not only if respiratory distress or other symptoms develop.

14. The nurse is taking a sexual history on an adolescent girl. Which of the following is the best way to determine whether she is sexually active? a. Ask her, "Are you sexually active?" b. Ask her, "Are you having sex with anyone?" c. Ask her, "Are you having sex with a boyfriend?" d. Ask both the girl and her parent if she is sexually active.

ANS: B Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information for the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Using gender-neutral terms is inclusive and conveys acceptance to the adolescent. Questioning about sexual activity should occur when the adolescent is alone. DIF: Cognitive Level: Application REF: p. 130 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

20. At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months, the infant can enjoy social interactions.

Which is descriptive of a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time, such as "just a minute" and "in an hour"

ANS: B At this age, the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. When a child puts objects into a container but cannot take them out, this is indicative of tertiary circular reactions. An embryonic sense of time exists, although the children may behave appropriately to time- oriented phrases; their sense of timing is exaggerated. DIF: Cognitive Level: Understand REF: p. 356 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is beginning chelation therapy on a child for lead poisoning. Which intervention should the nurse implement during the time the child is receiving chelation therapy? a. Calorie counts b. Strict intake and output c. Telemetry monitoring d. Contact isolation

ANS: B Because calcium disodium edetate (EDTA) and lead are toxic to the kidneys, a nurse should keep strict records of intake and output to monitor renal functioning. Adequate hydration is essential during therapy because the chelates are excreted via the kidneys. Calorie counts, telemetry, or contact isolation would not be nursing interventions appropriate for a child undergoing chelation therapy. DIF: Cognitive Level: Apply REF: p. 417 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity

A nurse is beginning chelation therapy on a child for lead poisoning. Which intervention should the nurse implement during the time the child is receiving chelation therapy? a. Calorie counts b. Strict intake and output c. Telemetry monitoring d. Contact isolation

ANS: B Because calcium disodium edetate (EDTA) and lead are toxic to the kidneys, a nurse should keep strict records of intake and output to monitor renal functioning. Adequate hydration is essential during therapy because the chelates are excreted via the kidneys. Calorie counts, telemetry, or contact isolation would not be nursing interventions appropriate for a child undergoing chelation therapy.

A nurse makes the decision to apply a topical anesthetic to a child's skin before drawing blood. Which ethical principle is the nurse demonstrating? a. Autonomy b. Beneficence c. Justice d. Truthfulness

ANS: B Beneficence is the obligation to promote the patient's well-being. Applying a topical anesthetic before drawing blood promotes reducing the discomfort of the venipuncture. Autonomy is the patient's right to be self-governing. Justice is the concept of fairness. Truthfulness is the concept of honesty. DIF: Cognitive Level: Understand REF: p. 10 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiological Integrity

2. The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately how many pounds? a. 10 b. 15 c. 20 d. 25

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7 pounds at birth would weigh approximately 15 pounds; 10 pounds is too little. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 20 to 25 pounds is too much. The infant would have tripled the birth weight at 6 months.

26. Which of the following explains the importance of detecting strabismus in young children? a. Color vision deficit may result. b. Amblyopia, a type of blindness, may result. c. Epicanthal folds may develop in affected eye. d. Corneal light reflexes may fall symmetrically within each pupil.

ANS: B By the age of 3 to 4 months, infants are able to fixate on one visual field with both eyes simultaneously. In strabismus, or cross-eye, one eye deviates from the point of fixation. If misalignment is constant, the weak eye becomes "lazy" and the brain eventually suppresses the image produced from that eye. If strabismus is not detected and corrected by age 4 to 6 years, blindness from disuse, known as amblyopia, may occur. Color vision is not the only concern. Epicanthal folds are not related to amblyopia. In children with strabismus, the corneal light reflex will not be symmetric for each eye. DIF: Cognitive Level: Comprehension REF: p. 155 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. What is most likely the cause of the diaper rash? a. Impetigo b. Candida albicans c. Urine and feces d. Infrequent diapering

ANS: B C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper, but sparing the folds, are likely to be caused by chemical irritation, especially urine and feces.

Airborne isolation is required for a child who is hospitalized with: a. mumps. b. chickenpox. c. exanthema subitum (roseola). d. erythema infectiosum (fifth disease).

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

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses.

ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A β-hemolytic streptococcal infections.

Which is most descriptive of clinical reasoning? a. A simple developmental process b. Purposeful and goal-directed c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate

ANS: B Clinical reasoning is a complex, developmental process based on rational and deliberate thought. Clinical reasoning is not a developmental process. Clinical reasoning is based on rational and deliberate thought. Clinical reasoning is not a guessing process. DIF: Cognitive Level: Understand REF: p. 10 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? a. Race b. Culture c. Ethnicity d. Social group

ANS: B Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perceptions and judgments. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize it as a distinct human type. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of systems of roles carried out in groups. Examples of primary social groups include the family and peer groups.

Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? a. Race b. Culture c. Ethnicity d. Social group

ANS: B Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perceptions and judgments. Race is defined as a division of mankind possessing traits that are transmissible by descent and are sufficient to characterize it as a distinct human type. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of systems of roles carried out in groups. Examples of primary social groups include the family and peer groups.

9. The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? a. Recommend that the child keep a diary. b. Provide supplies for the child to draw a picture. c. Suggest that the parent read fairy tales to the child. d. Ask the parent if the child is always uncommunicative.

ANS: B Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the children's inner self. A diary would be difficult for a 6-year-old child, who is most likely learning to read. The parent reading fairy tales to the child is a passive activity involving the parent and child; it would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not always uncommunicative. DIF: Cognitive Level: Application REF: p. 125 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

Which consideration is the most important in managing tuberculosis (TB) in children? a. Skin testing annually b. Pharmacotherapy c. Adequate nutrition d. Adequate hydration

ANS: B Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months. Pharmacotherapy is the most important intervention for TB.

Which 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 During growth spurts, the need for sleep increases. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue. DIF: Cognitive Level: Understand REF: p. 463 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which statement best describes fear in the school-age child? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years, children experience a wide variety of fears, but new fears relate predominantly to school and family. During the middle-school years, children become less fearful for body safety than they were as preschoolers. Parents and other persons involved with children should discuss children's fears with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding their fears does not end them and may lead to phobias.

Which should the nurse expect for a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of holophrases d. Approximately one third of speech understandable

ANS: B During the second year of life, level of comprehension and understanding of speech increases and is far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old child has a vocabulary of 10 or more words. At this age, the child does not use the one-word sentences that are characteristic of the 1-year-old child. The child has a limited vocabulary of single words that are comprehensible. DIF: Cognitive Level: Understand REF: p. 359 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which term best describes the identification of the distribution and causes of disease, injury, or illness? a. Nursing process b. Epidemiologic process c. Community-based statistics d. Mortality and morbidity statistics

ANS: B Epidemiology is the science of population health applied to the detection of morbidity and mortality in a population. It identifies the distribution and causes of diseases across a population. Nursing process is a systematic problem-solving approach for the delivery of nursing care. Morbidity and mortality statistics, along with natal rates, may provide an objective picture of a community's health status.

14. Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: a. be praised less often. b. be more achievement oriented. c. be more popular with the peer group. d. identify with peer group more than parents.

ANS: B Firstborn children, like only children, tend to be more achievement oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children.

Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: a. be praised less often. b. be more achievement oriented. c. be more popular with the peer group. d. identify with peer group more than parents.

ANS: B Firstborn children, like only children, tend to be more achievement-oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children.

When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction? a. Children as young as 4 years old rarely need to be punished. b. Parental control should be consistent. c. Withdrawal of love and approval is effective at this age. d. One should expect rules to be followed rigidly and unquestioningly.

ANS: B For effective discipline, parents must be consistent and must follow through with agreed-on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the child's age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old.

When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction? a. Children as young as 4 years old rarely need to be punished. b. Parental control should be consistent. c. Withdrawal of love and approval is effective at this age. d. One should expect rules to be followed rigidly and unquestioningly.

ANS: B For effective discipline, parents must be consistent and must follow through with agreed-on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the childs age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old.

What is the most effective way to clean a toddler's teeth? a. Child to brush regularly with a toothpaste of his or her choice b. Parent to stabilize the chin with one hand and brush with the other c. Parent to brush the mandibular occlusive surfaces, leaving the rest for the child d. Parent to brush the front labial surfaces, leaving the rest for the child

ANS: B For young children, the most effective cleaning of teeth is by the parents. Different positions can be used if the child's back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child's teeth. The child can participate in brushing, but for a thorough cleaning, adult intervention is necessary. DIF: Cognitive Level: Understand REF: p. 368 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

Which is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

ANS: B Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach or pose an airway threat.

Which is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

ANS: B Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach or pose an airway threat. DIF: Cognitive Level: Understand REF: p. 411 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity

24. The nurse has just started assessing a young child who is febrile and appears ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. Which of the following is the most appropriate action? a. Ask parent when neck was injured. b. Refer for immediate medical evaluation. c. Continue assessment to determine cause of neck pain. d. Record "head lag" on assessment record and continue assessment of child.

ANS: B Hyperextension of the child's head with pain on flexion is indicative of meningeal irritation and needs immediate evaluation. No indication of injury is present. This situation is not descriptive of head lag. DIF: Cognitive Level: Analysis REF: p. 154 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

ANS: B If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by H. influenzae in the respiratory tract.

21. The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large and one is too small. The best nursing action is which of the following? a. Use the small cuff. b. Use the large cuff. c. Use either cuff, using palpation method. d. Wait to take blood pressure until proper cuff can be located.

ANS: B If blood pressure measurement is indicated and the appropriate size cuff is not available, the next larger size is used. The nurse recognizes that this may be a falsely low blood pressure. Using the small cuff will give an incorrectly high reading. The palpation method will not improve the inaccuracy inherent in the cuff. DIF: Cognitive Level: Comprehension REF: p. 150 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A nurse, instructing parents of a hospitalized preschool child, explains that which is descriptive of the preschooler's understanding of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms like "yesterday" appropriately

ANS: B In a preschooler's understanding, time has a relation with events such as "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years. DIF: Cognitive Level: Understand REF: p. 385 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

37. Cardiopulmonary resuscitation (CPR) is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible? a. Radial b. Carotid c. Femoral d. Brachial

ANS: B In a toddler, the carotid pulse is palpated. The radial pulse is not considered a central pulse. The femoral pulse is not the most central and accessible. Brachial pulse is felt in infants younger than 1 year.

The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which statement made by a participant, indicates the correct understanding of the teaching? a. "My body weight will be almost triple in the next few years." b. "I will grow an average of 2 inches per year from this point on." c. "There are not that many physical differences among school-age children." d. "I will have a gradual increase in fat, which may contribute to a heavier appearance."

ANS: B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, children's weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicle, and juices are left. Which statement would best explain this? a. Parent is trying to feed child only what child likes most. b. Parent is trying to restore normal balance through appropriate hot remedies. c. Hispanics believe the evil eye enters when a person gets cold. d. Hispanics believe an innate energy, called chi, is strengthened by eating soup.

ANS: B In several groups, including Filipino, Chinese, Arabic, and Hispanic cultures, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are cold conditions and are treated with hot foods. The parent may be trying to feed the child only what the child likes most, but it is unlikely that a toddler would consistently prefer the broth to Jell-O, Popsicle, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals believe in chi as an innate energy.

Kimberly's parents have been using a rearward-facing, convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child reaches which age? a. 1 b. 2 c. 3 d. 4

ANS: B It is now recommended that all infants and toddlers ride in rear-facing car safety seats until they reach the age of 2 years or height recommended by the car seat manufacturer. Children 2 years old and older who have outgrown the rear-facing height or weight limit for their car safety seat should use a forward-facing car safety seat with a harness up to the maximum height or weight recommended by the manufacturer. One year is too young to switch to a forward-facing position. DIF: Cognitive Level: Understand REF: p. 372 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Safe and Effective Care Environment

17. The nurse is discussing development and play activities with the parent of a 2-month-old. Recommendations should include giving a first rattle at about which age? a. 2 months b. 4 months c. 7 months d. 9 months

ANS: B It is recommended that a brightly colored toy or rattle be given to the child at age 4 months. Grasping has begun as a deliberate act, and the infant grasps, holds, and begins shaking to hear a noise; 2 months is too young. The infant still has primarily reflex grips; 7 to 9 months is too old for the first rattle. The child should be given toys that provide for further exploration.

A nurse is assessing a child and notes Koplik spots. In which of these communicable diseases are Koplik spots present? a. Rubella b. Measles (rubeola) c. Chickenpox (varicella) d. Exanthema subitum (roseola)

ANS: B Koplik spots are small irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Rubella occurs with rash on the face, which rapidly spreads downward. Varicella appears with highly pruritic macules, followed by papules and vesicles. Roseola is seen with rose-pink macules on the trunk, spreading to face and extremities.

Which is considered characteristic of children who are the youngest in their family? a. More dependent than firstborn children b. More outgoing than firstborn children c. Identify more with parents than with peers d. Are subject to greater parental expectations

ANS: B Later-born children are obliged to interact with older siblings from birth and seem to be more outgoing and make friends more easily than firstborns. Being more dependent, identifying more with parents than peers, and being subject to greater parental expectations are characteristics of firstborn children and only children.

The nurse should implement which prescribed treatment for a child with warts? a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

ANS: B Local destructive therapy individualized according to location, type, and number—including surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies—is used. Vaccination is prophylaxis for warts and is not a treatment. Corticosteroids and specific antibiotic therapy are not effective in the treatment of warts.

Which describes marasmus? a. Deficiency of protein with an adequate supply of calories b. Not confined to geographic areas where food supplies are inadequate c. Syndrome that results solely from vitamin deficiencies d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)

ANS: B Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is a deficiency of both protein and calories. It is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears very old, with flabby and wrinkled skin.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What is the priority nursing intervention? a. Forcing fluids b. Monitoring pulse oximetry c. Instituting seizure precautions d. Encouraging a high-protein diet

ANS: B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

29. Which information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.

ANS: B One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies. Solid foods can be introduced earlier. The extrusion reflex usually disappears by age 6 months. Mixing solid foods in a bottle has no effect on the transition to solid food. Iron-fortified cereal should be the first solid food introduced into the infant's diet.

A child with cystic fibrosis (CF) is receiving recombinant human deoxyribonuclease (DNase). Which is an adverse effect of this medication? a. Mucus thickens b. Voice alters c. Tachycardia d. Jitteriness

ANS: B One of the only adverse effects of DNase is voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years. β2 Agonists can cause tachycardia and jitteriness.

28. Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to: a. prevent vomiting. b. bind phosphorus. c. stimulate appetite. d. increase absorption of fat-soluble vitamins.

ANS: B Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate. Serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins. PTS: 1 DIF: Cognitive Level: Apply REF: 922 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

A parent of a school-age child is going through a divorce. The parent tells the school nurse the child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which implication? a. Indication of maladjustment b. Common reaction to divorce c. Lack of adequate parenting d. Unusual response that indicates need for referral

ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. This is not an indication of maladjustment, suggestive of lack of adequate parent, or an unusual response that indicates need for referral in school-age children after parental divorce.

A parent of a school-age child is going through a divorce. The parent tells the school nurse the child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which implication? a. Indication of maladjustment b. Common reaction to divorce c. Lack of adequate parenting d. Unusual response that indicates need for referral

ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. This is not an indication of maladjustment, suggestive of lack of adequate parenting, or an unusual response that indicates need for referral in school-age children after parental divorce.

A nurse is conducting parenting classes for parents of adolescents. Which parenting style should the nurse recommend? a. Laissez-faire b. Authoritative c. Disciplinarian d. Confrontational

ANS: B Parents should be guided toward an authoritative style of parenting in which authority is used to guide the adolescent while allowing developmentally appropriate levels of freedom and providing clear, consistent messages regarding expectations. The authoritative style of parenting has been shown to have both immediate and long-term protective effects toward adolescent risk reduction. The laissez-faire method would not give adolescents enough structure. The disciplinarian and confrontational styles would not allow any autonomy or independence. DIF: Cognitive Level: Apply REF: p. 456 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

28. What is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

ANS: B Physiologically and developmentally, the 4- to 6-month-old infant is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding; 2 to 3 months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. No research indicates that the addition of solid food to a bottle has any benefit. Infant birth weight doubles at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

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

ANS: B Play develops from the solitary play of infancy to the parallel play of toddlers. The toddler plays alongside other children, not with them. This typical behavior of the toddler is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because the toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore, no right or wrong is associated with taking a toy. DIF: Cognitive Level: Analyze REF: p. 355 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A school nurse observes school-age children playing at recess. Which is descriptive of the play the nurse expects to observe? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States.

The nurse is preparing an in-service education to staff about a traumatic care for pediatric patients. Which intervention should the nurse include? a. Prepare the child for separation from parents during hospitalization by reviewing a video. b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control associated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure.

ANS: B Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In the provision of atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care. DIF: Cognitive Level: Understand REF: p. 8 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity

A 4-year-old child is hospitalized with a serious bacterial infection. The child tells the nurse that he is sick because he was "bad." Which is the nurse's best interpretation of this comment? a. Sign of stress b. Common at this age c. Suggestive of maladaptation d. Suggestive of excessive discipline at home

ANS: B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilty for things outside their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. Telling the nurse that he is sick because he was "bad" does not imply excessive discipline at home. DIF: Cognitive Level: Analyze REF: p. 385 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

19. Rectal temperatures are indicated in which of the following situations? a. In the newborn period b. Whenever accuracy is essential c. Rectal temperatures are never indicated d. When rapid temperature changes are occurring

ANS: B Rectal temperatures are recommended when definitive measurements are necessary in infants over age 1 month. Rectal temperatures are not done in the newborn period to avoid trauma to the rectal mucosa. Rectal temperature is an intrusive procedure that should be avoided whenever possible. DIF: Cognitive Level: Comprehension REF: p. 145 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which is an appropriate recommendation for preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

ANS: B Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth. DIF: Cognitive Level: Analyze REF: p. 368 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

What causes tinea capitis (ringworm)? a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

ANS: B Ringworm is caused by a group of closely related filamentous fungi that invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. Virus and bacterial infection are not the causative organisms for ringworm. Ringworm is not an allergic response.

Which bite causes Rocky Mountain spotted fever? a. Flea b. Tick c. Mosquito d. Mouse or rat

ANS: B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas. Fleas, mosquitoes, and mice or rats do not transmit Rocky Mountain spotted fever.

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The childs mother says she has rubbed the edge of a coin on her childs oiled skin. What explanation should the nurse recognize about this? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture

ANS: B Rubbing the edge of a coin on a childs oiled skin is descriptive of coining. The welts are created by repeatedly rubbing a coin on the childs oiled skin. The mother is attempting to rid the childs body of disease. The mother was engaged in an attempt to heal the child. This is not child abuse or discipline.

20. What is the earliest age at which a satisfactory radial pulse can be taken in children? a. 1 year b. 2 years c. 3 years d. 6 years

ANS: B Satisfactory radial pulses can be taken in children older than 2 years. In infants and young children the apical pulse is more reliable. DIF: Cognitive Level: Comprehension REF: p. 148 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Parents of a 12-year-old child ask the clinic nurse, "How many hours of sleep should our child get?" The nurse should respond that 12-year-old children need how many hours of sleep at night? a. 8 b. 9 c. 10 d. 11

ANS: B School-age children usually do not require naps, but they do need to sleep approximately 11 hours at age 5 years and 9 hours at age 12 years each night.

A school nurse is conducting vision and hearing testing on fifth-grade children. Which level of prevention is the nurse demonstrating? a. Primary b. Secondary c. Tertiary d. Health promotion

ANS: B Secondary prevention focuses on screening and early diagnosis of disease. Vision and hearing testing are screening tests to detect problems. Primary prevention focuses on health promotion and prevention of disease or injury. Tertiary prevention focuses on optimizing function for children with a disability or chronic disease. Health promotion is focused on preventing disease or illness. DIF: Cognitive Level: Understand REF: p. 2 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. What should the nurse suspect? a. Unintentional injury b. Shaken-baby syndrome c. Sudden infant death syndrome (SIDS) d. Congenital neurologic problem

ANS: B Shaken-baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. SIDS and congenital neurologic problems would not appear this way. DIF: Cognitive Level: Analyze REF: p. 419 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. What should the nurse suspect? a. Unintentional injury b. Shaken-baby syndrome c. Sudden infant death syndrome (SIDS) d. Congenital neurologic problem

ANS: B Shaken-baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. SIDS and congenital neurologic problems would not appear this way.

31. The appropriate placement of a tongue blade for assessment of the mouth and throat is which of the following? a. On the lower jaw b. Side of the tongue c. Against the soft palate d. Center back area of tongue

ANS: B Side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. On the lower jaw and against the soft palate are not appropriate places for the tongue blade. Placement in the center back area of tongue elicits the gag reflex. DIF: Cognitive Level: Comprehension REF: p. 162 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A nurse is teaching parents about language development for preschool children. Which dysfunctional speech pattern is a normal characteristic the parents might expect? a. Lisp b. Stammering c. Echolalia d. Repetition without meaning

ANS: B Stammering and stuttering are normal dysfluency patterns in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language. DIF: Cognitive Level: Apply REF: p. 389 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

22. A parent asks the nurse "when will my infant start to teethe?" The nurse responds that the earliest age at which an infant begins teething with eruption of lower central incisors is _____ months. a. 4 b. 6 c. 8 d. 12

ANS: B Teething usually begins at age 6 months with the eruption of the lower central incisors; 4 months is too early for teething. By age 8 months, the infant has the upper and lower central incisors. At age 12 months, the infant has six to eight deciduous teeth.

A school nurse is teaching a group of preadolescent girls about puberty. Which is the mean age of menarche for girls in the United States? a. 13 years b. 12 years c. 11 years d. 14 years

ANS: B The average age of menarche is 12 years 9.5 months in North American girls, with a normal range of to 15 years. Ages , , and 14 are within the normal range for menarche, but these are not the average ages. DIF: Cognitive Level: Remember REF: p. 448 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

11. The nurse is taking a health history of an adolescent. Which of the following best describes how the chief complaint should be determined? a. Request a detailed listing of symptoms. b. Ask adolescent, "Why did you come here today?" c. Interview parent away from adolescent to determine chief complaint. d. Use what adolescent says to determine, in correct medical terminology, what the problem is.

ANS: B The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. Requesting a detailed list of symptoms makes it difficult to determine the chief complaint. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. DIF: Cognitive Level: Application REF: p. 127 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which factor most impacts the type of injury a child is susceptible to according to the child's age? a. Physical health of the child b. Developmental level of the child c. Educational level of the child d. Number of responsible adults in the home

ANS: B The child's developmental stage determines the type of injury that is likely to occur. The child's physical health may facilitate the child's recovery from an injury but does not impact the type of injury. Educational level is related to developmental level, but it is not as important as the child's developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child's developmental stage. DIF: Cognitive Level: Understand REF: p. 3 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurse's rationale for this action is described primarily in which statement? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease the child's respiratory efforts. c. Separation from the mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

ANS: B The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt but this is not the best answer. The main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

A nurse is taking a history on a low-income Hispanic toddler. The parent tells the nurse that occasional diarrhea is treated with azogue, a mercury compound commonly used in the parents native Mexico. What should the nurse recognize about this remedy? a. It is harmless. b. It is dangerous. c. It has a scientific basis. d. It has importance in certain religious practices.

ANS: B The ingestion of mercury is extremely dangerous for children. Solutions containing mercury are not harmless. The nurse should work with folk healers or respected members of the culture to teach the family of the dangers of mercury ingestion. No scientific basis exists for the use of mercury to treat diarrhea.

36. The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: a. front facing in back seat. b. rear facing in back seat. c. front facing in front seat with airbag on passenger side. d. rear facing in front seat if an air bag is on the passenger side.

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

Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Allow children unrestricted permission to satisfy this curiosity. d. Get counseling for this unusual and dangerous behavior.

ANS: B Three-year-olds become aware of anatomic differences and are concerned about how the other "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. Encouraging the children to ask questions of the parents and redirecting their activity are more appropriate than giving permission. Exploration is age- appropriate and not dangerous behavior. DIF: Cognitive Level: Apply REF: p. 387 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan? a. Avoid use of pacifiers. b. Eliminate all second-hand smoke contact. c. Lay infant flat after feeding. d. Avoid swaddling the infant.

ANS: B To prevent and treat colic, teach parents that if household members smoke, avoid smoking near infant; preferably confine smoking activity to outside of home. A pacifier can be introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy blanket and placed in an upright seat after feedings.

According to Erikson, which psychosocial task is developing in adolescence? a. Intimacy b. Identity c. Initiative d. Independence

ANS: B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Independence is not one of Erikson's developmental stages. DIF: Cognitive Level: Understand REF: p. 453 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

2. Which of the following is considered a block to effective communication? a. Using silence b. Using clichés c. Directing the focus d. Defining the problem

ANS: B Using stereotyped comments or clichés can block effective communication. After the nurse uses such trite phrases, parents often do not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximum freedom of expression. By using open-ended questions and guiding questions, the nurse can obtain the necessary information and maintain a relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention. DIF: Cognitive Level: Application REF: p. 121 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

A nurse is admitting an infant with asthma. What usually triggers asthma in infants? a. Medications b. A viral infection c. Exposure to cold air d. Allergy to dust or dust mites

ANS: B Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease. DIF: Cognitive Level: Understand REF: p. 663 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A nurse is admitting an infant with asthma. What usually triggers asthma in infants? a. Medications b. A viral infection c. Exposure to cold air d. Allergy to dust or dust mites

ANS: B Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease.

11. 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 Voluntary control of the anal and urethral sphincters is achieved sometime 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 parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner. DIF: Cognitive Level: Understand REF: p. 360 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

When teaching injury prevention during the school-age years, what should the nurse include? a. Teach children to fear strangers. b. Teach basic rules of water safety. c. Avoid letting child cook in microwave ovens. d. Caution child against engaging in competitive sports.

ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check for sufficient water depth before diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes instructing children to not go with strangers, not wear personalized clothing in public places, tell parents if anyone makes child feel uncomfortable, and say "no" in uncomfortable situations. Teach child safe cooking. Caution against engaging in hazardous sports such as those involving trampolines.

A nurse is teaching parents about caring for their child with chickenpox. The nurse should let the parents know that the child is considered to be no longer contagious when which occurs? a. When fever is absent b. When lesions are crusted c. 24 hours after lesions erupt d. 8 days after onset of illness

ANS: B When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. Chickenpox is still contagious when child has fever. Children are contagious after lesions erupt. If lesions are crusted at 8 days, the child is no longer contagious.

b-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. Which describes their action? a. Liquefy secretions b. Dilate the bronchioles c. Reduce inflammation of the lungs d. Reduce infection

ANS: B b-Adrenergic agonists and methylxanthines work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs. DIF: Cognitive Level: Understand REF: p. 664 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

26. β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. Which describes their action? a. Liquefy secretions b. Dilate the bronchioles c. Reduce inflammation of the lungs d. Reduce infection

ANS: B β-Adrenergic agonists and methylxanthines work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

Which are characteristic of physical development of a 30-month-old child? (Select all that apply.) a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. f. Left- or right-handedness is established.

ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. Birth weight doubles at approximately ages 5-6 months. The anterior fontanel closes at age 12-18 months. Birth length is doubled around age 4. Left- or right-handedness is not established until about age 5.

Which are characteristic of physical development of a 30-month-old child? (Select all that apply.) a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. f. Left- or right-handedness is established.

ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at age 12 to 18 months. Birth length is doubled around age 4. Left- or right-handedness is not established until about age 5. DIF: Cognitive Level: Understand REF: p. 361 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

An infant has been diagnosed with cow's milk allergy. What are the clinical manifestations the nurse expects to assess? (Select all that apply.) a. Pink mucous membranes b. Vomiting c. Rhinitis d. Abdominal pain e. Moist skin

ANS: B, C, D An infant with cow's milk allergy will possibly have vomiting, rhinitis, and abdominal pain. The mucous membranes may be pale due to anemia from blood lost in the GI tract, and the skin will be itchy with the possibility of atopic dermatitis.

A toddler is in the sensorimotor, tertiary circular reactions stage of cognitive development. What behavior should the nurse expect to assess? (Select all that apply.) a. Refers to self by pronoun b. Gestures up and down c. Able to insert round object into a hole d. Can find hidden objects but only in the first location e. Uses future-oriented words, such as tomorrow

ANS: B, C, D Children in the sensorimotor, tertiary circular reactions stage of cognitive development show the behaviors of gesturing up and down, have the ability to insert round objects into a hole, and can find hidden objects but only in the first location. The behaviors of referring to oneself by pronoun and using future-oriented words such as tomorrow are seen in the preoperational stage of cognitive development.

The school nurse recognizes that children respond to stress by using which tactics? (Select all that apply.) a. Passivity b. Delinquency c. Daydreaming d. Delaying tactics e. Becoming outgoing

ANS: B, C, D Children respond to stress by using coping mechanisms that include internalizing symptoms such as withdrawal, delaying tactics, and daydreaming, along with externalizing symptoms such as aggression and delinquency.

A parent asks the nurse, When will I know my child is ready for toilet training? The nurse should include what in the response? (Select all that apply.) a. The child should be able to stay dry for 1 hour. b. The child should be able to sit, walk, and squat. c. The child should have regular bowel movements. d. The child should express a willingness to please.

ANS: B, C, D Signs of toilet training readiness include physical and psychological readiness. The ability to sit, walk, and squat and having regular bowel movements are physical readiness signs. Expressing a willingness to please is a sign of psychological readiness. The child should be able to stay dry for 2 hours, not 1.

A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.) a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor.

ANS: B, C, D Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children's social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.

The clinic nurse is assessing a 6-month-old infant during a well-child appointment. The nurse should use which approaches to alleviate the infants stranger anxiety? (Select all that apply.) a. Talk in a loud voice. b. Meet the infant at eye level. c. Avoid sudden intrusive gestures. d. Maintain a safe distance initially. e. Pick up the infant and hold him or her closely.

ANS: B, C, D The best approaches for the nurse to alleviate the infants stranger anxiety are to talk softly; meet the infant at eye level (to appear smaller); maintain a safe distance from the infant; and avoid sudden, intrusive gestures, such as holding out the arms and smiling broadly. Talking in a loud voice and picking the infant up would increase the infants anxiety.

An infant has been diagnosed with cow's milk allergy. What are the clinical manifestations the nurse expects to assess? (Select all that apply.) a. Pink mucous membranes b. Vomiting c. Rhinitis d. Abdominal pain e. Moist skin

ANS: B, C, D An infant with cow's milk allergy will possibly have vomiting, rhinitis, and abdominal pain. The mucous membranes may be pale due to anemia from blood lost in the GI tract, and the skin will be itchy with the possibility of atopic dermatitis.

A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.) a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor.

ANS: B, C, D Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children's social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.

The clinic nurse is assessing a child with bacterial conjunctivitis (pink eye). Which assessment findings should the nurse expect? (Select all that apply.) a. Itching b. Swollen eyelids c. Inflamed conjunctiva d. Purulent eye drainage e. Crusting of eyelids in the morning

ANS: B, C, D, E The assessment findings in bacterial conjunctivitis include swollen eyelids, inflamed conjunctiva, purulent eye drainage, and crusting of eyelids in the morning. Itching is seen with allergic conjunctivitis but not with bacterial conjunctivitis.

A nurse is working in a clinic that serves a culturally diverse population of children. The nurse should plan care, understanding that which complementary and alternative practices may be used by families of this diverse population? (Select all that apply.) a. Seeking another doctors opinion b. Seeking advice from a curandero or curandera c. Using acupuncture or acupressure as a therapy d. Consulting an herbalist e. Consulting a kahuna

ANS: B, C, D, E The curandero (male) or curandera (female) of the Mexican-American community is believed to have healing powers that are a gift from God. The Asian family may consult an herbalist, knowledgeable in medicines, or perhaps a specialized practitioner of Asian therapies, including acupuncture (insertion of needles) or acupressure (application of pressure). Native Hawaiians consult kahunas and practice hooponopono to heal family imbalance or disputes. The nurse may encounter use of these practices. Consulting another doctor would not be a complementary or alternative practice expected in a culturally diverse population.

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a sudden infant death syndrome incident? (Select all that apply.) a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness

ANS: B, C, E Certain groups of infants are at increased risk for SIDS: low birth weight, low Apgar scores, recent viral illness, and male sex. Breastfed infants and infants of average or above average weight are not at higher risk for SIDS.

Which finding would be considered to be abnormal with regard to growth and development principles? Select all that apply. A. Chest circumference is equal to head circumference at the end of the first year. B. Increased height is most likely to do to size of limbs rather than torso by the end of the first year. C. Increase in weight of the brain about 1.5 times by the end of the first year. D. Growth of heart is doubled by the end of the first year. E. Primitive reflexes remain consistently within the first year of life.

ANS: B, C, E Increased height is mostly seen in the trunk as opposed to limbs. Brain weight increases up to 2.5 times in the first year of life. Primitive reflexes are replaced by voluntary purposeful movements based on neural pathways.

A 12-month-old infant has been diagnosed with failure to thrive (FTT). Which assessment findings does the nurse expect to be documented with this infant? (Select all that apply.) a. Fear of strangers b. Minimal smiling c. Avoidance of eye contact d. Meeting developmental milestones e. Wide-eyed gaze and continual scan of the environment

ANS: B, C, E Signs and symptoms of FTT include minimal smiling, avoidance of eye contact, and a wide-eyed gaze and continual scan of the environment (radar gaze). There is no fear of strangers, and there are developmental delays, including social, motor, adaptive, and language.

A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room.

ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room.

A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room.

ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room.

Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.) a. Spending off-duty time with children and families b. Asking questions if families are not participating in the care c. Clarifying information for families d. Buying toys for a hospitalized child e. Learning about the family's religious preferences

ANS: B, C, E Asking questions if families are not participating in the care, clarifying information for families, and learning about the family's religious preferences are positive actions and foster therapeutic relationships with children and families. Spending off-duty time with children and families and buying toys for a hospitalized child are negative actions and indicate overinvolvement with children and families, which is nontherapeutic. DIF: Cognitive Level: Understand REF: p. 8 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a sudden infant death syndrome incident? (Select all that apply.) a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness

ANS: B, C, E Certain groups of infants are at increased risk for SIDS: low birth weight, low Apgar scores, recent viral illness, and male sex. Breastfed infants and infants of average or above average weight are not at higher risk for SIDS.

A nurse is planning care for a Spanish-speaking child and family. The nurse speaks limited Spanish. Which interventions should the nurse plan when caring for this child and family? (Select all that apply.) a. Ask a visitor to interpret. b. Use a language-line telephone interpreter if a hospital interpreter is not available. c. Use written cards with common phrases in the Spanish language. d. Ask the family to provide an interpreter. e. When using a hospital interpreter, speak to the family not the interpreter.

ANS: B, C, E If a live interpreter is not available, the nurse should use a language line telephone interpreter. The nurse should use cards with common greetings, phrases, and names of body parts in the familys language. When using a hospital interpreter, the nurse should speak directly to the family and allow the interpreter to translate. Visitors or other family members should not be used as interpreters because of the risk of misinterpretation of medical terms.

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.) a. Positioning child on the right side b. Assessing the chest tube and drainage device for correct settings c. Administering prescribed doses of analgesia d. Clamping the chest tube when child ambulates e. Monitoring for need of supplemental oxygen

ANS: B, C, E Nursing care of the child with a chest tube requires close attention to respiratory status; the chest tube and drainage device used are monitored for proper function (i.e., drainage is not impeded, vacuum setting is correct, tubing is free of kinks, dressing covering chest tube insertion site is intact, water seal is maintained, and chest tube remains in place). Movement in bed and ambulation with a chest tube are encouraged according to the child's respiratory status, but children require frequent doses of analgesia. Supplemental oxygen may be required in the acute phase of the illness and may be administered by nasal cannula, face mask, flow-by, or face tent. The child should be positioned on the left side, not the right. Lying on the affected side if the pneumonia is unilateral ("good lung up") splints the chest on that side and reduces the pleural rubbing that often causes discomfort. The chest tube should never be clamped; this can cause a pneumothorax. The chest tube should be maintained to the underwater seal at all times.

Which screening tests should the school nurse perform for the adolescent? (Select all that apply.) a. Glucose b. Vision c. Hearing d. Cholesterol e. Scoliosis

ANS: B, C, E The school nurse should perform vision, hearing, and scoliosis screening tests according to the school district's required schedule. Glucose and cholesterol screening would be performed in the medical clinic setting. DIF: Cognitive Level: Apply REF: p. 461 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

Which should the nurse teach to parents of toddlers about accidental poison prevention? (Select all that apply.) a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants.

ANS: B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, know the number of the nearest poison control center, and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances.

The nurse is teaching a group of parents at a community education program about introducing solid foods to their infants. Which recommendations should the nurse include? (Select all that apply.) a. Spoon feeding should be introduced after an entire milk feeding. b. It is best to introduce a wide variety of foods during the first year. c. As solid food consumption increases, the quantity of milk should decrease. d. Introduction of low-calorie milk and food should be done by the end of the first year. e. Introduction of citrus fruits, meats, and eggs should be delayed until after 6 months of age. f. Each new food item should be introduced at 5- to 7-day intervals.

ANS: B, C, E, F Teaching related to feeding an infant solid foods should include introducing a wide variety of foods because an infant has not developed a strong food preference as seen with a toddler. As solid food consumption increases, the amount of milk consumed should decrease to less than 1 L/day to prevent overfeeding. Introduction to citrus fruits, meats, and eggs should be delayed until after 6 months of age because of the potential to cause food allergies. New foods should be introduced at 5- to 7-day intervals to evaluate for food allergies. Spoon feedings should be introduced after a small ingestion of milk, not at the end of a milk feeding, to associate the activity with pleasure. In general, low-calorie milk and food should be avoided.

4. A nurse is preparing to administer routine immunizations to a 4-month-old infant. The infant is currently up to date on all previously recommended immunizations. Which immunizations will the nurse prepare to administer? (Select all that apply.) a. Measles, mumps, and rubella (MMR) b. Rotavirus (RV) c. Diphtheria, tetanus, pertussis (DTaP) d. Varicella e. Haemophilus influenzae type b (HIB) f. Inactivated poliovirus (IPV)

ANS: B, C, E, F Recommended immunization schedule for a 4-month-old, up to date on immunizations, would be to administer the rotavirus (RV), diphtheria, tetanus, pertussis (DTaP), Haemophilus influenza type b (HIB), and inactivated poliovirus (IPV) vaccinations. The measles, mumps, and rubella (MMR) and varicella would not be administered until the child is at least 1 year of age.

A nurse is preparing to administer routine immunizations to a 4-month-old infant. The infant is currently up to date on all previously recommended immunizations. Which immunizations will the nurse prepare to administer? (Select all that apply.) a. Measles, mumps, and rubella (MMR) b. Rotavirus (RV) c. Diphtheria, tetanus, pertussis (DTaP) d. Varicella e. Haemophilus influenzae type b (HIB) f. Inactivated poliovirus (IPV)

ANS: B, C, E, F Recommended immunization schedule for a 4-month-old, up to date on immunizations, would be to administer the rotavirus (RV), diphtheria, tetanus, pertussis (DTaP), Haemophilus influenza type b (HIB), and inactivated poliovirus (IPV) vaccinations. The measles, mumps, and rubella (MMR) and varicella would not be administered until the child is at least 1 year of age.

Which behaviors by the nurse indicate therapeutic nurse-family boundaries? (Select all that apply.) a. Nurse visits family on days off. b. House rules are negotiated. c. Nurse buys child expensive gifts. d. Communication is open and two-way.

ANS: B, D A home care nurse can establish therapeutic nurse-family boundaries by negotiating house rules and ensuring that communication is open and two-way. Visiting the family of off-duty days and buying expensive gifts for the child would be boundary crossing and nontherapeutic. DIF: Cognitive Level: Analyze REF: p. 8 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity

Characteristics of bullies include what? (Select all that apply.) a. Female b. Depressed c. Good peer relationships d. Poor academic performance e. Exposed to domestic violence

ANS: B, D, E Children who are bullies are likely to be male, depressed, have poor academic performance, be exposed to domestic violence, have poor peer relationships, and have poor communication with their parents.

The community health nurse is reviewing risk factors for vitamin D deficiency. Which children are at high risk for vitamin D deficiency? (Select all that apply.) a. Children with fair pigmentation b. Children who are overweight or obese c. Children who are exclusively bottle fed d. Children with diets low in sources of vitamin D e. Children of families who use milk products not supplemented with vitamin D

ANS: B, D, E Populations at risk for vitamin D deficiency include overweight or obese children, children with diets low in sources of vitamin D, and children of families who use milk products not supplemented with vitamin D. Children with dark, not fair, pigmentation and children who are exclusively breast fed, not bottle fed, are also at risk.

3. A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.) a. Weight loss b. Facial edema c. Cloudy smoky brown-colored urine d. Fatigue e. Frothy-appearing urine

ANS: B, D, E A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome. PTS: 1 DIF: Cognitive Level: Apply REF: 914 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

6. A nurse is teaching a parent about introduction of solid foods into an infant's diet. Which should the nurse include in the teaching session? (Select all that apply.) a. Solid food introduction can be started at 2 months of age. b. Rice cereal is introduced first. c. Begin the introduction of solid foods by mixing with formula in the bottle. d. Introduce egg white in small quantities (1 tsp) toward the end of the first year. e. Introduce one food at a time, usually at interval of 4 to 7 days.

ANS: B, D, E Rice cereal, because of its low allergenic potential, is the first solid food introduced to an infant at 4 to 6 months of age. Introduce one food at a time, usually at intervals of 4 to 7 days, to identify food allergies. Introduce egg white in small quantities (1 tsp) toward the end of the first year to detect an allergy. Solid food introduction should be started at 4 to 6 months of age. Never introduce foods by mixing them with the formula in a bottle.

A nurse is teaching a parent about introduction of solid foods into an infant's diet. Which should the nurse include in the teaching session? (Select all that apply.) a. Solid food introduction can be started at 2 months of age. b. Rice cereal is introduced first. c. Begin the introduction of solid foods by mixing with formula in the bottle. d. Introduce egg white in small quantities (1 tsp) toward the end of the first year. e. Introduce one food at a time, usually at intervals of 4 to 7 days.

ANS: B, D, E Rice cereal, because of its low allergenic potential, is the first solid food introduced to an infant at 4 to 6 months of age. Introduce one food at a time, usually at intervals of 4 to 7 days, to identify food allergies. Introduce egg white in small quantities (1 tsp) toward the end of the first year to detect an allergy. Solid food introduction should be started at 4 to 6 months of age. Never introduce foods by mixing them with the formula in a bottle.

The nurse is preparing to admit a 5-year-old child who developed lesions of varicella (chickenpox) 3 days ago. Which clinical manifestations of varicella should the nurse expect to observe? (Select all that apply.) a. Nonpruritic rash b. Elevated temperature c. Discrete rose pink rash d. Vesicles surrounded by an erythematous base e. Centripetal rash in all three stages (papule, vesicle, and crust)

ANS: B, D, E The clinical manifestations of varicella include elevated temperature, vesicles surrounded by an erythematous base, and a centripetal rash in all three stages (papule, vesicle, and crust). The rash is pruritic, and a discrete pink rash is seen with exanthema subitum, not varicella.

The nurse is preparing to admit a 1-year-old child with pertussis (whooping cough). Which clinical manifestations of pertussis should the nurse expect to observe? (Select all that apply.) a. Earache b. Coryza c. Conjunctivitis d. Low-grade fever e. Dry hacking cough ANS: B, D, E

ANS: B, D, E The clinical manifestations of pertussis include coryza, a low-grade fever, and a dry hacking cough. The child does not have an earache or conjunctivitis.

The nurse is talking to a parent of an infant with severe atopic dermatitis (eczema). Which response(s) should the nurse reinforce with the parent? (Select all that apply.) a. "You can use warm wet compresses to relieve discomfort." b. "You will need to keep your infant's skin well hydrated by using a mild soap in the bath." c. "You should bathe your baby in a bubble bath two times a day." d. "You will need to prevent your baby from scratching the area by using a mild antihistamine." e. "You can try a fabric softener in the laundry to avoid rough cloth." f. "You should apply an emollient to the skin immediately after a bath."

ANS: B, D, F The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection; an antihistamine can be used. Keeping the skin hydrated is a goal of treating atopic dermatitis. Applying an emollient immediately after a bath helps to trap moisture and prevent moisture loss. Cool wet compresses should be used for relief. Bubble baths and harsh soaps should be avoided, as is bathing excessively, since this leads to drying. Fabric softener should be avoided because of the irritant effects of some of its components.

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.) a. SIDS b. Torticollis c. Failure to thrive d. Apnea of infancy e. Plagiocephaly

ANS: B, E Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. The sternocleidomastoid muscle may tighten on the affected side, causing torticollis. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.

In terms of language and cognitive development, a 4-year-old child would be expected to have which traits? (Select all that apply.) a. Think in abstract terms. b. Follow directional commands. c. Understand conservation of matter. d. Use sentences of eight words. e. Tell exaggerated stories. f. Comprehend another person's perspective.

ANS: B, E Children ages 3 to 4 years can give and follow simple commands and tell exaggerated stories. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. Five-year-old children use sentences with eight words with all parts of speech. A 4-year-old child cannot comprehend another's perspective. DIF: Cognitive Level: Apply REF: p. 383 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.) a. SIDS b. Torticollis c. Failure to thrive d. Apnea of infancy e. Plagiocephaly

ANS: B, E Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. The sternocleidomastoid muscle may tighten on the affected side, causing torticollis. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.

Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.) a. Ability to stay connected without spending time together b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit e. Ability to engage in problem-solving activities f. Sense of balance between the use of internal and external family resources

ANS: B, E, F A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.) a. Ability to stay connected without spending time together b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit e. Ability to engage in problem-solving activities f. Sense of balance between the use of internal and external family resources

ANS: B, E, F A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boys birthday is close to the cut-off date, and he has not attended preschool. What is the nurses best recommendation? a. Start kindergarten. b. Talk to other parents about readiness. c. Perform a developmental screening. d. Postpone kindergarten and go to preschool.

ANS: C A developmental assessment with a screening tool that addresses cognitive, social, and physical milestones can help identify children who may need further assessment. A readiness assessment involves an evaluation of skill acquisition. Stating the child should start kindergarten or go to preschool and postpone kindergarten does not address the fathers concerns about readiness for school. Talking to other parents about readiness does not ascertain if the child is ready and does not address the fathers concerns.

16. What is most descriptive of atopic dermatitis (AD) (eczema) in an infant? a. Easily cured b. Worse in humid climates c. Associated with hereditary allergies d. Related to upper respiratory tract infections

ANS: C AD is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. Approximately 50% of children with AD develop asthma. AD can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. AD is not associated with respiratory tract infections.

The nurse is performing an assessment on a 12-month-old infant. Which fine or gross motor developmental skill demonstrates the proximodistal acquisition of skills? a. Standing b. Sitting without assistance c. Fully developed pincer grasp d. Taking a few steps holding onto something

ANS: C Acquisition of fine and gross motor skills occurs in an orderly center-to-periphery (proximodistal) or head-to-toe (cephalocaudal) sequence. A fully developed pincer grasp is an example of the proximodistal development because infants use a palmar grasp before developing the finer pincer grasp. Standing, sitting without assistance, and taking a few steps are examples of a cephalocaudal development sequence.

During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner? a. Respond to name. b. React to loud noise with Moro reflex. c. Turn his or her head to side when sound is at ear level. d. Locate sound by turning his or her head in a curving arc.

ANS: C At 2 months of age, an infant should turn his or her head to the side when a noise is made at ear level. At birth, infants respond to sound with a startle or Moro reflex. An infant responds to his or her name and locates sounds by turning his or her head in a curving arc at age 6 to 9 months.

The child of 15 to 30 months is likely to be struggling with which developmental task? a. Trust b. Initiative c. Autonomy d. Intimacy

ANS: C Autonomy vs shame and doubt is the developmental task of toddlers. Trust vs mistrust is the developmental stage of infancy. Initiative vs guilt is the developmental stage of early childhood. Intimacy and solidarity vs isolation is the developmental stage of early adulthood.

10. At which age should the nurse expect most infants to begin to say mama and dada with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

ANS: C Beginning at about age 10 months, an infant is able to ascribe meaning to the words mama and dada. Four to 6 months is too young for this behavior to develop. At 14 months, the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words.

A parent asks the nurse "at what age do most infants begin to fear strangers?" The nurse should give which response? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation-individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age

A female school-age child asks the school nurse, How many pounds should I expect to gain in a year? The nurse should give which response? a. You will gain about 2.4 to 4.6 lb per year b. You will gain about 3.4 to 5.6 lb per year. c. You will gain about 4.4 to 6.6 lb per year. d. You will gain about 5.5 to 7.6 lb per year.

ANS: C Between the ages of 6 and 12 years, children will almost double in weight, increasing 2 to 3 kg (4.4 to 6.6 lb) per year.

In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. What should the nurse recognize in this situation? a. Blocks at this age are used primarily for throwing b. Toddlers are too young to imitate the behavior of others c. Toddlers are capable of building a tower of blocks d. Toddlers are too young to build a tower of blocks

ANS: C Building with blocks is a good parent-child interaction. The 18-month-old child is capable of building a tower of three or four blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. The 18-month-old child imitates others around him or her.

Developmentally, what should most children at age 12 months be able to do? a. Use a spoon adeptly b. Relinquish the bottle voluntarily c. Eat the same food as the rest of the family d. Reject all solid food in preference to the bottle

ANS: C By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and be weaned from the bottle totally by 14 months. The child should be weaned from a milk- or formula-based diet to a balanced diet that includes iron-rich sources of food.

The nurse is examining an infant, age 10 months, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions. What is the most likely cause? a. Impetigo b. Urine and feces c. Candida albicans infection d. Infrequent diapering

ANS: C C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper but sparing the folds are likely to be caused by chemical irritation, especially urine and feces, and may be related to infrequent diapering.

A new parent asks the nurse, How can diaper rash be prevented? What should the nurse recommend? a. Wash the infant with soap before applying a thin layer of oil. b. Clean the infant with soap and water every time diaper is changed. c. Wipe stool from the skin using water and a mild cleanser. d. When changing the diaper, wipe the buttocks with oil and powder the creases.

ANS: C Change the diaper as soon as it becomes soiled. Gently wipe stool from the skin with water and mild soap. The skin should be thoroughly dried after washing. Applying oil does not create an effective barrier. Over washing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating. Baby powder should not be used because of the danger of aspiration.

Parent guidelines for relieving colic in an infant include: a. avoiding touching abdomen. b. avoiding using a pacifier. c. changing infant's position frequently. d. placing infant where family cannot hear the crying.

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

Which describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

The parents of 9-year-old twin children tell the nurse, They have filled up their bedroom with collections of rocks, shells, stamps, and bird nests. The nurse should recognize that this is which? a. Indicative of giftedness b. Indicative of typical twin behavior c. Characteristic of cognitive development at this age d. Characteristic of psychosocial development at this age

ANS: C Classification skills involve the ability to group objects according to the attributes they have in common. School-age children can place things in a sensible and logical order, group and sort, and hold a concept in their mind while they make decisions based on that concept. Individuals who are not twins engage in classification at this age. Psychosocial behavior at this age is described according to Eriksons stage of industry versus inferiority.

According to evidenced based practice in a recent Cochrane database, which statement is most accurate with regard to the relationship between vitamin A and measles? A. It is correlated with an increased risk of blindness. B. Vitamin A supplementation should not be provided to children who have measles. C. There was no correlation between blindness in children who had measles and who also had vitamin A deficiency. D. Vitamin A supplementation in children with measles will lead to blindness.

ANS: C Current research in Cochrane database reveals there is no relationship between ocular morbidities (blindness) and vitamin A deficiency in children who have measles. Research indicates that vitamin A supplementation can be given to children who have measles with no adverse outcomes.

An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents? a. "Did you hear the infant cry out?" b. "Why didn't you check on the infant earlier?" c. "What time did you find the infant?" d. "Was the head buried in a blanket?"

ANS: C During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as "Why didn't you go in earlier?" "Didn't you hear the infant cry out?" "Was the head buried in a blanket?"

A nurse is conducting a teaching session for parents of infants. The nurse explains that which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

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

Although a 14-month-old girl received a shock from an electric outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of the inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age. Trying to put things into an outlet is typical behavior for a toddler. Only some awareness exists of a causal relation between events.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb sucking. What should the nurse's reply be based on? A. A pacifier should be substituted for the thumb. B. Thumb sucking should be discouraged by age 12 months. C. Thumb sucking should be discouraged when permanent teeth begin to erupt. D. There is no need to restrain nonnutritive sucking during infancy.

ANS: C Evolve says the answer is C but it is also D Thumb sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Evidence is inconclusive over whether a pacifier or a thumb better satisfies sucking needs and what the impact of either is on tooth eruption.

A new parent relates to the nurse that the family has many known food allergies. Which is considered a primary strategy for feeding the infant with many family food allergies? a. Using soy formula for feeding b. Maternal avoidance of cows milk protein c. Exclusive breastfeeding for 4 to 6 months d. Delaying the introduction of highly allergenic foods past 6 months

ANS: C Exclusive breastfeeding for 4 to 6 months is now considered a primary strategy for avoiding atopy in families with known food allergies; however, there is no evidence that maternal avoidance (during pregnancy or lactation) of cows milk protein or other dietary products known to cause food allergy will prevent food allergy in children. Researchers indicate that delaying the introduction of highly allergenic foods past 4 to 6 months of age may not be as protective for food allergy as previously believed. Likewise, studies have shown that soy formula does not prevent allergic disease in infants.

An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of defective utilization. The nurse understands that the reason for the FTT is most likely related to what? a. Cystic fibrosis b. Hyperthyroidism c. Congenital infection d. Breastfeeding problems

ANS: C FTT classified according to the pathophysiology of defective utilization is related to a genetic anomaly, congenital infection of metabolic storage disease. Cystic fibrosis would be related to the pathophysiology of inadequate absorption, hyperthyroidism would be related to the pathophysiology of increased metabolism, and breastfeeding problems are related to inadequate caloric intake.

Rickets is caused by a deficiency in: a. vitamin A. b. vitamin C. c. vitamin D and calcium. d. folic acid and iron.

ANS: C Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the development of rickets. No correlation exists between vitamins A, C, folic acid, or iron and rickets.

The parent of a 2-week-old infant, exclusively breastfed, asks the nurse if fluoride supplements are needed. What is the nurse's best response? 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 4 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 4 months if the child is not drinking adequate amounts of fluoridated water. The amount of water that is ingested and the amount of fluoride in the water are taken into account when supplementation is being considered.

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

ANS: 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. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

A nurse is assessing a 12-month-old infant. Which statement best describes the infant's physical development a nurse should expect to find? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

At a well-child visit, parents ask the nurse how to know if a daycare facility is a good choice for their infant. Which observation should the nurse stress as especially important to consider when making the selection? a. Developmentally appropriate toys b. Nutritious snacks served to the children c. Handwashing by providers after diaper changes d. Certified caregivers for each of the age groups at the facility

ANS: C Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when handwashing and other hygienic measures are not consistently used. Developmentally appropriate toys are important, but hygiene and the prevention of disease transmission take precedence. An infant should not have snacks. This is a concern for an older child. Certified caregivers for each age group may be an indicator of a high-quality facility, but parental observation of good hygiene is a better predictor of care.

Parents report that they have been giving a multivitamin to their 1-year-old infant. The nurse counsels the parents that which vitamin can cause a toxic reaction at a low dose? a. Niacin b. B6 c. D d. C

ANS: C Hypervitaminosis of vitamin D presents the greatest problem because this fat-soluble vitamin is stored in the body. Vitamin D is the most likely of all vitamins to cause toxic reactions in relatively small overdoses. The water-soluble vitamins, primarily niacin, B6, and C, can also cause toxicity but not at the low dose that occurs with vitamin D.

According to Piaget, the 6-month-old infant should be in which developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. 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.

An infant weighed 8 lb at birth and was 18 inches in length. What weight and length should the infant be at 5 months of age? a. 12 lb, 20 inches b. 14 lb, 21.5 inches c. 16 lb, 23 inches d. 18 lb, 24.5 inches

ANS: C Infants gain 680 g (1.5 lb) per month until age 5 months, when the birth weight has at least doubled. Height increases by 2.5 cm (1 inch) per month during the first 6 months. Therefore, at 5 months the infant should weigh 16 lb and be 23 inches in length.

By which age should the nurse expect an infant to be able to pull to a standing position? a. 6 months b. 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs. Any infant who cannot pull to a standing position by age 1 year should be referred for further evaluation.

A nurse planning care for a school-age child should take into account that which thought process is seen at this age? a. Animism b. Magical thinking c. Ability to conserve d. Thoughts are all-powerful

ANS: C One cognitive task of school-age children is mastering the concept of conservation. At an early age (5 to 7 years), children grasp the concept of reversibility of numbers as a basis for simple mathematics problems (e.g., 2 + 4 = 6 and 6 - 4 = 2). They learn that simply altering their arrangement in space does not change certain properties of the environment, and they are able to resist perceptual cues that suggest alterations in the physical state of an object. Animism, magical thinking, and believing that thoughts are all powerful are thought processes seen in preschool children.

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 at this age. d. characteristic of children who later are at risk for membership in gangs.

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. 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. A boys-only club does not have a direct correlation with later gang activity.

Parents need further teaching about the use of car safety seats if they make which statement? a. "Even if our toddler helps buckle the straps, we will double-check the fastenings." b. "We won't start the car until everyone is properly restrained." c. "We won't need to use the car seat on short trips to the store." d. "We will anchor the car seat to the car's anchoring system."

ANS: C Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings; do not start the car until everyone is properly restrained; and anchor the car safety seat securely to the car's anchoring system and apply the harness snugly to the child.

A parent asks about whether a 7-year-old child is able to care for a dog. Based on the childs age, what does the nurse suggest? a. Caring for an animal requires more maturity than the average 7-year-old possesses. b. This will help the parent identify the childs weaknesses. c. A dog can help the child develop confidence and emotional health. d. Cats are better pets for school-age children.

ANS: C Pets have been observed to influence a childs self-esteem. They can have a positive effect on physical and emotional health and can teach children the importance of nurturing and nonverbal communication. Most 7-year-old children are capable of caring for a pet with supervision. Caring for a pet should be a positive experience. It should not be used to identify weaknesses. The pet chosen does not matter as much as the childs being responsible for a pet.

A middle age child understands that with regards to a mathematical equation that 7 can be composed of 4+3 as well as 2+5. Based on this finding, the nurse documents that the development level of the child reflects? A. Concrete operations B. Verification of latency period C. Conservation D. Accomplished industry versus inferiority

ANS: C Piaget's cognitive theory development describes conservation as the ability of the child to understand that the same concept may exist as identified by a different method. Numerical relationships are understood before substance conservation. Concrete operations is the term Piaget applies to the entire stage whereby children are able to use thought processes to experience events and actions. The latency period is described by Freud as the ability of the child to go from peer relationships to heterosexual relationships. Industry versus inferiority refers to Erikson's overview of this time frame whereby children if successful master the challenges between industry and inferiority.

A 4-year-old child tells the nurse that she doesnt want another blood sample drawn because I need all of my insides and I dont want anyone taking them out. What is the nurses best interpretation of this? a. The child is being overly dramatic. b. The child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

ANS: C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at this age. She truly has fear. Body image is just developing in school-age children. Preschoolers do not have good understanding of their bodies.

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

ANS: C Puberty signals the beginning of the development of secondary sex characteristics. This begins earlier in girls than in boys. Usually a 2-year difference occurs in the age of onset. Girls and boys do not usually begin puberty at the same age. Girls generally begin puberty 2 years earlier than boys.

A 1-year-old child is on a pure vegetarian (vegan) diet. This diet requires supplementation with what? a. Niacin b. Folic acid c. Vitamins D and B12 d. Vitamins C and E

ANS: C Pure vegetarian (vegan) diets eliminate any food of animal origin, including milk and eggs. These diets require supplementation with many vitamins, especially vitamin B6, vitamin B12, riboflavin, vitamin D, iron, and zinc. Niacin, folic acid, and vitamins C and E are readily obtainable from foods of vegetable origin.

A toddler is exploring the environment but returns to his mother within a few minutes of exploration. This finding would be noted as an example of A. separation anxiety. B. separation. C. rapprochement. D. individuation.

ANS: C Rapprochement occurs when the child returns to the mother for reassurance following exploration of the environment. Separation anxiety is when the child experiences anxiety based on separation from the parent or significant figure. Separation refers to the emergence of the child as a separate figure from the mother or parent. Individuation refers to the emergence of the child by expressing their own individual characteristic.

In terms of gross motor development, what should the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from the back to the abdomen. c. Turn from the abdomen to the back. d. Move from a prone to a sitting position.

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

What does the nurse understand about caloric needs for school-age children? a. The caloric needs for the school-age children are the same as for other age groups. b. The caloric needs for school-age children are more than they were in the preschool years. c. The caloric needs for school-age children are lower than they were in the preschool years. d. The caloric needs for school-age children are greater than they will be in the adolescent years.

ANS: C School-age children do not need to be fed as carefully, as promptly, or as frequently as before. Caloric needs are lower than they were in the preschool years and lower than they will be during the coming adolescent growth spurt.

What statement best describes the relationship school-age children have with their families? a. Ready to reject parental controls b. Desire to spend equal time with family and peers c. Need and want restrictions placed on their behavior by the family d. Peer group replaces the family as the primary influence in setting standards of behavior and rules

ANS: C School-age children need and want restrictions placed on their behavior, and they are not prepared to cope with all the problems of their expanding environment. Although increased independence is the goal of middle childhood, they feel more secure knowing that an authority figure can implement controls and restriction. In the middle school years, children prefer peer group activities to family activities and want to spend more time in the company of peers. Family values usually take precedence over peer value systems.

The nurse is teaching a class on nutrition to a group of parents of 10- and 11-year-old children. What statement by one of the parents indicates a correct understanding of the teaching? a. My child does not need to eat a variety of foods, just his favorite food groups. b. My child can add salt and sugar to foods to make them taste better. c. I will serve foods that are low in saturated fat and cholesterol. d. I will continue to serve red meat three times per week for extra iron.

ANS: C School-age children should be eating foods that are low in saturated fat and cholesterol to prevent long-term consequences. The childs diet should include a variety of foods, include moderate amounts of extra salt and sugar, emphasize consumption of lean protein (chicken and pork), and limit red meat.

8. At what age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

Which intervention is the most appropriate recommendation for relief of teething pain? a. Rub gums with aspirin to relieve inflammation. b. Apply hydrogen peroxide to gums to relieve irritation. c. Give the infant a frozen teething ring to relieve inflammation. d. Have the infant chew on a warm teething ring to encourage tooth eruption.

ANS: C Teething pain is a result of inflammation, and cold is soothing. A frozen teething ring or ice cube wrapped in a washcloth helps relieve the inflammation. Aspirin is contraindicated secondary to the risks of aspiration. Hydrogen peroxide does not have an anti-inflammatory effect. Warmth increases inflammation.

The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

The school nurse is teaching female school-age children about the average age of puberty. What is the average age of puberty for girls? a. 10 years b. 11 years c. 12 years d. 13 years

ANS: C The average age of puberty is 12 years in girls.

The school nurse is teaching male school-age children about the average age of puberty. What is the average age of puberty for boys? a. 12 years b. 13 years c. 14 years d. 15 years

ANS: C The average age of puberty is 14 years in boys. Boys experience little sexual maturation during preadolescence.

At what age does an infant start to recognize familiar faces and objects, such as a feeding bottle? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is able to anticipate feeding after seeing the bottle.

At which age does an infant start to recognize familiar faces and objects, such as his or her own hand? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is beginning to develop handeye coordination.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation? a. Punish the child. b. Leave the child alone until the tantrum is over. c. Remain close by the child but without eye contact. d. Explain to child that this is wrong.

ANS: C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common in toddlers as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The parent's presence is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

An infant experienced an apparent life-threatening event (ALTE) and is being placed on home apnea monitoring. Parents have understood the instructions for use of a home apnea monitor when they state: a. "We can adjust the monitor to eliminate false alarms." b. "We should sleep in the same bed as our monitored infant." c. "We will check the monitor several times a day to be sure the alarm is working." d. "We will place the monitor in the crib with our infant."

ANS: C The parents should check the monitor several times a day to be sure the alarm is working and that it can be heard from room to room. The parents should not adjust the monitor to eliminate false alarms. Adjustments could compromise the monitor's effectiveness. The monitor should be placed on a firm surface away from the crib and drapes. The parents should not sleep in the same bed as the monitored infant.

A 2-year-old child has recently started having temper tantrums where breath holding occurs and occasionally fainting. The most appropriate action by the nurse is to A. refer the child for a respiratory evaluation. B. refer the child for a psychological evaluation. C. explain to the parent that this is not harmful. D. explain to the parent that the child is spoiled.

ANS: C The rising carbon dioxide levels restart the breathing process when a child holds his or her breath; therefore, the process is self-limiting and not harmful. A respiratory evaluation is not indicated for this toddler. Temper tantrums are part of this developmental stage as the toddler asserts his or her independence. A psychological evaluation is not warranted. Temper tantrums are part of this developmental stage as the toddler asserts independence. There are no data to indicate that the child is spoiled.

The nurse notices that a toddler is more cooperative taking medicine from a small cup than from a large cup. This is an example of which characteristic of preoperational thought? A. Egocentrism B. Irreversibility C. Inability to conserve D. Transductive reasoning

ANS: C The smaller cup makes it look like less medicine to the child at this stage of cognitive development. The inability to see situations from other perspectives, besides their own, does not facilitate medication administration. The inability to reverse or undo actions physically initiated does not facilitate medication administration. Focusing on particulars does not explain the cooperation with the smaller medication cup.

The nurse is explaining about the developmental sequence in childrens capacity to conserve matter to a group of parents. What type of matter is last in the sequence for a child to develop? a. Mass b. Length c. Volume d. Numbers

ANS: C There is a developmental sequence in childrens capacity to conserve matter. Children usually grasp conservation of numbers (ages 5 to 6 years) before conservation of substance. Conservation of liquids, mass, and length usually is accomplished at about ages 6 to 7 years, conservation of weight sometime later (ages 9 to 10 years), and conservation of volume or displacement last (ages 9 to 12 years).

What should the nurse suggest to the parents of an infant who has a prolonged need for middle-of-the-night feedings? a. Decrease daytime feedings. b. Allow child to go to sleep with a bottle. c. Offer last feeding as late as possible at night. d. Put infant to bed after asleep from rocking.

ANS: C To manage an infant who has a prolonged need for middle-of-the-night feedings parents should be taught to offer last feeding as late as possible at night. Parent should increase daytime feeding intervals to 4 hours or more (may need to be done gradually), offer no bottles in bed, put to bed awake and when child is crying, check at progressively longer intervals each night; reassure child but do not hold, rock, take to parent's bed, or give bottle or pacifier.

What developmental characteristic does not occur until a child reaches age 2 1/2 years? a. Birth weight has doubled. b. Anterior fontanel is still open. c. Primary dentition is complete. d. Binocularity may be established.

ANS: C Usually by age 30 months, the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

Parents ask the nurse, How should we deal with our toddlers regression since our new baby has come home? The nurse should give the parents which response? a. Introduce new areas of learning. b. Use time-out as punishment when regression occurs. c. Ignore the behavior and praise appropriate behavior. d. Explain to the toddler that the behavior is not acceptable.

ANS: C When regression does occur, the best approach is to ignore it while praising existing patterns of appropriate behavior. It is advisable not to introduce new areas of learning when an additional crisis is present or expected, such as beginning toilet training shortly before a sibling is born or during a brief hospitalization. Time-out should not be used as a punishment, and the toddler does not have the cognitive ability to understand an explanation that the behavior is not acceptable.

15. When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: a. is lacking in protein. b. indicates they live in poverty. c. may provide sufficient amino acids. d. should be enriched with meat and milk.

ANS: C A diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Combinations of foods contain the essential amino acids necessary for growth. Many cultures use diets that contain this combination of foods. It is not indicative of poverty. A dietary assessment should be done, but many vegetarian diets are sufficient for growth. DIF: Cognitive Level: Application REF: p. 135 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The nurse is taking care of a 2-year-old child with a macule skin lesion. Which clinical finding should the nurse expect to assess with this type of lesion? a. Flat, nonpalpable, and irregularly shaped lesion that is greater than 1 cm in diameter b. Heaped-up keratinized cells, flaky exfoliation, irregular, thick or thin, dry or oily, varied in size c. Flat, brown mole less than 1 cm in diameter d. Elevated, flat-topped, firm, rough, superficial papule greater than 1 cm in diameter

ANS: C A macule is flat; nonpalpable; circumscribed; less than 1 cm in diameter; and brown, red, purple, white, or tan. A patch is a flat, nonpalpable, and irregularly shaped macule that is greater than 1 cm in diameter. Scale is heaped-up keratinized cells, flaky exfoliation, irregular, thick or thin, dry or oily, varied in size, and silver white or tan. A plaque is an elevated, flat-topped, firm, rough, superficial papule greater than 1 cm in diameter. It may be coalesced papules.

Which nursing consideration is important when caring for a child with impetigo contagiosa? a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications. This is done by thorough hand washing before and after contact with the affected child. Corticosteroids are not indicated in bacterial infections. Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states, such as tinea capitis.

33. When auscultating an infant's lungs, the nurse detects diminished breath sounds. The nurse should interpret this as which of the following? a. Suggestive of chronic pulmonary disease b. Suggestive of impending respiratory failure c. An abnormal finding warranting investigation d. A normal finding in infants less than 1 year of age

ANS: C Absent or diminished breath sounds are always an abnormal finding. Fluid, air, or solid masses in the pleural space all interfere with the conduction of breath sounds. Further data are necessary for diagnosis of chronic pulmonary disease or impending respiratory failure. Diminished breath sounds in certain segments of the lungs can alert the nurse to pulmonary areas that may benefit from chest physiotherapy. Further evaluation is needed in all age-groups. DIF: Cognitive Level: Comprehension REF: p. 165 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The single parent of a 3-year-old child who has just been diagnosed with chickenpox tells the nurse that she cannot afford to stay home with the child and miss work. The parent asks the nurse if some medication will shorten the course of the illness. Which is the most appropriate nursing intervention? a. Reassure the parent that it is not necessary to stay home with the child. b. Explain that no medication will shorten the course of the illness. c. Explain the advantages of the medication acyclovir (Zovirax) to treat chickenpox. d. Explain the advantages of the medication VCZ immune globulin (VariZIG) to treat chickenpox.

ANS: C Acyclovir is effective in treating the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. It is important the parent stay with the child to monitor fever. Acyclovir lessens the severity of chickenpox. VariZIG is given only to high-risk children.

A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many "mood swings" throughout the day. How should the nurse interpret this behavior? a. Requires a referral to a mental health counselor b. Requires some further lab testing c. It is normal behavior d. Related to feelings of depression

ANS: C Adolescents vacillate in their emotional states between considerable maturity and childlike behavior. One minute they are exuberant and enthusiastic; the next minute they are depressed and withdrawn. Because of these mood swings, adolescents are frequently labeled as unstable, inconsistent, and unpredictable, but the behavior is normal. The behavior would not require a referral to a mental health counselor or further lab testing. The mood swings do not indicate depression. DIF: Cognitive Level: Understand REF: p. 449 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

When is it generally recommended that a child with acute streptococcal pharyngitis may return to school? a. When sore throat is better. b. If no complications develop. c. After taking antibiotics for 24 hours. d. After taking antibiotics for 3 days.

ANS: C After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

Which play is most typical of the preschool period? a. Solitary b. Parallel c. Associative d. Team

ANS: C Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams. DIF: Cognitive Level: Understand REF: p. 383 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The child of 15 to 30 months is likely to be struggling with which developmental task? a. Trust b. Initiative c. Autonomy d. Intimacy

ANS: C Autonomy vs shame and doubt is the developmental task of toddlers. Trust vs mistrust is the developmental stage of infancy. Initiative vs guilt is the developmental stage of early childhood. Intimacy and solidarity vs isolation is the developmental stage of early adulthood. DIF: Cognitive Level: Remember REF: p. 355 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A parent reports to the nurse that her child has inflamed conjunctivae of both eyes with purulent drainage and crusting of the eyelids, especially on awakening. These manifestations suggest: a. viral conjunctivitis. b. allergic conjunctivitis. c. bacterial conjunctivitis. d. conjunctivitis caused by foreign body.

ANS: C Bacterial conjunctivitis has these symptoms. Viral or allergic conjunctivitis has watery drainage. Foreign body causes tearing and pain, and usually only one eye is affected.

A nurse is reviewing hormone changes that occur during adolescence. What is the hormone responsible for the growth of beard, mustache, and body hair in the male? a. Estrogen b. Pituitary c. Androgen d. Progesterone

ANS: C Beard, mustache, and body hair on the chest, upward along the linea alba, and sometimes on other areas (e.g., back and shoulders) appears in males and is androgen dependent. Estrogen and progesterone are produced by the ovaries in the female and do not contribute to body hair appearance in the male. The pituitary hormone does not have any relationship to body hair appearance in the male. DIF: Cognitive Level: Analyze REF: p. 448 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse manager at a home-care agency is planning a continuing education program for the home-care staff nurses. Which type of continuing education program should the nurse manager plan? a. On-line training modules b. A structured written teaching module each nurse completes individually c. A workshop training day, with a professional speaker, where nurses can interact with each other d. One-on-one continuing education training with each nurse

ANS: C Because of the unique practice environment of home care nurses, it is important for an agency to facilitate sharing among peers to decrease work-related stress, increase job satisfaction, and support high-quality patient care. On-line training, written teaching modules, and one-on-one training would not allow for any sharing with peers. DIF: Cognitive Level: Apply REF: p. 7 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

A nurse is assessing a preschool-age child and notes the child exhibits magical thinking. According to Piaget, which describes magical thinking? a. Events have cause and effect. b. God is like an imaginary friend. c. Thoughts are all-powerful. d. If the skin is broken, the child's insides will come out.

ANS: C Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all-powerful. Cause-and-effect implies logical thought, not magical thinking. Thinking God is like an imaginary friend is an example of concrete thinking in a preschooler's spiritual development. Thinking that if the skin is broken, the child's insides will come out is an example of concrete thinking in development of body image. DIF: Cognitive Level: Apply REF: p. 381 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

13. A parent asks the nurse "at what age do most infants begin to fear strangers?" The nurse should give which response? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation-individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. What should the nurse recognize in this situation? a. Blocks at this age are used primarily for throwing b. Toddlers are too young to imitate the behavior of others c. Toddlers are capable of building a tower of blocks d. Toddlers are too young to build a tower of blocks

ANS: C Building with blocks is a good parent-child interaction. The 18-month-old child is capable of building a tower of three or four blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. The 18-month-old child imitates others around him or her. DIF: Cognitive Level: Apply REF: p. 360 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Developmentally, what should most children at age 12 months be able to do? a. Use a spoon adeptly b. Relinquish the bottle voluntarily c. Eat the same food as the rest of the family d. Reject all solid food in preference to the bottle

ANS: C By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and be weaned from the bottle totally by 14 months. The child should be weaned from a milk- or formula-based diet to a balanced diet that includes iron-rich sources of food. DIF: Cognitive Level: Understand REF: p. 361 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Parent guidelines for relieving colic in an infant include: a. avoiding touching abdomen. b. avoiding using a pacifier. c. changing infant's position frequently. d. placing infant where family cannot hear the crying.

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

Which describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

18. With the National Center for Health Statistics criteria, which one of the following body mass index (BMI)-for-age percentiles would indicate the patient is at risk for being overweight? a. 10th percentile b. 75th percentile c. 85th percentile d. 95th percentile

ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits. DIF: Cognitive Level: Comprehension REF: p. 139 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The home health nurse asks a child's mother many questions as part of the assessment. The mother answers many questions, then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should take which action? a. Determine why the mother is so suspicious. b. Determine what the mother does not want to tell. c. Explain who will have access to the information. d. Explain that everything is confidential and that no one else will know what is said.

ANS: C Communication with the family should not be invasive. The nurse needs to explain the importance of collecting the information, its applicability to the child's care, and who will have access to the information. The mother is not being suspicious and is not necessarily withholding important information. She has a right to understand how the information she provides will be used. The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals. DIF: Cognitive Level: Apply REF: p. 9 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

A school nurse is teaching a group of preadolescent boys about puberty. By which age should concerns about pubertal delay be considered? a. 12 years b. 13 years c. 14 years d. 15 years

ANS: C Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes from to 14 years. Ages 12 to 13 years is too young for initial concern. DIF: Cognitive Level: Remember REF: p. 449 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

30. An appropriate screening test for hearing that the nurse can administer to a 5-year-old child is which of the following? a. Rinne test b. Weber test c. Conventional audiometry d. Eliciting the startle reflex

ANS: C Conventional audiometry is a behavioral test that measures auditory thresholds in response to speech and frequency-specific stimuli presented through earphones. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants. DIF: Cognitive Level: Comprehension REF: p. 161 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Maria, a Spanish-speaking 5-year-old girl, has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. Which description best explains Marias behavior? a. Lacks adequate culture for attending school b. Lacks the maturity needed in school c. Is experiencing culture shock d. Is experiencing minority group discrimination

ANS: C Culture shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Her inability to speak English inhibits her ability to interact. This would explain Marias inability to function in this new situation. There is no evidence to support that Maria lacks adequate culture or maturity needed in school, or that she is experiencing minority group discrimination.

An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents? a. "Did you hear the infant cry out?" b. "Why didn't you check on the infant earlier?" c. "What time did you find the infant?" d. "Was the head buried in a blanket?"

ANS: C During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as "Why didn't you go in earlier?" "Didn't you hear the infant cry out?" "Was the head buried in a blanket?"

12. A nurse is conducting a teaching session for parents of infants. The nurse explains that which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

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

Although a 14-month-old girl received a shock from an electric outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of the inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age. Trying to put things into an outlet is typical behavior for a toddler. Only some awareness exists of a causal relation between events. DIF: Cognitive Level: Understand REF: p. 356 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

19. What should injury prevention efforts emphasize during the preschool period? a. Constant vigilance and protection b. Punishment for unsafe behaviors c. Education for safety and potential hazards d. Limitation of physical activities

ANS: C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age because preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate. DIF: Cognitive Level: Understand REF: p. 390 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Safe and Effective Care Environment

Which drug is considered the most useful in treating childhood cardiac arrest? a. Bretylium tosylate (Bretylium) b. Lidocaine hydrochloride (Lidocaine) c. Epinephrine hydrochloride (Adrenaline) d. Naloxone (Narcan)

ANS: C Epinephrine works on alpha and beta receptors in the heart and is the most useful drug in childhood cardiac arrest. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine is used for ventricular arrhythmias only. Naloxone is useful only to reverse effects of opioids.

Vitamin A supplementation may be recommended for the young child who has which disease? a. Mumps b. Rubella c. Measles (rubeola) d. Erythema infectiosum

ANS: C Evidence shows vitamin A decreases morbidity and mortality in measles. Mumps is treated with analgesics for pain and antipyretics for fever. Rubella is treated similarly to mumps. Erythema infectiosum is treated similarly to mumps and rubella.

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Developmental systems theory c. Family stress theory d. Duvall's developmental theory

ANS: C Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction.

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Developmental systems theory c. Family stress theory d. Duvalls developmental theory

ANS: C Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Developmental systems theory is an outgrowth of Duvalls theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Duvalls developmental theory describes eight developmental tasks of the family throughout its life span.

Rickets is caused by a deficiency in: a. vitamin A. b. vitamin C. c. vitamin D and calcium. d. folic acid and iron.

ANS: C Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the development of rickets. No correlation exists between vitamins A, C, folic acid, or iron and rickets.

Which leading cause of death topic should the nurse emphasize to a group of African-American boys ranging in age from 15 to 19 years? a. Suicide b. Cancer c. Firearm homicide d. Occupational injuries

ANS: C Firearm homicide is the second overall cause of death in this age group and the leading cause of death in African-American males. Suicide is the third-leading cause of death in this population. Cancer, although a major health problem, is the fourth-leading cause of death in this age group. Occupational injuries do not contribute to a significant death rate for this age group. DIF: Cognitive Level: Understand REF: p. 7 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

32. The parent of a 2-week-old infant, exclusively breastfed, asks the nurse if fluoride supplements are needed. The nurse's best response should be: 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 4 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 4 months if the child is not drinking adequate amounts of fluoridated water. The amount of water that is ingested and the amount of fluoride in the water are taken into account when supplementation is being considered.

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

19. A nurse is teaching parents of kindergarten children general guidelines to assist their children in school. Which statement by the parents indicates they understand the teaching? a. "We will only meet with the teacher if problems occur." b. "We will discourage hobbies so our child focuses on school work." c. "We will plan a trip to the library as often as possible." d. "We will expect our child to make all As in school."

ANS: C General guidelines for parents to help their child in school include sharing an interest in reading. The library should be used frequently and books the child is reading should be discussed. Hobbies should be encouraged. The parents should not expect all As. They should focus on growth more than grades.

A nurse is teaching parents of kindergarten children general guidelines to assist their children in school. Which statement by the parents indicates they understand the teaching? a. "We will only meet with the teacher if problems occur." b. "We will discourage hobbies so our child focuses on schoolwork." c. "We will plan a trip to the library as often as possible." d. "We will expect our child to make all As in school."

ANS: C General guidelines for parents to help their child in school include sharing an interest in reading. The library should be used frequently, and books the child is reading should be discussed. Hobbies should be encouraged. The parents should not expect all As. They should focus on growth more than grades.

1. A nurse is assessing a 12-month-old infant. Which statement best describes the infant's physical development a nurse should expect to find? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. How should this practice be interpreted? a. Not appropriate in a school setting b. Never appropriate because adolescents are minors c. Important in establishing trusting relationships d. Suggestive that the nurse is meeting his or her own needs

ANS: C Health professionals who work with adolescents should consider adolescents' increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, in some circumstances, such as self-destructive behavior or maltreatment by others, they are not able to maintain confidentiality. Confidentiality and privacy are necessary to build trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction. DIF: Cognitive Level: Understand REF: p. 456 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Management of Care

Parents report that they have been giving a multivitamin to their 1-year-old infant. The nurse counsels the parents that which vitamin can cause a toxic reaction at a low dose? a. Niacin b. B6 c. D d. C

ANS: C Hypervitaminosis of vitamin D presents the greatest problem because this fat-soluble vitamin is stored in the body. Vitamin D is the most likely of all vitamins to cause toxic reactions in relatively small overdoses. The water-soluble vitamins, primarily niacin, B6, and C, can also cause toxicity but not at the low dose that occurs with vitamin D.

29. During an otoscopic examination on an infant, in which direction is the pinna pulled? a. Up and back b. Up and forward c. Down and back d. Down and forward

ANS: C In infants and toddlers the ear canal is curved upward. To visualize the ear canal, it is necessary to pull the pinna down and back to the 6 to 9 o'clock range to straighten the canal. In children over the age of 3 and adults, the canal curves downward and forward. The pinna is pulled up and back to the 10 o'clock position. Up and forward and down and forward are positions that do not facilitate visualization of the ear canal. DIF: Cognitive Level: Comprehension REF: p. 160 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

11. According to Piaget, the 6-month-old infant should be in which developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. 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.

42. A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made? a. "I will record the average of the readings." b. "I should be sitting comfortably when I perform the readings." c. "I will record the readings at the same time every day." d. "I will repeat the routine two times."

ANS: C Instructions for use of a peak flowmeter include standing up straight before performing the reading, recording the highest of the three readings (not the average), measuring the peak expiratory flow rate (PEFR) close to the same time each day, and repeating the entire routine three times, waiting 30 seconds between each routine.

Which is the most frequent source of acute childhood lead poisoning? a. Folk remedies b. Unglazed pottery c. Lead-based paint d. Cigarette butts and ashes

ANS: C Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead. DIF: Cognitive Level: Understand REF: p. 414 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity

Which is the most frequent source of acute childhood lead poisoning? a. Folk remedies b. Unglazed pottery c. Lead-based paint d. Cigarette butts and ashes

ANS: C Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead.

The school nurse is conducting a class for school-age children on Lyme disease. Which is characteristic of Lyme disease? a. Difficult to prevent b. Treated with oral antibiotics in stages 1, 2, and 3 c. Caused by a spirochete that enters the skin through a tick bite d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

ANS: C Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans. Tick bites should be avoided by entering tick-infested areas with caution. Light-colored clothing should be worn to identify ticks easily. Long-sleeved shirts and long pants tucked into socks should be the attire. Early treatment of the erythema migrans (stage 1) can prevent the development of Lyme disease. Lyme disease is caused by a spirochete, not mycotic spores.

The belief that health is a state of harmony with nature and the universe is common in which culture? a. Japanese b. African-American c. Native American d. Hispanic-American

ANS: C Many cultures ascribe attributes of health to natural forces. Many individuals of the Native-American culture view health as a state of harmony with nature and the universe. This belief is not consistent with the Japanese, African-American, or Hispanic-American cultural groups.

21. Which snack should the nurse recommend parents offer to their slightly overweight preschool child? a. Carbonated beverage b. 10% fruit juice c. Low fat chocolate milk d. Whole milk

ANS: C Milk and dairy products are excellent sources of calcium and vitamin D (fortified). Low-fat milk may be substituted, so the quantity of milk may remain the same while limiting fat intake overall. Parents should be educated regarding non-nutritious fruit drinks, which usually contain less than 10% fruit juice yet are often advertised as healthy and nutritious; sugar content is dramatically increased and often precludes an adequate intake of milk by the child. In young children, intake of carbonated beverages that are acidic or that contain high amounts of sugar is also known to contribute to dental caries. Low fat milk should be substituted for whole milk if the child is slightly overweight. DIF: Cognitive Level: Apply REF: p. 389 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

10. By which age should the nurse expect an infant to be able to pull to a standing position? a. 6 months b. 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs. Any infant who cannot pull to a standing position by age 1 year should be referred for further evaluation.

Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14? a. Mechanical suffocation b. Drowning c. Motor vehicle-related fatalities d. Fire- and burn-related fatalities

ANS: C Motor vehicle-related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second-leading cause of death. DIF: Cognitive Level: Remember REF: p. 3 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

36. 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 Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 and S2 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. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If it is heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding. DIF: Cognitive Level: Comprehension REF: p. 168 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A nurse planning care for a school-age child should take into account that which thought process is seen at this age? a. Animism b. Magical thinking c. Ability to conserve d. Thoughts are all-powerful

ANS: C One cognitive task of school-age children is mastering the concept of conservation. At an early age (5 to 7 years), children grasp the concept of reversibility of numbers as a basis for simple mathematics problems (e.g., 2 + 4 = 6 and 6 - 4 = 2). They learn that simply altering their arrangement in space does not change certain properties of the environment, and they are able to resist perceptual cues that suggest alterations in the physical state of an object. Animism, magical thinking, and believing that thoughts are all powerful are thought processes seen in preschool children.

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 One of the essential elements is the family's training and preparation. 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. 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. 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. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required.

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. How should this be interpreted? a. Behavior that encourages bullying and sexism b. Behavior that reinforces poor peer relationships c. Characteristic of social development at this age d. Characteristic of children who later are at risk for membership in gangs

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. 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. A boys-only club does not have a direct correlation with later gang activity.

Why are imaginary playmates beneficial to the preschool child? a. Take the place of social interactions b. Take the place of pets and other toys c. Become friends in times of loneliness d. Accomplish what the child has already successfully accomplished

ANS: C One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interaction, but may encourage conversation. Imaginary friends do not take the place of pets or toys. Imaginary friends accomplish what the child is still attempting. DIF: Cognitive Level: Understand REF: p. 384 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is taking care of a 7-year-old child with herpes simplex virus (type 1 or 2). Which prescribed medication should the nurse expect to be included in the treatment plan? a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical and/or systemic antibiotic

ANS: C Oral antiviral agents are effective for viral infections such as herpes simplex. Corticosteroids are not effective for viral infections. Griseofulvin is an antifungal agent and not effective for viral infections. Antibiotics are not effective in viral diseases.

A child is diagnosed with influenza. Management includes which recommendation? a. Clear liquid diet for hydration b. Aspirin to control fever c. Oseltamivie (Tamiflu) d. Antibiotics to prevent bacterial infection

ANS: C Oseltamivie (Tamiflu) may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

Parents need further teaching about the use of car safety seats if they make which statement? a. "Even if our toddler helps buckle the straps, we will double-check the fastenings." b. "We won't start the car until everyone is properly restrained." c. "We won't need to use the car seat on short trips to the store." d. "We will anchor the car seat to the car's anchoring system."

ANS: C Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings; do not start the car until everyone is properly restrained; and anchor the car safety seat securely to the car's anchoring system and apply the harness snugly to the child. DIF: Cognitive Level: Apply REF: p. 373 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

22. Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face b. Buttocks c. Oral mucosa d. Palms and soles

ANS: C Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark-skinned individuals unless they are in the mouth or conjunctiva. DIF: Cognitive Level: Comprehension REF: p. 152 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A 4-year-old child tells the nurse that she does not want another blood sample drawn because "I need all my insides, and I don't want anyone taking them out." Which is the nurse's best interpretation of this? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

ANS: C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies. DIF: Cognitive Level: Apply REF: p. 388 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is caring for a child in acute respiratory failure. Which blood gas analysis indicates the child is still in respiratory acidosis? a. pH 7.50, CO2 48 b. pH 7.30, CO2 30 c. pH 7.32, CO2 50 d. pH 7.48, CO2 33

ANS: C Respiratory failure is a process that involves pulmonary dysfunction generally resulting in impaired alveolar gas exchange, which can lead to hypoxemia or hypercapnia. Acidosis indicates the pH is less than 7.35 and the CO2 is greater than 45. If the pH is less than 7.35 but the CO2 is low, it is metabolic acidosis. Alkalosis is when the pH is greater than 7.45. If the pH is high and the CO2 is high, it is metabolic alkalosis. When the pH is high and the CO2 is low, it is respiratory alkalosis.

The nurse is taking care of a child with scabies. Which primary clinical manifestation should the nurse expect to assess with this disease? a. Edema b. Redness c. Pruritus d. Maceration

ANS: C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. Edema, redness, and maceration are not observed in scabies.

8. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is which of the following? 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 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 so that the child can then observe during the procedure. A 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. The child is not exhibiting anxiety in asking how the blood pressure apparatus works, just requesting clarification of what will occur. DIF: Cognitive Level: Comprehension REF: p. 123 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

23. During a routine health assessment the nurse notes that the 8-month-old infant has a significant head lag. Which of the following is the most appropriate action? a. Recheck head control at next visit. b. Teach parents appropriate exercises. c. Schedule child for further evaluation. d. Refer child for further evaluation if anterior fontanel is still open.

ANS: C Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Head control is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated. DIF: Cognitive Level: Comprehension REF: p. 154 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. At what age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a. Soccer b. Running c. Swimming d. Basketball

ANS: C Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance, such as soccer. Prophylaxis with medications may be necessary. DIF: Cognitive Level: Apply REF: p. 664 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a. Soccer b. Running c. Swimming d. Basketball

ANS: C Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance, such as soccer. Prophylaxis with medications may be necessary.

26. The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

21. At what age does an infant start to recognize familiar faces and objects, such as a feeding bottle? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is able to anticipate feeding after seeing the bottle.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

ANS: C The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing syndrome is caused by long-term systemic steroids.

Herpes zoster is caused by the varicella virus and has an affinity for: a. sympathetic nerve fibers. b. parasympathetic nerve fibers. c. posterior root ganglia and posterior horn of the spinal cord. d. lateral and dorsal columns of the spinal cord.

ANS: C The herpes zoster virus has an affinity for posterior root ganglia, the posterior horn of the spinal cord, and skin. The zoster virus does not involve sympathetic or parasympathetic nerve fibers and the lateral and dorsal columns of the spinal cord.

3. What is the single most important factor to consider when communicating with children? a. Presence of the child's parent b. Child's physical condition c. Child's developmental level d. Child's nonverbal behaviors

ANS: C The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Nonverbal behaviors vary in importance based on the child's developmental level and physical condition. Although the child's physical condition is a consideration, developmental level is much more important. The presence of parents is important when communicating with young children, but may be detrimental when speaking with adolescents. DIF: Cognitive Level: Comprehension REF: p. 177 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

A child has a postoperative appendectomy incision covered by a dressing. The nurse has just completed a prescribed dressing change for this child. Which description is an accurate documentation of this procedure? a. Dressing change to appendectomy incision completed, child tolerated procedure well, parent present b. No complications noted during dressing change to appendectomy incision c. Appendectomy incision non-reddened, sutures intact, no drainage noted on old dressing, new dressing applied, procedure tolerated well by child d. No changes to appendectomy incisional area, dressing changed, child complained of pain during procedure, new dressing clean, dry and intact

ANS: C The nurse should document assessments and reassessments. Appearance of the incision described in objective terms should be included during a dressing change. The nurse should document patient's response and the outcomes of the care provided. In this example, these include drainage on the old dressing, the application of the new dressing, and the child's response. The other statements partially fulfill the requirements of documenting assessments and reassessments, patient's response, and outcome, but do not include all three. DIF: Cognitive Level: Analyze REF: p. 12 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patient's status c. Questioning the use of daily central line dressing changes d. Clarifying a physician's prescription for morphine

ANS: C The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates EBP, which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patient's status are practices that follow established guidelines. Clarifying a physician's prescription for morphine constitutes safe nursing care. DIF: Cognitive Level: Apply REF: p. 10 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

When communicating with other professionals, what is important for the nurse to do? a. Ask others what they want to know. b. Share everything known about the family. c. Restrict communication to clinically relevant information. d. Recognize that confidentiality is not possible.

ANS: C The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals. Asking others what they want to know and sharing everything known about the family is inappropriate. Patients have a right to confidentiality. The nurse is not permitted to share information about clients, except clinically relevant information that pertains to the child's care. Confidentiality permits the disclosure of information to other health professionals on a need-to-know basis. DIF: Cognitive Level: Apply REF: p. 9 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

A nurse is collecting subjective and objective information about target populations to diagnose problems based on community needs. This describes which step in the community nursing process? a. Planning b. Diagnosis c. Assessment d. Establishing objectives

ANS: C The nursing process stages are similar, whether the client is one child or a population of children. The assessment phase of the nursing process focuses on collecting subjective and objective data. Planning is the development of community-centered goals and objectives. Diagnosis is the identification of problems specific to the community. DIF: Cognitive Level: Understand REF: p. 11 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation? a. Punish the child. b. Leave the child alone until the tantrum is over. c. Remain close by the child but without eye contact. d. Explain to child that this is wrong.

ANS: C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common in toddlers as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The parent's presence is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over. DIF: Cognitive Level: Apply REF: p. 364 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

An infant experienced an apparent life-threatening event (ALTE) and is being placed on home apnea monitoring. Parents have understood the instructions for use of a home apnea monitor when they state? a. "We can adjust the monitor to eliminate false alarms." b. "We should sleep in the same bed as our monitored infant." c. "We will check the monitor several times a day to be sure the alarm is working." d. "We will place the monitor in the crib with our infant."

ANS: C The parents should check the monitor several times a day to be sure the alarm is working and that it can be heard from room to room. The parents should not adjust the monitor to eliminate false alarms. Adjustments could compromise the monitor's effectiveness. The monitor should be placed on a firm surface away from the crib and drapes. The parents should not sleep in the same bed as the monitored infant.

Parents are concerned about the number of hours their teenage daughter spends with peers. The nurse explains that peer relationships are important during adolescence for which reason? 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 The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. During adolescence, the parent-child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy. DIF: Cognitive Level: Apply REF: p. 449 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

Which is a frequent health problem of migrant children and adolescents in the United States? a. Suicide b. Diabetes c. Tuberculosis d. Cardiovascular disease

ANS: C The rate of tuberculosis among migrant families is high. A high-risk factor for the children of migrant families is the migration of the families from areas that have high prevalence of tuberculosis; significant health issues, suicide, diabetes, and cardiovascular disease are not more prevalent in this population.

9. A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering? a. Taking over total care of the child to reduce stress on the family b. Encouraging family dependence on health care systems c. Recognizing that the family is the constant in a child's life d. Excluding families from the decision- making process

ANS: C The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child's life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is expected to be part of the decision-making process. DIF: Cognitive Level: Remember REF: p. 7 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

What should the nurse suggest to the parents of an infant who has a prolonged need for middle-of-the-night feedings? a. Decrease daytime feedings. b. Allow child to go to sleep with a bottle. c. Offer last feeding as late as possible at night. d. Put infant to bed after asleep from rocking.

ANS: C To manage an infant who has a prolonged need for middle-of-the-night feedings parents should be taught to offer last feeding as late as possible at night. Parent should increase daytime feeding intervals to 4 hours or more (may need to be done gradually), offer no bottles in bed, put to bed awake and when child is crying, check at progressively longer intervals each night; reassure child but do not hold, rock, take to parent's bed, or give bottle or pacifier.

Which is the major cause of death for children older than 1 year? a. Cancer b. Heart disease c. Unintentional injuries d. Congenital anomalies

ANS: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups. DIF: Cognitive Level: Remember REF: p. 7 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

28. The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months

ANS: C Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If the infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed. DIF: Cognitive Level: Comprehension REF: p. 157 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A nurse is teaching a parent of an infant about treatment of seborrhea dermatitis (cradle cap). Which should the nurse include in the instructions? a. Shampoo every three days with a mild soap. b. The hair should be shampooed with a medicated shampoo. c. Shampoo every day with an antiseborrheic shampoo. d. The loosened crusts should not be removed with a fine-toothed comb.

ANS: C When seborrheic lesions are present, the treatment is directed at removing the crusts. Parents are taught the appropriate procedure to clean the scalp. Shampooing should be done daily with a mild soap or commercial baby shampoo; medicated shampoos are not necessary, but an antiseborrheic shampoo containing sulfur and salicylic acid may be used. Shampoo is applied to the scalp and allowed to remain on the scalp until the crusts soften. Then the scalp is thoroughly rinsed. A fine-tooth comb or a soft facial brush helps remove the loosened crusts from the strands of hair after shampooing.

The nurse is providing anticipatory guidance to parents of a 6-month-old on preventing an accidental poisoning injury. Which should the nurse include in the teaching? (Select all that apply.) a. Place plants on the floor. b. Place medications in a cupboard. c. Discard used containers of poisonous substances. d. Keep cosmetic and personal products out of the childs reach. e. Make sure that paint for furniture or toys does not contain lead.

ANS: C, D, E Anticipatory guidance for a 7-month-old infant to prevent a suffocation injury takes into account that the infant will become more active and eventually crawl, cruise, and walk. Used containers of poisonous substances should be discarded, cosmetic and personal products should be kept out of the childs reach, and paint for furniture or toys should be lead free. Plants should be hung out of reach or placed on a high shelf. Medications should be locked, not just placed in a cupboard.

What are risk factors for sudden infant death syndrome? (Select all that apply.) a. Postterm b. Female gender c. Low Apgar scores d. Recent viral illness e. Native American infants

ANS: C, D, E Infant risk factors for sudden infant death syndrome include those with low Apgar scores and recent viral illness and Native American infants. Preterm, not postterm, birth and male, not female, gender are other risk factors.

Research is being done on the development of assets in children. A community that is supportive of children has which external assets? (Select all that apply.) a. Unstructured environments to allow for freedom of choice b. Social competencies to make positive choices c. Empowerment to feel safe and secure d. Positive values to direct choice e. Boundaries to set expectations and actions

ANS: C, E Young people need to feel valued by their community and able to contribute to others. They need to feel safe and secure. They also need boundaries to help set expectations and actions. To develop appropriately, children need boundaries and expectations. With these, they will learn what is expected of them and what behaviors are acceptable to the community. Social competencies to make positive choices and boundaries to set expectations and actions are internal assets that, when developed, help the child make positive choices.

The nurse is developing a teaching pamphlet for parents of school-age children. What anticipatory guidelines should the nurse include in the pamphlet? a. At age 6 years, parents should be certain that the child is reading independently with books provided by school. b. At age 8 years, parents should expect a decrease in involvement with peers and outside activities. c. At age 10 years, parents should expect a decrease in admiration of the parents with little interest in parentchild activities. d. At age 12 years, parents should be certain that the childs sex education is adequate with accurate information.

ANS: D A 12-year-old child should have been introduced to sex education, and parents should be certain that the information is adequate and accurate and that the child is not embarrassed to talk about sexual feelings or other aspects of sex education. At age 6 years, a child does not need to be reading independently and usually still needs help with reading and enjoys being read to. At 8 years of age, parents should expect their child to show increased involvement with peers and outside activities and should encourage this behavior. A 10-year-old child exhibits increased feelings of admiration of parents, especially fathers, and parentchild activities should be encouraged.

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) is to: a. explain how SIDS could have been predicted and prevented. b. interview parents in depth concerning the circumstances surrounding the child's death. c. discourage parents from making a last visit with the infant. d. make a follow-up home visit to parents as soon as possible after the child's death.

ANS: D A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their child.

The nurse is teaching parents about caring for their infant with seborrheic dermatitis (cradle cap). Which statement by the parents indicates understanding of the teaching? a. We will rinse off the shampoo quickly and dry the scalp thoroughly. b. We will shampoo the hair every other day with antiseborrheic shampoo. c. We will be sure to shampoo the hair without removing any of the crusts. d. We will use a fine-tooth comb to help remove the loosened crusts from the strands of hair.

ANS: D A fine-tooth comb or a soft facial brush helps remove the loosened crusts from the strands of hair after shampooing. This is an accurate statement. Shampoo should applied to the scalp and allowed to remain on the scalp until the crusts soften. Shampoo should not be rinsed off quickly. The crusts should be removed, and shampooing with antiseborrheic shampoo should be done daily, not every other day.

At what age should the nurse expect a child to give both first and last names when asked? a. 15 months b. 18 months c. 24 months d. 30 months

ANS: D At 30 months, the child is able to give both first and last names and refer to self with an appropriate pronoun. At 15 and 18 months, the child is too young to give his or her own name. At 24 months, the child is able to give first name and refer to self by that name.

Which characteristic best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily

ANS: D At age 5 months, the infant should be able to voluntarily grasp an object. The grasp reflex is present in the first 2 to 3 months of life. Gradually, the reflex becomes voluntary. The neat pincer grasp is not achieved until age 11 months. At age 12 months, an infant will attempt to build a tower of two cubes but will most likely be unsuccessful.

The nurse is teaching parents about expected language development for their 6-month-old infant. The nurse recognizes the parents understand the teaching if they make which statement? a. Our baby should comprehend the word no. b. Our baby knows the meaning of saying mama. c. Our baby should be able to say three to five words. d. Our baby should begin to combine syllables, such as dada.

ANS: D By 6 months, infants imitate sounds; add the consonants t, d, and w; and combine syllables (e.g., dada), but they do not ascribe meaning to the word until 10 to 11 months of age. By 9 to 10 months, they comprehend the meaning of the word no and obey simple commands accompanied by gestures. By age 1 year, they can say three to five words with meaning and may understand as many as 100 words.

The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching? a. "Most bicycle injuries occur from a fall off the bicycle." b. "Head injuries are the major causes of bicycle-related fatalities." c. "I should replace my helmet every 5 years." d. "I can ride double with a friend if the bicycle has an extra large seat."

ANS: D Children should not ride double. Most injuries result from falls. 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. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission and should replace the helmet at least every 5 years.

Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on which statement? a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.

ANS: D Co-sleeping, or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently under way; no evidence at this time supports or condemns the practice for safety reasons. Co-sleeping is a cultural practice. One year is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon.

A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse's knowledge of breastfed infants, what type of stool is expected? A. Dark brown and small hard pebbles B. Loose with green mucus streaks C. Formed and with white mucus D. Semiformed, seedy, yellow

ANS: D Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow. Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant. Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant. Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant.

Which statement best describes colic? a. Periods of abdominal pain resulting in weight loss b. Usually the result of poor or inadequate mothering c. Periods of abdominal pain and crying occurring in infants older than age 6 months d. A paroxysmal abdominal pain or cramping manifested by episodes of loud crying

ANS: D Colic is described as paroxysmal abdominal pain or cramping that is manifested by loud crying and drawing up the legs to the abdomen. Weight loss is not part of the clinical picture. There are many theories about the cause of colic. Emotional stress or tension between the parent and child is one component. This is not consistent throughout all cases. Colic is most common in infants younger than 3 months of age.

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their children. Which is most likely lacking in their particular diet? a. Fat b. Protein c. Vitamins C and A d. Iron and calcium

ANS: D Deficiencies can occur when various substances in the diet interact with minerals. For example, iron, zinc, and calcium can form insoluble complexes with phytates or oxalates (substances found in plant proteins), which impair the bioavailability of the mineral. This type of interaction is important in vegetarian diets because plant foods such as soy are high in phytates. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available.

Which term refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation? a. Congenital lactase deficiency b. Primary lactase deficiency c. Secondary lactase deficiency d. Developmental lactase deficiency

ANS: D Developmental lactase deficiency refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation. Congenital lactase deficiency occurs soon after birth after the newborn has consumed lactose-containing milk. Primary lactase deficiency, sometimes referred to as late-onset lactase deficiency, is the most common type of lactose intolerance and is manifested usually after 4 or 5 years of age. Secondary lactase deficiency may occur secondary to damage of the intestinal lumen, which decreases or destroys the enzyme lactase.

An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of inadequate caloric intake. The nurse understands that the reason for the FTT is most likely related to what? a. Cows milk allergy b. Congenital heart disease c. Metabolic storage disease d. Incorrect formula preparation

ANS: D FTT classified according to the pathophysiology of inadequate caloric intake is related to incorrect formula preparation, neglect, food fads, excessive juice poverty, breastfeeding problems, behavioral problems affecting eating, parental restriction of caloric intake, or central nervous system problems affecting intake consumption. Cows milk allergy would be related to the pathophysiology of inadequate absorption, congenital heart disease would be related to the pathophysiology of increased metabolism, and metabolic storage disease is related to defective utilization.

The nurse recommends to parents that peanuts are not a good snack food for toddlers. What is the nurse's rationale for this action? a. Low in nutritive value b. High in sodium c. Cannot be entirely digested d. Can be easily aspirated

ANS: D Foreign-body aspiration is common during the second year of life. Although they chew well, this age child may have difficulty with large pieces of food, such as meat and whole hot dogs, and with hard foods, such as nuts or dried beans. Peanuts have many beneficial nutrients, but should be avoided because of the risk of aspiration in this age group. The sodium level may be a concern, but the risk of aspiration is more important. Many foods pass through the gastrointestinal tract incompletely undigested. This is not necessarily detrimental to the child. DIF: Cognitive Level: Apply REF: p. 376 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Safe and Effective Care Environment

The parents of a 12-month-old child ask the nurse whether the child can eat hot dogs. The nurse's reply should be based on which statement? a. Child is too young to digest hot dogs. b. Child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut.

Which is an appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll head side to side. c. Hold by feet upside down with head supported. d. Gently stimulate trunk by patting or rubbing.

ANS: D If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. The infant should not be shaken vigorously, the head rolled side to side, or held by the feet upside down with the head supported. These can cause injury.

The psychosocial developmental tasks of toddlerhood include which characteristic? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

Which describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Are capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

ANS: D In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill.

At an 8-month-old well-baby visit, the parent tells the nurse that her infant falls asleep at night during the last bottle feeding but wakes up when moved to the infants crib. What is the most appropriate response for the nurse to make? a. You should put your baby to sleep 1 hour earlier without the nighttime feeding but with a pacifier for soothing. b. You could place rice cereal in the last bottle feeding of the day to ensure a longer sleep pattern. c. You should have your partner give the last bottle of the day and observe whether your infant stays awake for your partner. d. You could increase daytime feeding intervals to every 4 hours and put your baby in the crib while the baby is still awake.

ANS: D Increasing the daytime intervals to 4 hours and placing the baby in the crib while still awake are interventions for nighttime sleeping problems. Putting the baby to bed 1 hour earlier with a pacifier will not stop the need for the bedtime bottle; there is no research that rice cereal in the bottle helps to satisfy the baby longer at night, and switching partners does not guarantee that the baby will go to sleep better.

An infant is more likely to be at increased risk for infections based on the immunological premise that A. decreased amount of immunoglobulin M at birth. B. limited maternal transfer resulted in decreased protection during the first 3 months of life. C. inability to synthesize immunoglobulin G. D. limited ability to reach adult levels until 1 year of age.

ANS: D Infants reach 40% of their immunoglobulin levels by 1 year of age and are therefore at risk to develop an infection. Infants have an increased amount of immunoglobulin M at birth, have maternal transfer until 3 months of age, and are able to synthesize immunoglobulin at decreased rates.

Although infants may be allergic to a variety of foods, the most common allergens are: a. fruit and eggs. b. fruit, vegetables, and wheat. c. cow's milk and green vegetables. d. eggs, cow's milk, and wheat.

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

A 9-month-old infant is seen in the emergency department after developing urticaric rash with cough and wheezing. When collecting the history of events prior to the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant? A. Potatoes B. Green beans C. Spinach D. Peanut butter

ANS: D Nuts of any type, including peanuts, have a high allergy index in children and infants. The infant has demonstrated the cutaneous and respiratory type of reaction after possible ingestion of peanut butter. Potatoes are not a highly allergenic food. Green beans are not a highly allergenic food. Spinach is not a highly allergenic food.

Which is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain.

ANS: D Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. In this age group, children are able to distinguish between fact and fantasy. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems.

The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by what? a. Allowing the child to eat citrus foods at bedtime b. A hereditary factor that cannot be prevented c. Poor fluoride supply in the drinking water d. Giving the child a bottle of juice or milk at naptime

ANS: D One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

The nurse is administering an oral antihistamine at bedtime to a child with atopic dermatitis (eczema). Which antihistamine should the nurse expect to be prescribed at bedtime? a. Cetirizine (Zyrtec) b. Loratadine (Claritin) c. Fexofenadine (Allegra) d. Diphenhydramine (Benadryl)

ANS: D Oral antihistamine drugs such as hydroxyzine or diphenhydramine usually relieve moderate or severe pruritus. Nonsedating antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra) may be preferred for daytime pruritus relief. Because pruritus increases at night, a mildly sedating antihistamine such as Benadryl is prescribed.

A nurse is observing children playing in the playroom. What describes parallel play? a. A child playing a video game b. Two children playing a card game c. Two children watching a movie on a television d. A child playing with blocks next to a child playing with trucks

ANS: D Parallel play is when a toddler plays alongside, not with, other children. A child playing with blocks next to a child playing with trucks is descriptive of parallel play. The child playing a video game is descriptive of solitary play. Two children playing cards is descriptive of cooperative play. Two children watching a television is descriptive of associative play.

Parents ask the nurse for strategies to help their toddler adjust to a new baby. What should the nurse suggest? a. Start talking about the baby very early in the pregnancy. b. Move the toddler to a new bed after the baby comes home. c. Tell the toddler that a new playmate will be coming home soon. d. Alert visitors to the new baby to include the toddler in the visit.

ANS: D Parents can minimize sibling rivalry by alerting visitors to the toddlers needs, having small presents on hand for the toddler, and including the child in the visits as much as possible. Time is a vague concept for toddlers. A good time to start talking about the new baby is when the toddler becomes aware of the pregnancy and the changes occurring in the home in anticipation of the new member. To avoid additional stresses when the newborn arrives, parents should perform anticipated changes, such as moving the toddler to a different room or bed, well in advance of the birth. Telling the toddler that a new playmate will come home soon sets up unrealistic expectations.

The nurse is teaching parents of toddlers about animal safety. Which should be included in the teaching session? a. Petting dogs in the neighborhood should be encouraged to prevent fear of dogs. b. The toddler is safe to approach an animal if the animal is chained. c. It is permissible for your toddler to feed treats to a dog. d. Teach your toddler not to disturb an animal that is eating.

ANS: D Parents should be taught that toddlers should not disturb an animal that is eating, sleeping, or caring for young puppies or kittens. The child should avoid all strange animals and not be encouraged to pet dogs in the neighborhood. The child should never approach a strange dog that is confined or restrained. The inexperienced child should not feed a dog (if the child pulls back when the animal moves to take the food, this can frighten and startle the animal). DIF: Cognitive Level: Apply REF: p. 377 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

The nurse is teaching parents of toddlers about animal safety. Which should be included in the teaching session? a. Petting dogs in the neighborhood should be encouraged to prevent fear of dogs. b. The toddler is safe to approach an animal if the animal is chained. c. It is permissible for your toddler to feed treats to a dog. d. Teach your toddler not to disturb an animal that is eating.

ANS: D Parents should be taught that toddlers should not disturb an animal that is eating, sleeping, or caring for young puppies or kittens. The child should avoid all strange animals and not be encouraged to pet dogs in the neighborhood. The child should never approach a strange dog that is confined or restrained. The inexperienced child should not feed a dog (if the child pulls back when the animal moves to take the food, this can frighten and startle the animal).

Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides: a. opportunity to become defiant. b. time to remain dependent on their parents for a longer time. c. time to establish a one-on-one relationship with the opposite sex. d. security as they gain independence from their parents.

ANS: D Peer-group identification is an important factor in gaining independence from parents. Children learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. Becoming defiant in a peer-group relationship may lead to bullying. Peer-group identification helps in gaining independence rather than remaining dependent. One-on-one opposite sex relationships do not occur until adolescence. School-age children form peer groups of the same sex.

Which recommendation would a nurse make to new parents who are planning to introduce solid foods to their 6-month-old son? A. Cream of wheat cereal B. Cream of farina cereal C. Cereals fortified with iron D. Rice cereal

ANS: D Rice cereal is recommended as it is easily digestible. The other options may contain additional ingredients such as iron as well as complex grains making it harder to digest.

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

ANS: D Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-old children. Temperature should be reduced on the hot water in the house and hot liquids placed out of the childs reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected 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 electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group but not one of the most common types of burn.

Austin, age 6 months, has six teeth. How should the nurse interpret this finding? a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier-than-normal tooth eruption

ANS: D Six months is earlier than expected. Most infants at age 6 months have two teeth. Although unusual, it is not dangerous.

The parents of a 5-year-old child ask the nurse, How many hours of sleep a night does our child need? The nurse should give which response? a. A 5-year-old child requires 8 hours of sleep. b. A 5-year-old child requires 9.5 hours of sleep. c. A 5-year-old child requires 10 hours of sleep. d. A 5-year-old child requires 11.5 hours of sleep.

ANS: D Sleep requirements decrease during school-age years; 5-year-old children generally require 11.5 hours of sleep.

A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth? a. Twice a day b. Three times a day c. After meals d. After meals, snacks, and bedtime

ANS: D Teeth should be brushed after meals, after snacks, and at bedtime. Children who brush their teeth frequently and become accustomed to the feel of a clean mouth at an early age usually maintain the habit throughout life. Twice a day, three times a day or after meals would not be often enough.

A nurse is planning care for a 17-month-old child. According to Piaget, which stage should the nurse expect the child to be in cognitively? a. Trust b. Preoperational c. Secondary circular reaction d. Tertiary circular reaction

ANS: D The 17-month-old child is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperational is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips and can hop in place on one foot b. Rides tricycle and broad jumps c. Jumps with both feet and stands on one foot momentarily d. Walks up and down stairs and runs with a wide stance

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step and runs with a wide stance. Skipping and hopping on one foot are achieved by 4-year-old children. Jumping with both feet and standing on one foot momentarily are achieved by 30-month-old children. Tricycle riding and broad jumping are achieved at age 3.

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." Which is the nurse's best reply? 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 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. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to tend to the doll's needs at the same time the parent is performing similar care for the newborn.

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. What should the nurse explain to the father? 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 The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain 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. Ritualism is not indicative of a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning.

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stools. The nurse's explanation of this is based on which statement? a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is normal for the child and is a normal part of the maturational process; no further investigation is necessary.

Where do eczematous lesions most commonly occur in an infant? a. Abdomen, cheeks, and scalp b. Buttocks, abdomen, and scalp c. Back and flexor surfaces of the arms and legs d. Cheeks and extensor surfaces of the arms and legs

ANS: D The lesions of atopic dermatitis are generalized in infants. They are most common on the cheeks, scalp, trunk, and extensor surfaces of the extremities. The abdomen and buttocks are not common sites of lesions. The back and flexor surfaces are not usually involved.

A 3-month-old bottle-fed infant is allergic to cow's milk. Which is the best substitute to teach the parents to use? A. Goat's milk B. Soy-based formula C. Skim milk diluted with water D. Casein hydrolysate milk formula

ANS: D The milk protein is broken down in casein hydrolysate milk formulas, making them a safe alternative for the infant who has an allergy to cow's milk. The milk protein in goat's milk cross-reacts with cow's milk protein, and goat's milk is therefore not a safe alternative. Soy-based formulas are avoided due to the cross-reaction with cow's milk protein; they are not a safe alternative. Cow's milk protein is contained in skim milk, making it an unsafe alternative.

A nurse is preparing to feed a 12-month-old infant with failure to thrive. Which intervention should the nurse implement? a. Provide stimulation during feeding. b. Avoid being persistent during feeding time. c. Limit feeding time to 10 minutes. d. Maintain a face-to-face posture with the infant during feeding.

ANS: D The nurse preparing to feed an infant with failure to thrive should maintain a face-to-face posture with the infant when possible. Encourage eye contact and remain with the infant throughout the meal. Stimulation is not recommended; a quiet, unstimulating atmosphere should be maintained. Persistence during feeding may need to be implemented. Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Although forced feeding is avoided, "strictly encouraged" feeding is essential. The length of the feeding should be established (usually 30 minutes); limiting the feeding to 10 minutes would make the infant feel rushed.

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

ANS: D The nurse should suggest to the parent that questions be phrased with realistic choices rather than yes or no answers. This provides the toddler with a sense of control and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say "no." DIF: Cognitive Level: Apply REF: p. 364 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

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

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

What do nursing interventions to promote health during middle childhood include? a. Stress the need for increased calorie intake to meet increased demands. b. Instruct parents to defer questions about sex until the child reaches adolescence. c. Advise parents that the child will need increasing amounts of rest toward the end of this period. d. Educate parents about the need for good dental hygiene because these are the years in which permanent teeth erupt.

ANS: D The permanent teeth erupt during the school-age years. Good dental hygiene and regular attention to dental caries are vital parts of health supervision during this period. Caloric needs are decreased in relation to body size for this age group. Balanced nutrition is essential to promote growth. Questions about sex should be addressed honestly as the child asks questions. The child usually no longer needs a nap, but most require approximately 11 hours of sleep each night at age 5 years and 9 hours at age 12 years.

The nurse is teaching parents about toilet training. What should the nurse include in the teaching session? a. Bladder training is accomplished before bowel training. b. The mastery of skills required for toilet training is present at 18 months. c. By 12 months, the child is able to retain urine for up to 2 hours or longer. d. The physiologic ability to control the sphincters occurs between 18 and 24 months.

ANS: D The physiologic ability to control the sphincters occurs somewhere between ages 18 and 24 months. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The mastery of skills required for training are not present before 24 months of age. By 14 to 18 months of age, the child is able to retain urine for up to 2 hours or longer.

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their child. Which is most likely lacking in their particular diet? a. Fat b. Protein c. Vitamins C and A d. Complete protein

ANS: D The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives for Healthy People. Parents should be taught about food preparation to ensure that complete proteins are available for growth. When parents use a strict vegetarian diet, likelihood exists of inadequate protein for growth and calories for energy. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available. Foods must be combined to provide complete proteins for growth.

Which vitamin is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida? a. A b. C c. Niacin d. Folic acid

ANS: D The vitamin supplement that is recommended for all women of childbearing age is a daily dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can reduce the risk of neural tube defects by 70%. No correlation exists between vitamins A, C, or folic acid and neural tube defects.

A parent is concerned because her 18-month-old daughter who was previously a "good eater" by her accounts is now being very picky during meal times. Meal time patterns of intake vary from one day to the next with eating large amounts then hardly eating at all. Based on this information, the nurse would suspect that the toddler A. probably has an ear infection so the parent should not be concerned. B. refer the parent to the pediatrician for a diagnostic work up. C. tell the mother that this type of behavior is associated with regression. D. may be exhibiting physiological anorexia which is a common finding during this time period.

ANS: D These findings are indicative of physiological anorexia as during this time period, many toddlers demonstrate variation in food intake, strong food preferences and picky eating behaviors. There is no correlation with ear infections causing this type of eating behavior. A diagnostic work up is not warranted and this behavior does not demonstrate regression.

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. What knowledge should the nurse's response should be based? a. Unacceptable because of the risk of sudden infant death syndrome (SIDS) b. Unacceptable because it does not encourage achievement of developmental milestones c. Acceptable to encourage fine motor development d. Acceptable to encourage head control and turning over

ANS: D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development.

The father of a 12-year-old child tells the nurse that he is concerned about his son getting "fat." His son is at the 50th percentile for height and the 75th percentile for weight on the growth chart. The most appropriate nursing action is to: a. reassure the father that his child is not fat. b. reassure the father that his child is just growing. c. suggest a low-calorie, low-fat diet. d. explain that this is typical of the growth pattern of boys at this age.

ANS: D This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and the child and develop a plan to maintain physical exercise and a balanced diet. It is false reassurance to tell the father that his son is not fat. His weight is high for his height. The child needs to maintain his physical activity. The father is concerned, so an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.

Which factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? A. Help the toddler complete tasks. B. Provide opportunities for the toddler to play with other children. C. Help the toddler learn the difference between right and wrong. D. Encourage the toddler to do things for himself or herself when he or she is capable of doing them.

ANS: D Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy.

The school nurse is discussing after-school sports participation with parents of children age 10 years. The nurses presentation includes which important consideration? a. Teams should be gender specific. b. Organized sports are not appropriate at this age. c. Competition is detrimental to the establishment of a positive self-image. d. Sports participation is encouraged if the type of sport is appropriate to the childs abilities.

ANS: D Virtually every child is suited for some type of sport. The child should be matched to the type of sport appropriate to his or her abilities and physical and emotional makeup. At this age, girls and boys have the same basic structure and similar responses to exercise and training. After puberty, teams should be gender specific because of the increased muscle mass in boys. Organized sports help children learn teamwork and skill acquisition. The emphasis should be on playing and learning. Children do enjoy appropriate levels of competition.

The school nurse has been asked to begin teaching sex education in the fifth grade. The nurse should recognize that: a. children in fifth 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 When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth-graders are usually 10 or 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? a. Explain how SIDS could have been predicted and prevented. b. Interview parents in depth concerning the circumstances surrounding the child's death. c. Discourage parents from making a last visit with the infant. d. Make a follow-up home visit to parents as soon as possible after the child's death.

ANS: D A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their child.

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

ANS: D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Bronchoscopy, although helpful for identifying bacterial infection in children with CF, is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

The nurse is guiding parents in selecting a daycare facility for their child. Which is especially important to consider when making the selection? a. Structured learning environment b. Socioeconomic status of children c. Cultural similarities of children d. Teachers knowledgeable about development

ANS: D A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others, so cultural similarities are not necessary. DIF: Cognitive Level: Apply REF: p. 384 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is teaching nursing students about childhood skin lesions. Which is an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid? a. Cyst b. Papule c. Pustule d. Vesicle

ANS: D A vesicle is elevated, circumscribed, superficial, less than 1 cm in diameter, and filled with serous fluid. A cyst is elevated, circumscribed, palpable, encapsulated, and filled with liquid or semisolid material. A papule is elevated, palpable, firm, circumscribed, less than 1 cm in diameter, and brown, red, pink, tan, or bluish red. A pustule is elevated, superficial, and similar to a vesicle but filled with purulent fluid.

What is the result of acute salicylate (ASA, aspirin) poisoning? a. Chemical pneumonitis b. Hepatic damage c. Retractions and grunting d. Disorientation and loss of consciousness

ANS: D ASA poisoning causes disorientation and loss of consciousness. Chemical pneumonitis is caused by hydrocarbon ingestion. Hepatic damage is caused by acetaminophen overdose. ASA does not cause airway obstruction. DIF: Cognitive Level: Understand REF: p. 412 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity

What is the result of acute salicylate (ASA, aspirin) poisoning? a. Chemical pneumonitis b. Hepatic damage c. Retractions and grunting d. Disorientation and loss of consciousness

ANS: D ASA poisoning causes disorientation and loss of consciousness. Chemical pneumonitis is caused by hydrocarbon ingestion. Hepatic damage is caused by acetaminophen overdose. ASA does not cause airway obstruction.

A young child has just arrived at the emergency department after ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which way? a. Administer through a nasogastric tube because the child will not drink it because of the taste. b. Serve in a clear plastic cup so the child can see how much has been drunk. c. Give half of the solution, and then give the other half in 1 hour. d. Serve in an opaque container with a straw.

ANS: D Although the activated charcoal can be mixed with a flavorful beverage, it will be black and resemble mud. When it is served in an opaque container, the child does not have any preconceived ideas about its being distasteful. The nasogastric tube should be used only in children without a gag reflex. The ability to see the charcoal solution may affect the child's desire to drink it. The child should be encouraged to drink the solution all at once. DIF: Cognitive Level: Apply REF: p. 412 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity

A young child has just arrived at the emergency department after ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which way? a. Administer through a nasogastric tube because the child will not drink it because of the taste. b. Serve in a clear plastic cup so the child can see how much has been drunk. c. Give half of the solution, and then give the other half in 1 hour. d. Serve in an opaque container with a straw.

ANS: D Although the activated charcoal can be mixed with a flavorful beverage, it will be black and resemble mud. When it is served in an opaque container, the child does not have any preconceived ideas about its being distasteful. The nasogastric tube should be used only in children without a gag reflex. The ability to see the charcoal solution may affect the child's desire to drink it. The child should be encouraged to drink the solution all at once.

Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Binuclear d. Extended

ANS: D An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one step-parent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Binuclear d. Extended

ANS: D An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

A nurse is planning a teaching session for parents of preschool children. Which statement explains why the nurse should include information about morbidity and mortality? a. Life span statistics are included in the data. b. It explains effectiveness of treatment. c. Cost-effective treatment is detailed for the general population. d. High-risk age groups for certain disorders or hazards are identified.

ANS: D Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data. DIF: Cognitive Level: Apply REF: p. 11 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

At what age should the nurse expect a child to give both first and last names when asked? a. 15 months b. 18 months c. 24 months d. 30 months

ANS: D At 30 months, the child is able to give both first and last names and refer to self with an appropriate pronoun. At 15 and 18 months, the child is too young to give his or her own name. At 24 months, the child is able to give first name and refer to self by that name. DIF: Cognitive Level: Understand REF: p. 362 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

By which age should the nurse expect that most children could obey prepositional phrases such as "under," "on top of," "beside," and "behind"? a. 18 months b. 24 months c. 3 years d. 4 years

ANS: D At 4 years, children can understand directional phrases. Children at 18 months, 24 months, and 3 years are too young. DIF: Cognitive Level: Understand REF: p. 385 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Describes an object according to its composition d. Talks incessantly regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition. DIF: Cognitive Level: Understand REF: p. 385 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

35. The nurse must assess a child's capillary refill time. This can be accomplished by doing which of the following? a. Inspect the chest. b. Auscultate the heart. c. Palpate the apical pulse. d. Palpate the nail bed with pressure to produce a slight blanching.

ANS: D Capillary refill time is assessed by pressing lightly on the skin to produce blanching, and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary refill time. DIF: Cognitive Level: Comprehension REF: p. 166 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

At what blood level is chelation therapy for lead poisoning initiated in a child? a. 10 to 14 g/dl b. 15 to 19 g/dl c. 20 to 44 g/dl d. ≥45 g/dl

ANS: D Chelation therapy is initiated if the child's blood level is greater than or equal to 45 g/dl. At 10 to 14 g/dl, the family should have lead-poisoning education and follow-up level. At 15 to 19 g/dl, the family should have lead-poisoning education and follow-up level but if it persists, initiate environmental investigation. At 20 to 44 g/dl environmental investigation and lead hazard control are necessary. DIF: Cognitive Level: Apply REF: p. 415 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity

At what blood level is chelation therapy for lead poisoning initiated in a child? a. 10 to 14 g/dl b. 15 to 19 g/dl c. 20 to 44 g/dl d. ≥45 g/dl

ANS: D Chelation therapy is initiated if the child's blood level is greater than or equal to 45 g/dl. At 10 to 14 g/dl, the family should have lead-poisoning education and follow-up level. At 15 to 19 g/dl, the family should have lead-poisoning education and follow-up level but if it persists, initiate environmental investigation. At 20 to 44 g/dl environmental investigation and lead hazard control are necessary.

A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes b. Respiratory disease c. Celiac disease d. Type II diabetes

ANS: D Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity. DIF: Cognitive Level: Apply REF: p. 2 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching? a. "Most bicycle injuries occur from a fall off the bicycle." b. "Head injuries are the major causes of bicycle-related fatalities." c. "I should replace my helmet every 5 years." d. "I can ride double with a friend if the bicycle has an extra-large seat."

ANS: D Children should not ride double. Most injuries result from falls. 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. The child should always wear a properly fitted helmet approved by the US Consumer Product Safety Commission and should replace the helmet at least every 5 years.

Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test? a. Every year for all children older than 2 years b. Every year for all children older than 10 years c. Every 2 years for all children starting at age 1 year d. Periodically for children who reside in high-prevalence regions

ANS: D Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

31. Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on which statement? a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.

ANS: D Co-sleeping, or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently under way; no evidence at this time supports or condemns the practice for safety reasons. Co-sleeping is a cultural practice. One year is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon.

Which is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate parental concern for the degree of injury b. Absence of parents for questioning about child's injuries c. Inappropriate response of child d. Incompatibility between the history and injury observed

ANS: D Conflicting stories about the "accident" are the most indicative red flags of abuse. Inappropriate response of caregiver or child may be present, but is subjective. Parents should be questioned at some point during the investigation. DIF: Cognitive Level: Apply REF: p. 419 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity

A nurse is selecting a family theory to assess a patient's family dynamics. Which family theory best describes a series of tasks for the family throughout its life span? a. Interactional theory b. Developmental systems theory c. Structural-functional theory d. Duvall's developmental theory

ANS: D Duvall's developmental theory describes eight developmental tasks of the family throughout its life span. Interactional theory and structural-functional theory are not family theories. Developmental systems theory is an outgrowth of Duvall's theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.

A nurse is selecting a family theory to assess a patients family dynamics. Which family theory best describes a series of tasks for the family throughout its life span? a. Interactional theory b. Developmental systems theory c. Structural-functional theory d. Duvalls developmental theory

ANS: D Duvalls developmental theory describes eight developmental tasks of the family throughout its life span. Interactional theory and structural-functional theory are not family theories. Developmental systems theory is an outgrowth of Duvalls theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.

The nurse observes that the families who do not show up for scheduled clinic appointments are usually from minority cultural groups. The best explanation for this is that these families often differ from the dominant culture because they: a. lack education. b. avoid health care. c. are more forgetful. d. view time differently.

ANS: D Each cultural group has different conceptions of time and waiting. The dominant culture in the United States has a fairly rigid view of time. Other cultures may be late or miss activities because other issues take precedence over the appointment. Education is not the issue. It is the concept of time in the cultural group. It is not done to avoid health care. The family usually believes that the appointment can be made for a later time. The family does not forget the time, but other issues take priority.

The nurse suspects that a child has ingested some type of poison. Which clinical manifestation would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, coma d. Edema of lips, tongue, pharynx

ANS: D Edema of lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system (CNS). DIF: Cognitive Level: Analyze REF: p. 394 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity

The nurse suspects that a child has ingested some type of poison. Which clinical manifestation would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, coma d. Edema of lips, tongue, pharynx

ANS: D Edema of lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system (CNS).

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). What nursing considerations should be included? a. Do not administer pancreatic enzymes if the child is receiving antibiotics. b. Decrease dose of pancreatic enzymes if the child is having frequent, bulky stools. c. Administer pancreatic enzymes between meals if at all possible. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

ANS: D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Pancreatic enzymes are not a contraindication for antibiotics. The dosage of enzymes should be increased if the child is having frequent, bulky stools. Enzymes should be given just before meals and snacks.

Which term best describes the emotional attitude that one's own ethnic group is superior to others? a. Culture b. Ethnicity c. Superiority d. Ethnocentrism

ANS: D Ethnocentrism is the belief that one's way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one's ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serves as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity.

Which term best describes the emotional attitude that ones own ethnic group is superior to others? a. Culture b. Ethnicity c. Superiority d. Ethnocentrism

ANS: D Ethnocentrism is the belief that ones way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of ones ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serves as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity.

Rickets is caused by a deficiency in what? a. Vitamin A b. Vitamin C c. Folic acid and iron d. Vitamin D and calcium

ANS: D Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets. No correlation exists between rickets and folic acid, iron, or vitamins A and C.

The nurse recommends to parents that peanuts are not a good snack food for toddlers. What is the nurse's rationale for this action? a. Low in nutritive value b. High in sodium c. Cannot be entirely digested d. Can be easily aspirated

ANS: D Foreign-body aspiration is common during the second year of life. Although they chew well, this age child may have difficulty with large pieces of food, such as meat and whole hot dogs, and with hard foods, such as nuts or dried beans. Peanuts have many beneficial nutrients, but should be avoided because of the risk of aspiration in this age group. The sodium level may be a concern, but the risk of aspiration is more important. Many foods pass through the gastrointestinal tract incompletely undigested. This is not necessarily detrimental to the child.

What is the most common cause of death in the adolescent age group? a. Drownings b. Firearms c. Drug overdoses d. Motor vehicles

ANS: D Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death. DIF: Cognitive Level: Understand REF: p. 458 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Safe and Effective Care Environment: Safety and Infection Control

Which is the causative agent of scarlet fever? a. Enteroviruses b. Corynebacterium organisms c. Scarlet fever virus d. Group A β-hemolytic streptococci (GABHS)

ANS: D GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

38. Superficial palpation of the abdomen is often perceived by the child as tickling. Which of the following measures by the nurse is most likely to minimize this sensation and promote relaxation? a. Palpate another area simultaneously. b. Ask child not to laugh or move if it tickles. c. Begin with deeper palpation and gradually progress to superficial palpation. d. Have child "help" with palpation by placing his or her hand over the palpating hand.

ANS: D Having the child "help" with palpation by placing his or her hand over the palpating hand will help minimize the feeling of tickling and enlist the child's cooperation. Palpating another area simultaneously will create the sensation of tickling in the other area also. Asking the child not to laugh or move will bring attention to the tickling and make it more difficult for the child. Superficial palpation is done before deep palpation. DIF: Cognitive Level: Comprehension REF: p. 170 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

35. The parents of a 12-month-old child ask the nurse whether the child can eat hot dogs. The nurse's reply should be based on which statement? a. Child is too young to digest hot dogs. b. Child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut.

The nurse should expect to assess which causative agent in a child with warts? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Human warts are caused by the human papillomavirus. Infection with bacteria, fungus, and parasites does not result in warts.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation? a. Fussiness b. Coughing c. A fever over 99° F d. Signs of an earache

ANS: D If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses.

Which is an appropriate action when an infant becomes apneic? a. Shake vigorously b. Roll head side to side c. Hold by feet upside down with head supported d. Gently stimulate trunk by patting or rubbing

ANS: D If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. The infant should not be shaken vigorously, the head rolled side to side, or held by the feet upside down with the head supported. These can cause injury.

The psychosocial developmental tasks of toddlerhood include which characteristic? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years. DIF: Cognitive Level: Understand REF: p. 355 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Are capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

ANS: D In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill.

What is the initial indication of puberty in girls? a. Menarche b. Growth spurt c. Growth of pubic hair d. Breast development

ANS: D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sex 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. DIF: Cognitive Level: Understand REF: p. 448 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The Vietnamese mother of a child being seen in the clinic avoids eye contact with the nurse. The best explanation for this, considering cultural differences, is that the parent: a. feels responsible for her childs illness. b. feels inferior to the nurse. c. is embarrassed to seek health care. d. is showing respect for the nurse.

ANS: D In some ethnic groups, eye contact is avoided. In the Vietnamese culture, an individual may not look directly into the nurses eyes as a sign of respect. The nurse providing culturally competent care would recognize that feeling responsible for the illness, feeling inferior, or embarrassment are not reasons for the mother to avoid eye contact with the nurse.

A parent has asked the nurse about how her child can be tested for pinworms. The nurse responds by stating that which is the most common test for diagnosing pinworms in a child? a. Lower gastrointestinal (GI) series b. Three stool specimens, at intervals of 4 days c. Observation for presence of worms after child defecates d. Laboratory examination of a fecal smear

ANS: D Laboratory examination of substances containing the worm, its larvae, or ova can identify the organism. Most are identified by examining fecal smears from the stools of persons suspected of harboring the parasite. Fresh specimens are best for revealing parasites or larvae. Lower GI series is not helpful for diagnosing enterobiasis. Stool specimens are not necessary to diagnose pinworms. Worms will not be visible after child defecates.

A school-age child falls on the playground and has a small laceration on the forearm. The school nurse should do which to cleanse the wound? a. Slowly pour hydrogen peroxide over wound. b. Soak arm in warm water and soap for at least 30 minutes. c. Gently cleanse with sterile pad and a non-stinging povidone-iodine solution. d. Wash wound gently with mild soap and water for several minutes.

ANS: D Lacerations should be washed gently with mild soap and water or normal saline. A sterile pad is not necessary, and hydrogen peroxide and povidone-iodine should not be used because they have a cytotoxic effect on healthy cells and minimal effect on controlling infection. Soaking the arm will not effectively clean the wound.

39. During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is which of the following? a. Abnormal and requires 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 Lateral bowing of the tibia (bowlegged) is an expected finding in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children. DIF: Cognitive Level: Comprehension REF: p. 173 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." The nurse's most appropriate answer would be which statement? a. "I'm sure he'll be fine if you get a good babysitter." b. "You will need to stay home until Eric starts school." c. "You should go back to work so Eric will get used to being with others." d. "Let's talk about the child care options that will be best for Eric."

ANS: D Let's talk about the child care options that will be best for Eric is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. I'm sure he'll be fine if you get a good babysitter, You will need to stay home until Eric starts school, and You should go back to work so Eric will get used to being with others are directive statements. They do not address the effect of her working on Eric.

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, I want to go back to work, but I dont want Eric to suffer because Ill have less time with him. The nurses most appropriate answer would be which statement? a. Im sure hell be fine if you get a good babysitter. b. You will need to stay home until Eric starts school. c. You should go back to work so Eric will get used to being with others. d. Lets talk about the child-care options that will be best for Eric.

ANS: D Lets talk about the child-care options that will be best for Eric is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. Im sure hell be fine if you get a good babysitter, You will need to stay home until Eric starts school, and You should go back to work so Eric will get used to being with others are directive statements. They do not address the effect of her working on Eric.

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which result? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

ANS: D Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic issue of hydrocarbon ingestion. DIF: Cognitive Level: Apply REF: p. 411 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Physiologic Integrity

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which result? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

ANS: D Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic issue of hydrocarbon ingestion.

Although infants may be allergic to a variety of foods, the most common allergens are: a. fruit and eggs. b. fruit, vegetables, and wheat. c. cow's milk and green vegetables. d. eggs, cow's milk, and wheat.

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

32. When assessing a preschooler's chest, the nurse would expect: a. respiratory movements to be chiefly thoracic. b. anteroposterior diameter to be equal to the transverse diameter. c. retraction of the muscles between the ribs on respiratory movement. d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing.

ANS: D Movement of the chest wall should be symmetric bilaterally and coordinated with breathing. In children younger than 6 or 7 years, respiratory movement is principally abdominal or diaphragmatic. The anteroposterior diameter is equal to the transverse diameter during infancy. As the child grows, the chest increases in the transverse direction, so that the anteroposterior diameter is less than the lateral diameter. Retractions of the muscles between the ribs on respiratory movement are indicative of respiratory distress. DIF: Cognitive Level: Comprehension REF: p. 163 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

How is chronic otitis media with effusion (OME) differentiated from acute otitis media (AOM)? a. A fever as high as 40° C (104° F) b. Severe pain in the ear c. Nausea and vomiting d. A feeling of fullness in the ear

ANS: D OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media. DIF: Cognitive Level: Understand REF: p. 645 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

How is chronic otitis media with effusion (OME) differentiated from acute otitis media (AOM)? a. A fever as high as 40° C (104° F) b. Severe pain in the ear c. Nausea and vomiting d. A feeling of fullness in the ear

ANS: D OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media.

Which is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain.

ANS: D Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. In this age group, children are able to distinguish between fact and fantasy. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems.

22. Which clinical manifestation would be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Abdominal pain that is most intense at McBurney point

ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright red or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis. DIF: Cognitive Level: Understand REF: p. 709 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Parents have understood teaching about prevention of childhood otitis media if they make which statement? a. "We will only prop the bottle during the daytime feedings." b. "Breastfeeding will be discontinued after 4 months of age." c. "We will place the child flat right after feedings." d. "We will be sure to keep immunizations up to date."

ANS: D Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides: a. opportunity to become defiant. b. time to remain dependent on their parents for a longer time. c. time to establish a one-on-one relationship with the opposite sex. d. security as they gain independence from their parents.

ANS: D Peer-group identification is an important factor in gaining independence from parents. Children learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. Becoming defiant in a peer-group relationship may lead to bullying. Peer-group identification helps in gaining independence rather than remaining dependent. One-on-one opposite sex relationships do not occur until adolescence. School-age children form peer groups of the same sex.

Parents tell the nurse that their child keeps scratching the areas where he has poison ivy. The nurse's response should be based on which knowledge? a. Poison ivy does not itch and needs further investigation. b. Scratching the lesions will not cause a problem. c. Scratching the lesions will cause the poison ivy to spread. d. Scratching the lesions may cause them to become secondarily infected.

ANS: D Poison ivy is a contact dermatitis that results from exposure to the oil urushiol in the plant. Every effort is made to prevent the child from scratching because the lesions can become secondarily infected. The poison ivy produces localized, streaked or spotty, oozing, and painful impetiginous lesions. Itching is a common response. Scratching the lesions can result in secondary infections. The lesions do not spread by contact with the blister serum or by scratching.

Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration.

ANS: D Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

Which is a common childhood communicable disease that may cause severe defects in the fetus when it occurs in its congenital form? a. Erythema infectiosum b. Roseola c. Rubeola d. Rubella

ANS: D Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

34. A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. this cannot be prevented. b. infants do not feel pain as adults do. c. this is not a good reason for refusing immunizations. d. a topical anesthetic, EMLA, can be applied before injections are given.

ANS: D Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented and minimized by using the principles of atraumatic care. With preparation, the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to feel pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain? a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic, EMLA, can be applied before injections are given.

ANS: D Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented and minimized by using the principles of atraumatic care. With preparation, the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to feel pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting b2 agonists

ANS: D Short-acting b2 agonists are the first treatment in an acute asthma exacerbation. Ephedrine is not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations. Aminophylline is not helpful for acute asthma exacerbation. DIF: Cognitive Level: Apply REF: p. 666 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting β2 agonists

ANS: D Short-acting β2 agonists are the first treatment in an acute asthma exacerbation. Ephedrine is not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations. Aminophylline is not helpful for acute asthma exacerbation.

24. Austin, age 6 months, has six teeth. The nurse should recognize that this is: a. normal tooth eruption. b. delayed tooth eruption. c. unusual and dangerous. d. earlier-than-normal tooth eruption.

ANS: D Six months is earlier than expected. Most infants at age 6 months have two teeth. Although unusual, it is not dangerous.

What is cellulitis often caused by? a. Herpes zoster b. Candida albicans c. Human papillomavirus d. Streptococcus or Staphylococcus organisms

ANS: D Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. C. albicans is associated with candidiasis, or thrush. Human papillomavirus is associated with various types of human warts.

A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth? a. Twice a day b. Three times a day c. After meals d. After meals, after snacks, and at bedtime

ANS: D Teeth should be brushed after meals, after snacks, and at bedtime. Children who brush their teeth frequently and become accustomed to the feel of a clean mouth at an early age usually maintain the habit throughout life. Twice a day, three times a day, or after meals would not be often enough.

A nurse is planning care for a 17-month-old child. According to Piaget, which stage should the nurse expect the child to be in cognitively? a. Trust b. Preoperational c. Secondary circular reaction d. Tertiary circular reaction

ANS: D The 17-month-old child is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperational is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months. DIF: Cognitive Level: Remember REF: p. 356 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips and can hop in place on one foot b. Rides tricycle and broad jumps c. Jumps with both feet and stands on one foot momentarily d. Walks up and down stairs and runs with a wide stance

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step and runs with a wide stance. Skipping and hopping on one foot are achieved by 4-year-old children. Jumping with both feet and standing on one foot momentarily are achieved by 30-month-old children. Tricycle riding and broad jumping are achieved at age 3. DIF: Cognitive Level: Remember REF: p. 361 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

33. A parent asks the nurse whether her infant is susceptible to pertussis. The nurse's response should be based on which statement concerning susceptibility to pertussis? a. Neonates will be immune the first few months. b. If the mother has had the disease, the infant will receive passive immunity. c. Children younger than 1 year seldom contract this disease. d. Most children are highly susceptible from birth.

ANS: D The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age group.

A 14-year-old male mentions that he now has to use deodorant but never had to before. The nurse's response should be based on knowledge that which occurs during puberty? a. Eccrine sweat glands in the axillae become fully functional during puberty. b. Sebaceous glands become extremely active during puberty. c. New deposits of fatty tissue insulate the body and cause increased sweat production. d. Apocrine sweat glands reach secretory capacity during puberty.

ANS: D The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles, in the axilla, genital, anal, and other areas. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitalia and the "flush" areas of the body such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue is not the etiology of apocrine sweat gland activity. DIF: Cognitive Level: Understand REF: p. 449 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

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." Which is the nurse's best reply? 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 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. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to tend to the doll's needs at the same time the parent is performing similar care for the newborn. DIF: Cognitive Level: Apply REF: p. 363 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

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. What should the nurse explain to the father? 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 The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain 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. Ritualism is not indicative of a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning. DIF: Cognitive Level: Apply REF: p. 355 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

37. Examination of the abdomen is performed correctly by the nurse in the following order: a. Inspection, palpation, percussion, and auscultation b. Inspection, percussion, auscultation, and palpation c. Palpation, percussion, auscultation, and inspection d. Inspection, auscultation, percussion, and palpation

ANS: D The correct order of abdominal examination is inspection, auscultation, percussion, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds. Auscultation is performed before percussion. The act of percussion can influence the findings on auscultation. DIF: Cognitive Level: Comprehension REF: p. 168 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stools. The nurse's explanation of this is based on which statement? a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is normal for the child and is a normal part of the maturational process; no further investigation is necessary.

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which symptom? a. Gagging b. Coughing c. Pulse over 100 beats/min d. Inability to speak

ANS: D The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. Gagging indicates irritation at the back of the throat, not obstruction. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons.

Which is now referred to as the "new morbidity"? a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problems that alter health

ANS: D The new morbidity reflects the behavioral, social, and educational problems that interfere with the child's social and academic development. It is currently estimated that the incidence of these issues is from 5% to 30%. Limitations in major activities of daily living and unintentional injuries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time. DIF: Cognitive Level: Remember REF: p. 2 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is preparing to feed a 12-month-old infant with failure to thrive. Which intervention should the nurse implement? a. Provide stimulation during feeding. b. Avoid being persistent during feeding time. c. Limit feeding time to 10 minutes. d. Maintain a face-to-face posture with the infant during feeding.

ANS: D The nurse preparing to feed an infant with failure to thrive should maintain a face-to-face posture with the infant when possible. Encourage eye contact and remain with the infant throughout the meal. Stimulation is not recommended; a quiet, unstimulating atmosphere should be maintained. Persistence during feeding may need to be implemented. Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Although forced feeding is avoided, "strictly encouraged" feeding is essential. The length of the feeding should be established (usually 30 minutes); limiting the feeding to 10 minutes would make the infant feel rushed.

A nurse is establishing several health programs, such as bicycle safety, to improve the health status of a target population. This describes which step in the community nursing process? a. Planning b. Evaluation c. Assessment d. Implementation

ANS: D The nurse working with the community to put into practice a program to reach community goals is the implementation phase of the community nursing process. Planning involves designing the program to meet community-centered goals. The evaluation stage would determine the effectiveness of the program. During the assessment phase, the nurse would identify the resources necessary and the barriers that would interfere with implementation. DIF: Cognitive Level: Understand REF: p. 11 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their child. Which is most likely lacking in their particular diet? a. Fat b. Protein c. Vitamins C and A d. Complete protein

ANS: D The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives for Healthy People. Parents should be taught about food preparation to ensure that complete proteins are available for growth. When parents use a strict vegetarian diet, likelihood exists of inadequate protein for growth and calories for energy. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available. Foods must be combined to provide complete proteins for growth.

Which vitamin is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida? a.A b.C c.Niacin d.Folic acid

ANS: D The vitamin supplement that is recommended for all women of childbearing age is a daily dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can reduce the risk of neural tube defects by 70%. No correlation exists between vitamins A, C, or folic acid and neural tube defects.

An adolescent boy tells the nurse that he has recently had homosexual feelings. What knowledge should the nurse's response be based on? a. This indicates the adolescent is homosexual. b. This indicates the adolescent will become homosexual as an adult. c. The adolescent should be referred for psychotherapy. d. The adolescent should be encouraged to share his feelings and experiences.

ANS: D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society's reaction to the behavior. The nurse's first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentiality, appreciate his feelings, and remain sensitive to his need to talk about the topic. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing self-labels one or more times during their adolescence. An assessment must be made about any risks to himself or others. If these do not exist, the adolescent needs a supportive person to talk with. DIF: Cognitive Level: Apply REF: p. 449 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance

9. The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is: a. unacceptable because of the risk of sudden infant death syndrome (SIDS). b. unacceptable because it does not encourage achievement of developmental milestones. c. acceptable to encourage fine motor development. d. acceptable to encourage head control and turning over.

ANS: D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development.

The father of a 12-year-old child tells the nurse that he is concerned about his son getting "fat." His son is at the 50th percentile for height and the 75th percentile for weight on the growth chart. What is the most appropriate nursing action? a. Reassure the father that his child is not fat b. Reassure the father that his child is just growing c. Suggest a low-calorie, low-fat diet d. Explain that this is typical of the growth pattern of boys at this age

ANS: D This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and the child and develop a plan to maintain physical exercise and a balanced diet. It is false reassurance to tell the father that his son is not fat. His weight is high for his height. The child needs to maintain his physical activity. The father is concerned, so an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.

In terms of fine motor development, which should the 3-year-old child be expected to do? a. Lace shoes and tie shoelaces with a bow. b. Use scissors to cut pictures, and print a few numbers. c. Draw a person with seven parts and correctly identify the parts. d. Draw a circle and name what has been drawn.

ANS: D Three-year-olds are able to accomplish this fine motor skill. Being able to lace shoes and tie shoelaces with a bow, use scissors to cut pictures, and print a few numbers, or draw a person with seven parts and correctly identify the parts are fine motor skills of 4- or 5-year-olds. DIF: Cognitive Level: Understand REF: p. 380 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which should the nurse expect of a healthy 3-year-old child? a. Jump rope b. Ride a two-wheel bicycle c. Skip on alternate feet d. Balance on one foot for a few seconds

ANS: D Three-year-olds are able to accomplish this gross motor skill. Jumping rope, riding a two-wheel bicycle, and skipping on alternate feet are gross motor skills of 5-year-olds. DIF: Cognitive Level: Understand REF: p. 391 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which is most characteristic of the physical punishment of children, such as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Children's development of reasoning increases. d. Misbehavior is likely to occur when parents are not present.

ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the child's development of moral reasoning.

Which is most characteristic of the physical punishment of children, such as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Childrens development of reasoning increases. d. Misbehavior is likely to occur when parents are not present.

ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the childs development of moral reasoning.

Which factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy. DIF: Cognitive Level: Analyze REF: p. 355 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity

The nurse is talking to the parents of a child with pediculosis capitis. Which should the nurse include when explaining how to manage pediculosis capitis? a. "You will need to cut the hair shorter if infestation and nits are severe." b. "You can distinguish viable from nonviable nits, and remove all viable ones." c. "You can wash all nits out of hair with a regular shampoo." d. "You will need to remove nits with an extra-fine-tooth comb or tweezers."

ANS: D Treatment consists of the application of pediculicide and manual removal of nit cases. An extra-fine-tooth comb facilitates manual removal. Parents should be cautioned against cutting the child's hair short; lice infest short hair as well as long. It increases the child's distress and serves as a continual reminder to peers who are prone to tease children with a different appearance. It is not possible to differentiate between viable and nonviable eggs. Regular shampoo is not effective; a pediculicide is necessary.

16. Which of the following parameters correlates best with measurements of total muscle mass? a. Height b. Weight c. Skinfold thickness d. Upper arm circumference

ANS: D Upper 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. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold thickness is a measurement of the body's fat content. DIF: Cognitive Level: Comprehension REF: p. 138 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which may be given to high-risk children after exposure to chickenpox to prevent varicella? a. Acyclovir (Zovirax) b. Varicella globulin c. Diphenhydramine hydrochloride (Benadryl) d. VCZ immune globulin (VariZIG)

ANS: D VariZIG is given to high-risk children to prevent the development of chickenpox. Acyclovir decreases the severity, not the development, of chickenpox. Varicella globulin is not effective because it is not the immune globulin. Diphenhydramine may help pruritus but not the actual chickenpox.

The school nurse has been asked to begin teaching sex education in the fifth grade. What should the nurse recognize about this age group? a. Children in fifth 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 When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth-graders are usually 10 or 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage the child to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

ANS: D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

Poverty has serious implications for children and families. Social and cultural deprivation, including limited employment opportunities, inferior educational opportunities, inferior or no access to health care, and a lack of public services, is referred to as the _______________ type of poverty.

ANS: invisible Social and cultural deprivation, including limited employment opportunities, inferior educational opportunities, inferior or no access to health care, and a lack of public services is the definition of invisible poverty. Visible poverty is the lack of money or material resources, including insufficient clothing, poor sanitation, and deteriorating housing.

What are common s/s of parasitic gastroenteritis?

Abd cramping and diarrhea

What is colic?

Abdominal pain that irritates the baby causing a LOUD cry **Remember the #3

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

Able to grasp an object voluntarily PG 303

Immunity from exposure to the invading agent, which is a bacteria, virus, or toxin

Acquired immunity

Psychosocial DevelopmentDeveloping a Sense of Trust

Acquiring a sense of trust while overcoming a sense of mistrust Trust = feeding, comfort, stimulation & caring needs are met Mistrust = infant & parent must jointly learn to satisfactorily meet their needs or mistrust develops Need to learn delayed gratification Consistency of care is essential Grasping and biting (social modalities)

A state in which immune bodies are actively formed against specific antigens, either naturally by having had the disease or artificially

Active immunity

The nurse teaches the parent measures to be followed when administering iron supplements to a 3-year-old child. During a follow-up visit, the nurse finds that the child still has anemia, even after following the complete treatment regimen. Which action by the parent is likely responsible for this condition? Select all that apply.

Administering iron supplements with milk Administering iron supplements with an oral antacid Administering iron supplements with sweet potato

A registered nurse is explaining to a nursing intern about atraumatic care in a pediatric care facility. Which example should the nurse cite to explain this process? Administering pain medications Recording blood pressure Administering intravenous fluids Providing diet as listed in the diet chart

Administering pain medications Rationale: A traumatic care refers to the provision of therapeutic care that eliminates or minimizes the psychologic and physical distress experienced by children and their families in the health care system. Controlling pain by administering pain medications is an example of a traumatic care. Nursing procedures such as recording blood pressure, administering fluids, and providing diet according to the diet chart are not examples of a traumatic care.

What is the most important nursing consideration in the management of cellulitis? Application of Burow solution compresses Administration of oral or parenteral antibiotics Topical application of an antibiotic Incision and drainage of severe lesions

Administration of oral or parenteral antibiotics Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. Antibiotics need to be administered systemically (orally or parenterally), not topically. If incision and drainage are implemented, there is a risk of spreading infection or making the lesion worse.

The nurse is administering the first hepatitis A vaccine to an 18-month-old child. When should the child return to the clinic for the second dose of hepatitis A vaccination?

After 6 months. (Hepatitis A vaccine is now recommended for all children beginning at age 1 year (i.e., 12 months to 23 months). The second dose in the two-dose series may be administered no sooner than 6 months after the first dose.)

When does GER occur the most?

After meals and at night, causes burning, and leads to GER

Polygamy refers to either multiple wives, polygyny, or rarely, multiple husbands, polyandry. Many societies practice polygyny that is further designated as sororal, in which the wives are sisters, or nonsororal, in which the wives are unrelated.

Age differences between siblings affect the childhood environment but to a lesser extent than does the gender of the sibling. In general, the narrower the spacing between siblings, the more the children influence one another, especially in emotional characteristics. The wider the spacing, the greater the influence of the parents.

Number of teeth calculated by

Age of child in months-6 (Ex: 8 mos-6=2 teeth)

Which statement is not accurate regarding the roles and responsibilities of a school nurse? They are responsible for development and implementation of plans of care for all children within the designated school. All school nurses are registered nurses. They are responsible for medical needs of the children within the designated school. They evaluate implementation of care delivered to children within the designated school setting.

All school nurses are registered nurses. Not all schools have a school nurse but may have unlicensed assistive personnel that work within the school setting that have received training to provide routine standardized care under the supervision of a school nurse. The other options are all within the roles and responsibilities of a school nurse.

Which serious reaction should the nurse be alert for when administering vaccines?

Allergic reaction (Each vaccine administration carries the risk of an allergic reaction. The nurse must be prepared to intervene if the child demonstrates signs of a severe reaction. Mild febrile reactions do occur after administration. The nurse includes management of fever in the parent teaching. Local skin irritation may occur at the injection site after administration. Parents are informed that this is expected. The injection can be painful. The nurse can minimize the discomfort with topical analgesics and nonpharmacologic measures.)

While assessing a toddler's eyes, the nurse finds the presence of persistent strabismus. The nurse instructs the parents to immediately consult an ophthalmologist for the toddler. Which condition does the nurse seek to prevent by this instruction?

Amblyopia PG 543

The change from the exclusive use of oral polio vaccine (OPV) to the exclusive use of inactivated poliovirus vaccine (IPV) related to the rare risk of vaccine-associated polio paralysis (VAPP) from OPV has resulted in which of the following?

An increased number of injections and increased cost

A nurse is assisting a group of parents of adolescents to develop skills that will improve communication within the family. The nurse hears one parent state, "My son knows he better do what I say." Which of the following parenting styles is the parent exhibiting? A. authoritarian b. permissive c. authoritative d. passive

Ans: A This parent is exhibiting an authoritarian parenting style. The parent controls the adolescent's behaviors and attitudes through unquestioned rules and expectations.

The nurse is performing a family assessment. Which of the following should the nurse include? (select all that apply) A. Medical History B. parents' educational level c. child's physical growth d. support systems e. Stressors

Ans: A, B, D, E

A nurse manager on a pediatric floor is preparing an education program on working with families for a group of newly hired nurses. Which of the following should the nurse include when discussing the developmental theory? A. Describes that stress in inevitable B. Emphasizes that change with one member affects the entire family C. Provides guidance to assist families adapting to stress D. Defines consistencies in how families change

Ans: D The nurse should include that the developmental theory defines consistencies in how families change. The family stress theory describes that stress is inevitable. The family system theory emphasizes that change with one family member affects the entire family. The family stress theory provides guidance to assist families adapting to stress.

A nurse is providing teaching about age-appropriate activities to the parent of a 2 year old. Which of the following statements by the parent indicated an understanding of the teaching? a. "I will send my child's favorite stuffed animal when she will be napping away from home" b. "My child should be able to stand on one foot for a second" c. "The soccer team my child will be playing on starts practicing next week" d. "I should expect my child to be able to draw circles"

Answer: A Provides a sense of security. Age-appropriate activity for a 2 year old. Standing on 1 foot = 2.5 yr Toddlers prefer parallel play (play alongside of, instead of with, other children) making team sport difficult Drawing circles = 2.5 yr

The nurse is performing a developmental screening on a 10-month-old infant. Which of the following fine motor skills should the nurse expect the infant to perform? (Select all that apply). a. grasp a rattle by the handle b. try building a two-block tower c. use a crude pincer grasp d. place object into a container e. walks with one hand held

Answer: A & C rattle: 10 months two-block tower: 12 months cruse pincer grasp: 9 months objects into container: 11 months walk with hand held: 12 months

A nurse is providing anticipatory guidance to the parents of a toddler. Which of the following should the nurse include? (Select all that apply). a. develop food habits that will prevent dental caries b. meeting caloric needs results in an increased appetite c. expression of bedtime fears in common d. expect behaviors associated with negativism and ritualism e. annual screenings for PKU are important

Answer: A, C, D Toddlers often experience physiologic anorexia and become fussy eaters because of a decreased appetite. Assessment of PKU happens with newborn.

A nurse is providing education about introducing new foods to the parents of a 4-month-old infant. The nurse should recommend that the parents introduce which of the following foods first? a. strained yellow vegatables b. Iron-fortified cereals c. pureed fruits d. whole milk

Answer: B Initially want iron-rich content, foods introduced after are variable.

A nurse is assessing a 12-mo-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? a. Closed anterior fontanel b. eruption of six teeth c. birth weight doubled d. birth length increased by 50%

Answer: C By the age of 12 months, the infant's birthweight should have tripled. Therefore the nurse should report this finding to the provider. By the age of 12-18 months, the infant's anterior fontanel should close. By the age of 12 months, the infant should have six to eight teeth erupted. By the age of 12 months, the infant's birth length should increase by 50%.

Which is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate parental concern for the degree of injury b. Absence of parents for questioning about child's injuries c. Inappropriate response of child d. Incompatibility between the history and injury observed

Answer: D Conflicting stories about the "accident" are the most indicative red flags of abuse. Inappropriate response of caregiver or child may be present, but is subjective. Parents should be questioned at some point during the investigation.

What is antibiotic associated diarrhea?

Antibiotics alter the normal intestinal flora

>37

Apnea of infancy is different from ALTE in that it afflicts infants _____ weeks gestation

Management of appendicitis?

Appendectomy, penrose drain

What foods are high in fiber?

Apples, beans, raisins, prunes, APPLE CIDER

zinc, phosphorus

Aside from iron, what (2) other minerals commonly are low in infants and cause issues?

What are extreme complications of GER/GERD?

Aspiration pneumonia, apnea, esophagitis, growth failure, no response to meds

Temperament

Assess parents' perception of the child & the degree of fit Strong biologic component Temperament may be modified by the environment Childbearing practices related to temperament May respond better to scheduled feedings & structure routines, etc. Even just letting parents know that "difficult" traits are innate can relieve feelings of guild & incompetence

Other essential skills that parents need to feel comfortable in the parenting role include a basic understanding of childhood growth and development, bathing, feeding, use of play, and interpersonal communication skills.

Authoritarian or dictatorial parents try to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Punishment need not be corporal but may be stern withdrawal of love and approval.

Authoritative or democratic parents combine practices from both of the previously described parenting styles. They direct their children's behavior and attitudes by emphasizing the reason for rules and negatively reinforcing deviations. They respect the individuality of each child and allow the child to voice objections to family standards or regulations.

Authoritative parental control is firm and consistent but tempered with encouragement, understanding, and security. Control is focused on the issue, not on withdrawal of love or the fear of punishment. These parents foster "inner directedness", a conscience that regulates behavior based on feelings of guilt or shame for wrongdoing, not on fear of being caught or punished.

A toddler is brought to the emergency room following an accidental swallowing of a foreign body. The child undergoes treatment and is well now. What instructions does the nurse give the parents during discharge? Select all that apply.

Avoid contact with small plastic balls. Cut fruits in small pieces and give to the child. Slice hot dogs lengthwise into short pieces for the child to eat.

An infant is diagnosed with iron deficiency and prescribed iron syrup. What instructions should the nurse give to the parents regarding administration of the syrup? Select all that apply.

Avoid giving the iron syrup along with milk products. Rinse the child's mouth thoroughly after administering the syrup. Give orange juice or citrus fruit after administering the syrup.

2. The nurse may be called upon to have knowledge about sex chromosome aneuploidies. In answering families' questions, the nurse can report: A. "Some of the most common genetic disorders caused by sex chromosome aneuploidies are Klinefelter, XXY, triple X female, and Turner syndromes." B. "Klinefelter's syndrome is the most common of all sex chromosome aneuploidies, and mental development is normal in most cases." C. "Triple X females have premature menarche and delayed menopause." D. "Turner's syndrome girls have a prepubertal growth spurt and then mostly stop growing."

B

An immediate intervention to teach parents for when an infant chokes on a piece of food would be to A. have infant lie quietly while a call is placed for emergency help. B. position infant in a head-down, face-down position and administer five quick back slaps. C. administer mouth-to-mouth resuscitation. D. give some water by a cup to relieve the obstruction.

B

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

B

The most appropriate time to perform bronchial postural drainage is A. immediately before all aerosol therapy. B. before meals and at bedtime. C. Immediately on arising and at bedtime. D. thirty minutes after meals and at bedtime

B

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend A. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. D. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.

B

When developing a care plan for the child diagnosed with cystic fibrosis, which of the following must the nurse keep in mind? A. CF is an autosomal dominant hereditary disorder B. Pulmonary secretions are abnormally thick C. Obstruction of the endocrine glands occurs D. Elevated levels of potassium are found in the sweat

B

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

B

The nurse is caring for a hospitalized 4-year-old boy, Ryan. His parents tell the nurse that they will be back to visit at 6 PM. When Ryan asks the nurse when his parents are coming, the nurse's best response is: a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be."

B A 4-year-old understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. This answer assumes that the child understands the concept of hours and minutes, which is not developed until age 5 or 6 years.

The parent of a 4-year-old son tells the nurse that the child believes "monsters and the boogeyman" are in his bedroom at night. The nurse's best suggestion for coping with this problem is to: a. Insist that the child sleep with his parents until the fearful phase passes. b. Suggest involving the child to find a practical solution such as a night-light. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and the boogeyman do not exist.

B A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents or telling the child that these creatures do not exist will not get rid of the fears. A 4-year-old is in the preconceptual age and cannot understand logical thought.

Which type of play is most typical of the preschool period? a. Solitary b. Associative b. Parallel d. Team

B Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams.

In terms of language and cognitive development, a 4-year-old child would be expected to: a. Think in abstract terms. b. Follow simple commands. c. Understand conservation of matter. d. Comprehend another person's perspective.

B Children ages 3 to 4 years can give and follow simple commands. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. A 4-year-old child cannot comprehend another's perspective.

What is descriptive of the preschooler's understanding of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms like "yesterday" appropriately

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

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." The nurse's best interpretation of this comment is that it is: a. A sign of stress. b. Common at this age. c. Suggestive of maladaptation. d. Suggestive of excessive discipline at home.

B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

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."

B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. 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. Secondary teeth erupt at about 6 years of age. If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

Vitamin A supplementation may be recommended for the young child who has: a. Mumps. b. Measles (rubeola). c. Rubella. d. Erythema infectiosum.

B Evidence shows that vitamin A decreases morbidity and mortality associated with measles. Vitamin A will not lessen the effects of mumps, rubella, or fifth disease.

Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Allow children unrestricted permission to satisfy this curiosity. d. Get counseling for this unusual and dangerous behavior.

B Three-year-olds become aware of anatomic differences and are concerned about how the other "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. Encouraging the children to ask questions of the parents and redirecting their activity are more appropriate than giving permission. Exploration is age-appropriate and not dangerous behavior.

Which findings would the nurse suspect to be observe during a work up for in a pediatric patient suspected of having a brain tumor? (Select all that apply.) A. Vomiting following eating B. Headaches upon arising that dissipates as the day progresses C. Decreased pulse pressure D. Abnormal cranial nerve examination E. Negative Babinksi sign

B, C, D The presence of brain tumor would cause a variety of clinical symptoms depending on the location and extent of the tumor. Expected physical findings are associated with headache upon arising that subsides as the day progresses, a decreased pulse pressure, abnormal neurological exam which includes cranial nerve abnormalities as well as a positive Babinski reflex. Vomiting specifically associated with eating is not directly correlated with a brain tumor. Vomiting can be present but may or not be associated with nausea or feeding.

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

B, C, D, E

5. The pediatric nurse may be in the unique position to talk with a family about further genetic evaluation of their child. Which assessment findings by the nurse may alert the nurse to this need? Select all that apply. A. Digestive difficulties, especially after 6 months of age B. Skeletal abnormalities: limb abnormalities, asymmetry, hyperextendible joints C. Recurrent infection or immunodeficiency: ear infections, pneumonia, poor healing of the umbilicus D. Urinary tract issues: recurrent infections, delay in toilet training E. Development and speech delays or loss of developmental milestones

B, C, E

Which should the nurse teach to parents of toddlers about accidental poison prevention? (Select all that apply.) a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants.

B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, know the number of the nearest poison control center, and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances. DIF: Cognitive Level: Apply REF: p. 371 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

While orienting a new nurse to the ICU, she asks, "How do these children sleep and not become frightened with all the lights and noises?" How should you respond? Select all that apply. A. "These children are sicker than those on the pediatric unit, so the noises and lights are necessary." B. "We try to organize care into clusters so infants and children can sleep and we can turn down lights." C. "We silence alarms to allow for periods of sleep, especially at night." D. "When possible, we allow for uninterrupted sleep cycles—for infants 90 minutes and for older children 60 minutes." E. "We encourage parents to sit with and touch their child as often as possible."

B, E

In terms of language and cognitive development, a 4-year-old child would be expected to have which traits (select all that apply)? a. Think in abstract terms. b. Follow directional commands. c. Understand conservation of matter. d. Use sentences of eight words. e. Tell exaggerated stories.

B, E Children ages 3 to 4 years can give and follow simple commands and tell exaggerated stories. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. Five-year-old children use sentences with eight words with all parts of speech.

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? (Select all that apply.) A. The childs bruises are located only on the right arm and leg. B. The child is brought to the emergency department by an unrelated adult. C. The child has a history of a broken arm last year from falling off a swing. D. The childs caregiver is anxious that the child get immediate medical attention. E. The child has red, green, and yellow bruises on more than one plane of the body.

B, E B. The child is brought to the emergency department by an unrelated adult. E. The child has red, green, and yellow bruises on more than one plane of the body. A child brought to a healthcare provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse.<br>Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse.<br>Falling down stairs can be an unintentional injury.<br>A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse.<br>An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.

Duvall's Developmental Stages of the Family include which of the following? Select all that apply. A. Stages an individual progresses through in their moral and spiritual development B. Stages families progress through in adulthood C. Stages that designate how parenting progresses as a child develops D. Stages that designate appropriate discipline related to developmental stages E. Stages that describe the journey a couple will take as their children mature

B,C,E

With regard to incidence of childhood cancer, which statement is accurate? A. In children there is a high incidence of cancer. B. Despite a low incidence, there is high morbidity in children under the age of 15. C. Gender does not affect incidence of childhood cancers. D. Higher incidence in found in African American children as compared to Caucasians.

B. Despite a lower incidence of childhood cancer, there is a higher morbidity associated with specific age groups. Different subtypes of cancer are affected by gender, age and ethnicity. A higher incidence of cancers are found in Caucasian children as compared to African American children.

In reviewing information about a school-age child, the nurse notes that the child goes to after school activities each day as the parents do not get home until considerably later in the day. Based on this description, the nurse would document A. concern for the growth and development due to lack of parental influence. B. no further action is needed. C. referral to a social worker for evaluation of the family unit. D. notation of being a latchkey child.

B. Many children have working parents and do not exhibit any adverse outcomes if they attend after school activities each day following release from school. There is no need for referral to a social worker. A latchkey child by definition is one that has no parental or supervision contact following the school day and are responsible for their own care until the parent comes home.

An example of a disease process with underlying immune adaptation l potentially leading to a cancer diagnosis is? A. Fanconi anemia B. Wiskott Aldrich syndrome C. Klinefelter syndrome D. Retinoblastoma

B. Wiskott Aldrich syndrome is an example of an immunodeficiency state may place the individual at increased risk to develop certain cancers. Fanconi anemia and Klinefelter syndrome are examples of chromosomal abnormalities which can potentially lead to development of cancer. Retinoblastoma is an example of "two-hit" hypothesis of inheritance leading to development of cancer states.

A 1-day-old breastfed neonate, with the same blood type and Rh type as its mother, has a yellowish facial tone and a bilirubin level of 9.0. The most appropriate response by the nurse is A. "Infants' livers can't produce enough glycogen to bind to the circulating bilirubin." B. "Your baby is breaking down fetal red blood cells, and bilirubin is a waste product." C. "Your baby probably has breast milk jaundice, which is common for a 2-day-old infant." D. "We should restrict fluids until the baby can clear the bilirubin from its system."

B. "Your baby is breaking down fetal red blood cells, and bilirubin is a waste product." Bilirubin is one of the breakdown products of hemoglobin that results from red blood cell destruction. The baby's red blood cells are destroyed and the liver is too immature to maintain a balance between the destruction and excretion. The result is elevated bilirubin levels and a yellow hue to the skin tone of the baby. Infants' livers can't produce enough glycogen to bind to the circulating bilirubin is not a correct statement. Breast milk jaundice is common for 2- to 4-day-old infants. Restricting fluid will make the problem worse. Early frequent breastfeeding promotes increased intestinal motility, decreasing enterohepatic shunting and establishing normal bacterial flora in the bowel to effectively enhance the excretion of unconjugated bilirubin.

Phenylketonuria (PKU) testing is most accurate when obtained: A. 20 hours after birth. B. 24 to 48 hours after birth. C. during newborn transition. D. at the newborns two-week check-up.

B. 24 to 48 hours after birth. At 24 to 48 hours after birth test results for PKU will be reliable because the newborn has ingested an ample amount of the amino acid phenylalanine, which is a constituent of human milk. PKU is an inborn error of metabolism and testing is not reliable until the newborn has ingested an ample amount of the amino acid phenylalanine, which is a constituent of human milk. PKU is an inborn error of metabolism and is not reliable until the newborn has ingested an ample amount of the amino acid phenylalanine, which is a constituent of human milk. PKU is an inborn error of metabolism and testing is not reliable until the newborn has ingested an ample amount of the amino acid phenylalanine, which is a constituent of human milk.

What is the most important nursing consideration in the management of cellulitis? A. Application of Burow solution compresses B. Administration of oral or parenteral antibiotics C. Topical application of an antibiotic D. Incision and drainage of severe lesions

B. Administration of oral or parenteral antibiotics Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. Antibiotics need to be administered systemically (orally or parenterally), not topically. If incision and drainage are implemented, there is a risk of spreading infection or making the lesion worse.

A child with a serious chronic illness will soon be discharged home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. Based on the principles of family-centered care, which statement addresses this principle? A. Appropriate because families are usually eager to get involved B. Appropriate because it can be beneficial to the transition from hospital to home C. Inappropriate because of legal issues when parents care for their children on hospital property D. Inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily

B. Appropriate because it can be beneficial to the transition from hospital to home This is appropriate. At least two family members should be comfortable caring for the child before discharge. Caring for the child with the nurse available to answer questions and provide support and guidance will make the transition home for the parents and child easier. The family needs to learn the skills necessary to care for the child at home. Their eagerness is important, but it is not the reason to provide total care for their child while still hospitalized. The family members will be able to learn to care for their child with the supervision of nursing staff. Legal issues related to caring for their child in the hospital setting are not relevant. Learning to care for their child before discharge is essential to properly prepare the family to assume the care and minimize their stress level as much as possible.

A nurse is caring for an adolescent client who has mononucleosis. The nurse assesses fever, fatigue, swollen lymph nodes, sore throat, and a sore upper abdomen. Which of the following instructions should the nurse discuss with the adolescent and her parents? (Select all that apply.)

B. CORRECT: Fluids are encouraged to prevent dehydration with illness. C. CORRECT: The spleen could rupture as a result of injury. Therefore, strenuous activities should be avoided. D. CORRECT: Fatigue is common in clients who have mononucleosis. Therefore, allowing for periods of rest facilitates healing. F. CORRECT: It can soothe discomfort associated with a sore throat.

When teaching the adolescent about the management of acne, the nurse should include what instructions? A. Clean the face with an antibacterial soap twice each day. B. Clean the face gently with a mild soap once or twice each day. C. Avoid foods with a high-fat content such as French fries and chocolate. D. Express comedones by gentle squeezing; then cleanse with alcohol.

B. Clean the face gently with a mild soap once or twice each day. Cleansing the face with mild soap and water will remove surface dirt and oil, which is essential in the management of acne. Antibacterial soaps may be too drying when used in combination with topical medications and may exacerbate acne. No relationship has been established between food intake and acne. Squeezing the acne can break down the ductal walls of the lesions and cause the acne to worsen.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? A. Inactivity B. Clinging to the parent C. Depression and sadness D. Forming superficial relationships

B. Clinging to the parent In the protest phase of separation anxiety, the child aggressively responds to separation from a parent by clinging and holding onto the parent and screaming for the parent. Inactivity is a sign of despair in a young child, not protest. A depressed, sad child indicates despair, not the protest phase. The formation of superficial relationships indicates that a young child is in the phase of detachment, not protest.

Which statement about bottle-mouth caries should be taught to the parents? A. This syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. B. Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. C. This syndrome can be completely prevented by breastfeeding. D. Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

B. Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. Sweet liquids, or the sugars in milk and even breast milk, pooling in a toddler's mouth during sleep increase the incidence of dental caries. Changes in the positioning of the teeth may result from pacifier use or thumb-sucking and are not related to bottle-mouth caries. Frequent breastfeeding before sleep can cause bottle-mouth caries, since breast milk does contain lactose, which is present in higher concentrations than in cow's milk-based formula. Juice, which contains varying concentrations of sugar, in bottles before sleep contributes to bottle-mouth caries.

The nurse is assessing newborns during a routine shift assessment. Which infant requires further assessment? A. Heart rate of 120 beats per minute; respiratory rate of 45 breaths per minute B. Heart rate of 135 beats per minute; respiratory rate of 65 breaths per minute C. Heart rate of 150 beats per minute; respiratory rate of 35 breaths per minute D. Heart rate of 145 beats per minute; respiratory rate of 55 breaths per minute

B. Heart rate of 135 beats per minute; respiratory rate of 65 breaths per minute The expected heart rate for a newborn is 110 to 160 beats per minute, and the expected respiratory rate is 30 to 60 breaths per minute. Any vital signs noted outside the expected range require further assessment. A heart rate of 120 beats per minute and a respiratory rate of 45 breaths per minute are within the normal range. A heart rate of 150 beats per minute and a respiratory rate of 35 breaths per minute are within the normal range. A heart rate of 145 beats per minute and a respiratory rate of 55 breaths per minute are within the normal range.

Which statement best represents infectious mononucleosis? A. Human herpesvirus type 2 is the principal cause. B. Herpes-like Epstein-Barr virus is the principal cause. C. Diagnosis is established by a complete blood count, which reveals a characteristic leukopenia. D. Diagnosis is established by clinical manifestations because diagnostic tests cannot confirm the diagnosis.

B. Herpes-like Epstein-Barr virus is the principal cause. Herpes-like Epstein-Barr virus accounts for most cases of mononucleosis. Herpes-like Epstein-Barr virus is the principal cause of mononucleosis. A complete blood count in an adolescent with mononucleosis would indicate a lymphocytic leukocytosis with atypical lymphs, not leukopenia. The monospot test is a highly specific test for mononucleosis.

What is the causative agent for erythema infectiosum (fifth disease)? A. Paramyxovirus B. Human parvovirus B19 C. Human herpesvirus type 6 D. Group A β-hemolytic streptococcus

B. Human parvovirus B19 Human parvovirus B19 is the causative agent of fifth disease. Paramyxovirus causes mumps. Human herpesvirus types 1 and 2 are the major causes of herpetic infections in humans. Group A β-hemolytic streptococcus is the causative agent for scarlet fever.

What is described as the time interval between early manifestations of a disease and the overt clinical syndrome? A. Incubation period B. Prodromal period C. Desquamation period D. Period of communicability

B. Prodromal period The prodromal period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms. The incubation period is the time from exposure to the appearance of the first symptom. The desquamation period refers to the shedding of skin when applicable for a syndrome or disorder. The period of communicability describes the period when the child is infectious.

An infant at 36 weeks' gestation with a maternal history of gestational diabetes is moved to the NICU from the transitional nursery at 3 hours of life. The infant is noted to have poor muscle tone and rapid respirations with retractions. The most probable diagnosis for this infant is: A. Hyperbilirubinemia B. Respiratory distress syndrome C. Acrocyanosis D. Polycythemia

B. Respiratory distress syndrome The infant is most likely to have respiratory distress syndrome (RDS). RDS is often associated with preterm delivery and also with mothers who have gestational diabetes. The infant needs further assessment and support in the NICU. Hyperbilirubinemia is indicated by jaundice. Acrocyanosis is a persistent blue or cyanotic discoloration of the extremities. In polycythemia, the proportion of blood volume that is occupied by red blood cells increases.

A hospitalized toddler clings to a worn, tattered blanket. The toddler screams when anyone tries to take it away. Which is the best explanation for the toddler's attachment to the blanket? A. The blanket encourages immature behavior. B. The blanket is an important transitional object. C. The developmental task of individuation-separation has not been mastered. D. The child and mother have inadequate bonding

B. The blanket is an important transitional object. The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are important to help toddlers separate, and attachment to them does not indicate immature behavior. Transitional objects are helpful when a toddler experiences increased stress such as hospitalization. The attachment to the blanket does not reflect inadequate bonding with the mother.

Which statement is most characteristic of the motor skills of a 24-month-old child? A. The toddler walks alone but falls easily. B. The toddler's activities begin to produce purposeful results. C. The toddler is able to grasp small objects but cannot release them at will. D. The toddler's motor skills are fully developed but occur in isolation from the environment.

B. The toddler's activities begin to produce purposeful results Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new toy. By 2 years of age, children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is a task of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

When giving instructions to a parent whose child has scabies, the school nurse should tell the parent to: A. treat all family members if symptoms develop. B. be prepared for symptoms to last 2 to 3 weeks. C. notify the practitioner so an antibiotic can be prescribed. D. carefully treat only those areas where there is a rash.

B. be prepared for symptoms to last 2 to 3 weeks. The mite responsible for scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. Only the affected child needs to be treated for scabies. A scabicide is used. Permethrin and lindane are currently used for topical administration. Permethrin is applied to all skin surfaces in the treatment of scabies.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: A. nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. C. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. D. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first.'' Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. There is no universal right age to begin toilet training or an absolute deadline to complete training. One of the nurse's most important responsibilities is to help parents identify the readiness signs in their child.

A mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. She plays "house" in it with her toddler brother. Based on the nurse's knowledge of growth and development, the nurse recognizes that this is: A. unsafe play that should be discouraged. B. creative play that should be encouraged. C. suggestive of limited family resources. D. suggestive of limited adult supervision.

B. creative play that should be encouraged This type of play should be encouraged. After children create something new, they can then transfer it to other situations. There should be some supervision to prevent injury or accidents. As long as the play is supervised, it should be encouraged. This is not considered unsafe play. There is no indication of limited resources. There is no indication of limited adult supervision.

During the rehabilitative phase of care, pressure dressings are primarily applied to burned areas to: A. relieve pain. B. decrease blood supply to scar. C. limit motion during the healing process. D. encourage healing through scar formation.

B. decrease blood supply to scar. Uniform pressure to the scar decreases the blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. The goal of the pressure dressing is to improve the appearance of scars by decreasing the blood supply to the area. Motion is encouraged because it prevents contractures. Movement should take place to the point of pain, but no further. The goal of the pressure dressing is to minimize the development of scar tissue.

A toddler has a deep laceration contaminated with dirt and sand. Before suturing, the nurse should irrigate the wound with: A. alcohol. B. normal saline. C. hydrogen peroxide. D. povidone-iodine.

B. normal saline. Normal saline is the only acceptable fluid for irrigation from the choices given above. The nurse should cleanse the wound with a forced stream of normal saline or water. Alcohol should not be used as an irrigation solution, because it is toxic to the wound. Hydrogen peroxide should not be used as an irrigation solution, because it is toxic to the wound. Povidone-iodine should not be used as an irrigation solution, because it is toxic to the wound

When preparing parents to teach their preschool child about human sexuality, the nurse should emphasize that: A. a parent's words may have a greater influence on the child's understanding than the parent's actions. B. parents should determine exactly what the child wants to know before answering a question about sex. C. parents should avoid using correct anatomic terms because they are confusing to the preschooler. D. parents should allow children to satisfy their sexual curiosity by playing "doctor."

B. 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 asking. Actions may have a greater influence because language is not fully developed in the preschool years. Using correct terminology lays the foundation for later discussion of human sexuality. Parents should encourage children to ask questions to provide accurate information at their cognitive level.

During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. His birthday is close to the cutoff date, and he has not attended preschool. The nurse's BEST recommendation is to: A. start kindergarten. B. perform developmental screening. C. observe a kindergarten class. D. postpone kindergarten and go to preschool.

B. perform developmental screening A developmental screening will provide the necessary information to help the family determine readiness. Encouraging the father to have the child start kindergarten does not address the father's concern about readiness and suggests that his concerns are not warranted. Recommending to the father that he postpone kindergarten and send the child to preschool assumes that the child is not ready for kindergarten, but the recommendation is not based on any data or facts. Recommending to the father that he simply place his child in preschool may lead to the child's boredom with school. Having the father observe a kindergarten class and then decide if the child would enjoy the experience will provide information about kindergarten but not about whether his child is ready to begin and thrive there.

The nurse's BEST approach for effective communication with a preschool age child is through: A. speech. B. play. C. drawing. D. actions.

B. play Preschoolers' most effective means of communication is through play. Play allows preschoolers to understand, adjust to, and work out life's experiences through their imagination and ability to invent and imitate. Speech is not effective, because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meaning of words and often take statements literally. Drawing is still being developed as a fine motor skill; therefore, it is not the most effective means of communication. Actions are not an appropriate means of communication for a preschooler.

A 4-year-old boy has been having increasingly more frequent angry outbursts in preschool. He is very aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. The MOST appropriate intervention is to: A. explain that this is normal in preschoolers, especially boys. B. refer the child for professional help. C. talk to the preschool teacher to obtain validation for the behavior the parent reports. D. encourage the parent to try more consistent and firm discipline.

B. refer the child for professional help. This is not expected behavior. The child should be referred to a competent professional to deal with his aggression so that an accurate assessment can be made and a care plan determined. Outward aggression to others is not normal behavior and should be evaluated. The validation will be helpful for the referral, but the referral is the priority action. This may be recommended by the professional once an accurate assessment is made.

A 4-year-old female child sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened. Yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This is MOST likely described as: A. a nightmare. B. sleep terror. C. seizure activity. D. sleep apnea.

B. sleep terror Nightmares are associated with difficulty returning to sleep as opposed to sleep terrors where the individual easily goes back to sleep. With the advent of a nightmare, the child has a memory of the dream like state, is comforted by traditional methods of contact and thrashing type behaviors cease upon awakening. In sleep terrors, the child has no memory of the event, continues thrashing behaviors when awaken, and is not comforted by traditional methods of contact.

The nurse needs to start an intravenous (IV) line for an 8-year-old child to begin administering IV antibiotics. The child starts to cry and tells the nurse, "Do it later, OK?" The most appropriate action by the nurse is to: A. start the IV because allowing the child to manipulate the nurse is not professional behavior B. start the IV because unlimited procrastination results in heightened anxiety C. postpone starting the IV until the child is ready so that the child experiences a sense of control D. postpone starting the IV until the child is ready so that the child's anxiety is reduced

B. start the IV because unlimited procrastination results in heightened anxiety Beginning IV antibiotics is 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 child's anxiety. The nurse should start the IV, recognizing that the child is attempting to gain control. Whether the child is trying to manipulate the nurse should have no bearing on the implementation of the nursing action. If the timing of the IV start was not essential, delaying the starting of the IV might be acceptable. The child may never be ready to have the IV started. The child's anxiety is likely to increase with a prolonged delay.

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to: A. consistently use safety caps. B. store poisonous substances in a locked cabinet. C. keep ipecac in the home. D. store poisonous substances out of reach.

B. store poisonous substances in a locked cabinet. This is an appropriate action to prevent the curious toddler from getting into poisonous substances and products. Not all poisonous substances have safety caps, and safety caps are not always foolproof. Ipecac does not prevent poisoning and is not recommended as a treatment for poisoning. Toddlers can climb and are curious; therefore, storing substances out of reach only does not eliminate the potential for poisoning.

Who does Meckel Diverticulum mostly occur in?

BOYS

Who does pyloric stenosis usually occur in?

BOYS

Who does this normally occur in?

BOYS

Who is Hirschsprung Disease more common in?

BOYS

Who is intussusception most common?

BOYS

What is a congenital disease?

Baby is born with it

The Hib conjugate vaccines protect an infant against which of the following diseases? (Select all that apply.)

Bacterial meningitis Epiglottitis Bacterial pneumonia Septic arthritis Sepsis (Hib conjugate vaccines protect against a number of serious infections caused by Haemophilus influenza type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis.)

When giving instructions to a parent whose child has scabies, what should the nurse include?

Be prepared for symptoms to last 2 to 3 weeks. (The mite responsible for the scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. Initiation of therapy does not wait for clinical symptom development. All individuals in close contact with the affected child need to be treated. Permethrin, a scabicide, is the preferred treatment and is applied to all skin surfaces.)

When is voluntary control of the anal and urethral sphincters typically achieved?

Between 18 and 24 months PG 360

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria and pertussis (Tdap) vaccine optimally at which of the following times?

Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital .(The ACIP of the CDC and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital.)

Which is the bad one, bilious or non-bilious?

Bilious- meaning bile coming out and ileocecal valve has issues

What is Esophageal Atresia?

Birth defect causing the esophagus to end in a BLIND POUCH

A 6-month-old infant has been recently diagnosed with iron deficiency anemia and is treated with iron supplements. After 2 days the parent of the infant complains of black stools in the infant and is very worried about it. What advice should be given to the parent?

Black stools are one of the common side effects of iron supplements; hence there is no need to worry. PG 318

If a patient with acute diarrhea is NOT stable what do you give to replace the deficit?

Bolus

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, what is it important for the nurse to emphasize?

Bowel control is accomplished before bladder control, so bowel training should be addressed first. PG 362

How to diagnose lactose intolerance?

Breath hydrogen test, if it's + then it's +

How is pyloric stenosis diagnoses?

By a palpable olive-like mass

An infant is treated with a liquid iron preparation as a supplement. How does the nurse ensure safe and proper administration of the liquid iron supplementation? Select all that apply.

By administering the medication with a dropper towards the back of mouth By educating the parents that iron supplementation will turn stools to a black color By educating the parents to avoid administering with milk products in order to increase absorption

4. The nurse is discharging an infant diagnosed with PKU from the hospital. Which statement made by the parents indicates a further need for teaching? A. "I can continue breastfeeding because breast milk is low in phenylalanine." B. "Since my baby will begin a reduced phenylalanine diet so early, it is very likely he will have little cognitive impairment." C. "I will bring my baby back to the doctor to obtain another blood sample by 4 weeks of age, since the first sample was drawn before he was 24 hours old." D. "My child should remain on the special diet, which is a diet restricted in protein and close monitoring of the phenylalineine levels."

C

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary? A. C, D B. A, E, K C. A, D, E, K D. C, folic acid

C

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

C

Separation anxiety is something that affects children when they are hospitalized. Each developmental stage has a somewhat different reaction as they deal with this difficulty. Which stage corresponds to the adolescent stage? A. May demonstrate separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying quietly for their parents, continually asking when the parents will visit, or withdrawing from others B. Separation anxiety comes in stages: protest, despair, detachment C. Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance D. May need and desire parental guidance or support from other adult figures but may be unable or unwilling to ask for it.

C

The nurse is assessing a child with croup and a sore throat in the ED. The child is drooling and agitated. The nurse knows that examining the child's throat using a tongue depressor might precipitate which of the following? A. Profuse coughing B. Inspiratory stridor C. Complete obstruction D. Increased agitation

C

The nurse is explaining the strategy of consequences to a parent he is working with. Which response by the parent indicates more teaching is needed when he describes the types of consequences? A. Natural: Those that occur without any intervention B. Logical: Those that are directly related to the rule C. Transforming: Allowing the child to come to the conclusion on his or her own D. Unrelated: Those that are imposed deliberately

C

The nurse teaches the caregiver of the infant diagnosed with nasopharyngitis to call the physician if which of the following occurs? A. Coughing B. Infant becomes irritable C. Shows signs and symptoms of an ear infection D. Low-grade fever

C

Which of the following statements by the family of a child with asthma indicates a need for additional home care teaching? A. "We need to identify what things trigger his attacks" B. "He is to use his bronchodilator inhaler before the steroid inhaler" C. "We'll make sure that he avoids exercise to prevent attacks" D. "He should increase his fluid intake regularly to thin secretions"

C

During the preschool period, the emphasis of injury prevention should be placed on: a. Constant vigilance and protection. b. Punishment for unsafe behaviors. c. Education for safety and potential hazards. d. Limitation of physical activities.

C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate.

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

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. The child's ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. 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. Preschool and day care programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

The nurse is performing an assessment on a child and notes the presence of Koplik's spots. In which communicable disease are Koplik's spots present? a. Rubella b. Chickenpox (varicella) c. Measles (rubeola) d. Exanthema subitum (roseola)

C Koplik's spots are small, irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Koplik's spots are not present with rubella, varicella, or roseola.

Imaginary playmates are beneficial to the preschool child because they: a. Take the place of social interactions. b. Take the place of pets and other toys. c. Become friends in times of loneliness. d. Accomplish what the child has already successfully accomplished.

C One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interactions but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished.

A 4-year-old child tells the nurse that she does not want another blood sample drawn because "I need all my insides, and I don't want anyone taking them out." Which is the nurse's best interpretation of this? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.

When is a child with chickenpox considered to be no longer contagious? a. When fever is absent b. 24 hours after lesions erupt c. When lesions are crusted d. 8 days after onset of illness

C When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. The child is still contagious once the fever has subsided and after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over.

Acyclovir (Zovirax) is given to children with chickenpox to: a. Minimize scarring. b. Prevent aplastic anemia. c. Decrease the number of lesions. d. Prevent spread of the disease.

C Acyclovir decreases the number of lesions, shortens duration of fever, and decreases itching, lethargy, and anorexia; however, it does not prevent scarring. Preventing aplastic anemia is not a function of acyclovir. Only quarantine of the infected child can prevent the spread of disease.

A normal characteristic of the language development of a preschool-age child is: a. Lisp. b. Echolalia. c. Stammering. d. Repetition without meaning.

C Stammering and stuttering are normal dysfluencies in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.

Informed consent is valid when (Select all that apply) A. Universal consent is used B. It is completed only for major surgery C. A person is over the age of majority and competent D. Information is provided to make an intelligent decision E. The choice exercised is free of force, fraud, duress, or coercion

C, D, E The age of majority is usually 18 years. The term competent is defined as possessing the mental capacity to make choices and understand their consequences. Enough information is provided so that the person can make an intelligent decision. The person giving consent does so voluntarily, that is, freely without coercion, any form of constraint, force, fraud, duress, or deceit. Universal consent is not sufficient. Informed consent must be obtained for each surgical or diagnostic procedure. Informed consents must be obtained for major and minor surgery, diagnostic tests, medical treatments, release of medical information, postmortem examination, removal of a child from the health care provider against medical advice, and photographs for medical, educational, or public use.

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

C, E

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after gastrostomy feedings, there is often a backup of feeding into the tube. The most appropriate intervention by the nurse is to A. Position the child in a supine position after feedings. B. Position the child on the left side after feedings. C. Leave the gastrostomy tube open and suspended after feedings. D. Leave the gastrostomy tube clamped after feedings.

C. The formula is backing up into the tube because of delayed emptying. By keeping the tube open to air, it will prevent the buildup of pressure on the operative site and the subsequent backup of feeding into the tube. The child should be positioned on the right side with the head elevated approximately 30 degrees after feeding. The child should be positioned on the right side with the head elevated approximately 30 degrees after feeding. Leaving the gastrostomy tube clamped after feedings will create pressure on the operative site and increase the risk of backup of the feedings.

Administration of colony stimulating agents for the pediatric oncology patient are based on the fact that A. increase the time frame for genetic adaptation. B. delays the onset of cellular regeneration. C. it will stimulate production of blood cell components. D. increase bone marrow recovery time.

C. Colony stimulating agents used in the treatment of pediatric oncology patients help to restore functional integrity of the bone marrow leading to decreased likelihood of infections. They decrease bone marrow recovery time and stimulate bone marrow growth of specific cellular components.

Pediatric oncology patients are affected by medical management of their respective disease process and yet it is critical to include health promotion measures as part of their overall care. Which health promotion is not indicated in the plan of care? A. Continuation of dental hygiene treatment plan consistent with developmental age of child. B. Family members should receive live measles, mumps and rubella vaccinations as warranted. C. No treatment should be given if the patient has been exposed to varicella. D. The patient should not receive live attenuated vaccines during the course of chemotherapy protocol.

C. If a pediatric oncology patient has been exposed to varicella, dependent on the time frame either varicella immune zoster immunoglobulin should be administered (within 96 hours of exposure) and/or treatment with antiviral agents should be provided if the patient develops varicella. This treatment is indicated as the development of varicella can lead to increased morbidity and mortality. All of the other options should be included in a health promotion plan of care.

A pediatric patient has been diagnosed with leukemia and presents with a white blood cell (WBC) count of 80,000 mm3. In teaching a group of nursing students about the disease process, how would the nursing instructor describe the proliferation of white blood cells and their ability to fight off infection? A. The increase in WBC provides protection against viral infections but not bacterial infections. B. Although the WBC count is elevated, there are limited blast cells which leads to an increased likelihood that the patient will develop an infection. C. There is an increase in immature cells which reduce the body's ability to fight off infection. D. Although the WBC count is elevated, they are overwhelmed with mature cells that predispose the individual to develop an infection.

C. In leukemia, WBC count is elevated with an increase in blast or immature cells which limit the functional ability of WBCs being able to fight off infection.

A pediatric oncology patient is undergoing chemotherapy. Which treatment option would the nurse anticipate being included in the plan of care in order to prevent the development of sterile hemorrhagic cystitis? A. Restrictive fluid intake. B. Inclusion of dairy foods in the diet. C. Implementing a frequent voiding plan throughout the course of the day to the patient. D. Limiting mobility during course of chemotherapy.

C. Providing a frequent voiding plan to encourage the patient to void upon urge, immediately upon arising, before bedtime and one nighttime void will help to prevent possibility of urinary stasis. Encouraging fluid intake rather than restricting fluid is the mainstay of treatment. Dairy foods in the diet provide no effective treatment against the development of sterile hemorrhagic cystitis. Similarly, limiting mobility is not indicated.

A young pediatric oncology patient has stomatitis. Which intervention if observed by the charge nurse would warrant immediate action? A. The nurse assigned to the patient was offering mouth care using a sponge toothbrush. B. The nurse offers the patient frequent mouth rinses. C. The nurse is preparing to use viscous lidocaine to offer pain relief. D. The nurse administers sucralfate as ordered.

C. Use of viscous lidocaine is contraindicated in mucosal alterations as it can lead to potential aspiration and seizure activity. All of the other interventions are appropriate and can be used for symptomatic relief of stomatitis.

When treating nausea and vomiting as a side effect of chemotherapy and/or radiotherapy, ondansetron (Zofran) is the preferred drug of choice because? A. It has a shorter onset of action. B. It can be administered via several different routes. C. It does not cause extrapyramidal side effects. D. It has no adverse side effects if administered appropriately.

C. Zofran is a 5-hydroxytryptamine-3 receptor antagonist and is considered the antiemetic of choice for oncology patients as it produces no extrapyramidal side effects. Pharmacodynamics and pharmacokinetic features aside, the preference for this medication is due to producing no extrapyramidal side effects. Any medication even if administered properly has the potential to cause side effects. The ability to administer via different routes does not indicate a preferred drug choice.

Several types of long-term central venous access devices are used in practice. The benefit of using a long-term central venous access device such as a Port-a-Cath is that A. Implanted devices are easy to use for self-administered infusions. B. implanted devices do not require piercing the skin for access. C. implanted devices do not require limiting regular physical activity, including swimming. D. implanted devices cannot dislodge, even if child "plays" with the port site.

C. Because this device is totally implanted under the skin, there are no activity limitations for the child. The implantable port has to be accessed with a special needle, making it difficult to self-administer infusions. Because the implantable port is totally under the skin, a needle must be used to access the port; therefore, the skin must be pierced for access. The implantable port site is under the skin, so the child cannot play with it.

When should clear liquids be stopped before scheduled surgery? A. 2 hours before surgery B. 6 hours before surgery C. Varies according to the surgical procedure to be done D. The night before surgery, at midnight

C. Each surgical procedure may have a different requirement for when nothing by mouth (NPO) status should be initiated. The nurse should follow the surgeon's or anesthesiologist's order as to when clear liquids should be stopped. Although 2 hours before surgery is a common time for stopping clear liquids to reduce the risk of pulmonary aspiration in healthy patients, the timing may vary. Therefore, it should be clarified with the surgeon or anesthesiologist. Although a 6-hour time frame is often used for stopping milk and milk products before surgery, the timing may vary. Therefore, it should be clarified with the surgeon or anesthesiologist. Stopping clear liquids by midnight may be too long a period before surgery. Therefore, the timing should be clarified with the surgeon or anesthesiologist.

Standard precautions for infection control include A. gloves are worn anytime a patient is touched. B. needles are capped immediately after use and disposed of in a special container. C. gloves are worn to change diapers when there are loose or explosive stools. D. masks are needed only when caring for patients with airborne infections.

C. Handling diapers with loose or explosive stools has the greatest risk for exposure to body substances. Gloves are not indicated, unless there is potential for contact with body substances. Needles should never be recapped. They should be immediately disposed of in a rigid, puncture-proof container. Masks are a component of transmission-based precautions, not standard precautions.

A 2-year-old child has recently started having temper tantrums where breath holding occurs and occasionally fainting. The most appropriate action by the nurse is to: A. Refer the child for a respiratory evaluation B. Refer the child for a psychological evaluation C. Explain to the parent that this is not harmful D. Explain to the parent that the child is spoiled

C. Explain to the parent that this is not harmful The rising carbon dioxide levels restart the breathing process when a child holds his or her breath; therefore, the process is self-limiting and not harmful. A respiratory evaluation is not indicated for this toddler. Temper tantrums are part of this developmental stage as the toddler asserts his or her independence. A psychological evaluation is not warranted. Temper tantrums are part of this developmental stage as the toddler asserts independence. There are no data to indicate that the child is spoiled.

The nurse notices that a toddler is more cooperative taking medicine from a small cup than from a large cup. This is an example of which characteristic of preoperational thought? A. Egocentrism B. Irreversibility C. Inability to conserve D. Transductive reasoning

C. Inability to conserve The smaller cup makes it look like less medicine to the child at this stage of cognitive development. The inability to see situations from other perspectives, besides their own, does not facilitate medication administration. The inability to reverse or undo actions physically initiated does not facilitate medication administration. Focusing on particulars does not explain the cooperation with the smaller medication cup.

The nurse receives a report about a newborn who was resuscitated at birth secondary to poor respiratory effort. Which assessment data would concern the nurse 6 hours after birth? A. Sleepiness during feeding B. Acrocyanotic hands and feet C. Low body temperature D. Respirations of 40 breaths per minute

C. Low body temperature An infant with respiratory difficulty at birth requires frequent and further assessment. Any time an infant has a low body temperature with difficulty stabilizing the temperature, the infant is at increased risk for further respiratory complications. Many newborns are sleepy during initial feedings following birth. Acrocyanotic hands and feet is a normal finding in newborn infants. The normal respiratory rate for newborns is 30 to 60 breaths per minute.

When the nurse uses a standard nursing care plan as a guide in planning care for a hospitalized child, which should be eliminated? A. Expected outcome or goal B. Dependent nursing functions C. Problems not pertinent to the child and family D. Potential health problems of the child and family

C. Problems not pertinent to the child and family To create an individualized care plan, the nurse eliminates the irrelevant material and specific information not pertinent to the child and family in question. Consideration of an expected outcome or goal is an essential component of an individualized nursing care plan. Consideration of dependent nursing functions, or those interventions requiring an order, is an essential component of an individualized nursing care plan. Consideration of potential health problems of the child and family is an essential component of an individualized nursing care plan.

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which of the following suggestions should the nurse include? A. Send the child to his or her room. B. If the child cries, refuses, or is more disruptive, try another approach. C. Select an area that is safe and nonstimulating, such as a hallway. D. The general rule for length of time is 1 hour per year of age.

C. Select an area that is safe and nonstimulating, such as a hallway. The area must be nonstimulating and safe. The child becomes bored in this environment and then changes his or her behavior to rejoin activities. The child's room may have toys and other forms of amusement that may negate the effect of being separated from family activities. When the child engages in this type of behavior, the timeout begins when the child quiets. The general rule is 1 minute per year. An hour per year is excessive.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which instruction should be included? A. Flossing is not recommended at this age. B. Toddlers are old enough to brush their teeth effectively. C. The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. D. The toddler's toothbrush should be small and have hard, rounded, nylon bristles.

C. The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. Some toddlers do not like the flavor of toothpaste, so water can be used for teeth brushing at this age. Flossing should be done after brushing to establish it as part of dental care for the toddler. Two-year-olds cannot effectively brush their own teeth; parental assistance is necessary. Soft multitufted bristled toothbrushes are recommended to avoid damaging a toddler's teeth or gums.

The school nurse is concerned about an outbreak of chickenpox because two children at the school have cancer and are immunodeficient from chemotherapy. The most appropriate recommendation by the school nurse is that: A. no precautions necessary. B. Acyclovir (Zovirax) should be taken to minimize the symptoms of chickenpox. C. Varicella-zoster immune globulin (VZIG) to prevent chickenpox. D. temporarily stopping chemotherapy will allow the immune system to recover.

C. Varicella-zoster immune globulin (VZIG) to prevent chickenpox. VZIG is an antibody to the virus that causes chickenpox. Administration of VZIG can prevent development of the disease in immunocompromised children secondary to chemotherapy. Chickenpox can be a life-threatening event for a child who is immunocompromised and must be addressed. Acyclovir is effective in reducing the number of lesions from chickenpox, but in immunodeficient children the disease itself should be prevented. The administration of VZIG does not place the child at any greater risk; therefore, there is no need to stop chemotherapy.

The psychosexual conflicts of preschool children make them extremely vulnerable to: A. separation anxiety. B. loss of control. C. bodily injury and pain. D. loss of identity.

C. bodily injury and pain. Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschooler because of the poorly developed concept of body integrity. Separation anxiety is more of a characteristic of infancy. Loss of control is a characteristic fear of school-age children. Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.

A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on the knowledge that: A. preparation at this age will only increase the child's stress B. preparation needs to be at least 2 to 3 weeks before hospitalization to be effective C. children who are prepared experience less fear and stress during hospitalization D. children who are prepared experience overwhelming fear by the time hospitalization occurs

C. children who are prepared experience less fear and stress during hospitalization Preparing the child for the hospitalization will reduce the number of unknown elements. Taking tours, handling some of the equipment, or being told stories about what to expect will increase the familiar items. Timing of the preparation must also be considered. Four- to 7-year-olds can be prepared up to 1 week in advance of the hospitalization. Preparation of a 4-year-old will reduce stress by having the child incorporate and assimilate the information more slowly. Children between the ages of 4 and 7 years should be prepared about 1 week before hospitalization. A reduction in fear is usually observed when children are prepared appropriately for hospitalization.

When caring for a preschool age child, the nurse should incorporate knowledge that body image has developed to include: A. a well-defined body boundary. B. knowledge about his or her internal anatomy. C. fear of intrusive procedures. D. anxiety and fear of separation.

C. fear of intrusive procedures. Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. The fear of looking different is a concept that occurs in later school-aged children and adolescents.

The parents of a 4-year-old girl are worried because she has an imaginary playmate. The nurse's BEST response is to tell the parents: A. a psychosocial evaluation is indicated. B. an evaluation of possible parent-child conflict is indicated. C. having imaginary playmates is normal and useful at this age. D. having imaginary playmates is abnormal after about age 2 years.

C. having imaginary playmates is normal and useful at this age. Imaginary playmates are a part of normal development at this age and serve many purposes, including being a friend in times of loneliness, accomplishing what the preschooler is still attempting, and experiencing what the preschooler wants to forget or remember. Because an imaginary playmate is part of normal development, a psychosocial evaluation is not warranted. Because an imaginary playmate is part of normal development, an evaluation of the parent-child relationship is not warranted. Imaginary playmates are commonly present during the preschool years; therefore, they are not abnormal after the age of 2 years.

The nurse is giving anticipatory guidance to the parent of a 5-year-old. In this guidance, it is MOST important to: A. prepare the parent for increased aggression. B. encourage the parent to offer the child choices. C. inform the parent to expect a more tranquil period at this age. D. advise parents that this is the age when stuttering may develop.

C. inform the parent to expect a more tranquil period at this age. The end of preschool and the beginning of school age is a more tranquil period. Preparing the parent for increased aggression is anticipatory guidance for 4-year-old children. Encouraging the parent to offer the child choices is anticipatory guidance for 3-year-old children. Advising the parent that this is the age when stuttering may develop is anticipatory guidance for 3-year-old children.

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of: A. identity. B. intimacy. C. initiative. D. industry.

C. initiative Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity versus role confusion is associated with adolescence. Intimacy versus isolation is associated with young adulthood. Industry versus inferiority is associated with the school-aged child.

An occlusive dressing, is applied to a large abrasion. This is advantageous because the dressing will: A. provide an antiseptic for the wound. B. deliver vitamin C to wound. C. maintain a moist environment for healing. D. promote mechanical friction for healing.

C. maintain a moist environment for healing. Occlusive dressings such as Acuderm do not adhere to the wound site. They provide a moist wound surface and insulate the wound. Acuderm does not have antiseptic capabilities. Acuderm does not contain vitamin C. Acuderm protects against friction.

Enteral feedings are ordered for a young child with burns covering 40% of the total body surface area. The nurse should know that: A. oral feedings are contraindicated. B. enteral feedings must be stopped during painful procedures. C. paralytic ileus precludes use of enteral feedings. D. the feedings will be high in carbohydrate and low in protein.

C. paralytic ileus precludes use of enteral feedings. Enteral feedings can begin when the paralytic ileus resolves. Oral feedings are not contraindicated. Oral feedings are encouraged. Most children with burns are unable to consume sufficient calories by mouth, but every possible effort is made to encourage oral feeding. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended to compensate for the increased basal metabolic rate that occurs after a burn injury.

A 21/2-year-old ventilator-dependent child will be discharged home soon. The family expresses concern that their child might change the ventilator settings by exploring the control knobs and buttons. Based on the nurse's knowledge of child development, the most appropriate intervention by the nurse is to: A. teach the child not to touch controls B. explain that the child cannot be left alone because of the risk of the child changing the settings C. recommend ways to cover the controls to reduce the risk of the child changing the settings D. reassure the family that developmentally the child is unable to change the ventilator settings

C. recommend ways to cover the controls to reduce the risk of the child changing the settings If the equipment does not have "lock-out" capabilities, then clear plastic covers and tape should be applied, similar to how a parent might secure the knobs in a tub. The toddler is too young to understand the concept associated with harm. The child will need to be supervised while awake, and alarms must be on when the child is asleep. Toddlers can manipulate dials; therefore, protective mechanisms must be in place at all times.

The school nurse is seeing a child who brought poison ivy to school in a leaf collection. The child says that only hands touched it. The most appropriate nursing action is to: A. apply Burow solution compresses immediately. B. soak hands in warm water. C. rinse hands in cold, running water. D. scrub hands thoroughly with antibacterial soap.

C. rinse hands in cold, running water. Washing the child's hands in cold running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold running water within 15 minutes of exposure. This will neutralize the urushiol not yet bonded to the skin. Applying Burrow solution is effective for soothing the skin lesions once the dermatitis has begun. Cold running water, not warm water, is effective in removing the oil. The antibacterial soap removes protective skin oils and dilutes the urushiol, allowing it to spread.

A nurse is teaching the parent of a child who has hand, foot, and mouth disease. Which of the following should be included in the teaching?

CORRECT: Children are most contagious the first week of illness. However, they can be contagious even when symptoms are gone.

What are the foods to avoid if you have GER/GERD?

Caffeine, citrus, tomatoes, alcohol, peppermint, spicy/fried foods

How does acute diarrhea occur?

Can come from antibiotics, and can cause change in normal flora.

The nurse is planning care for an infant with candidiasis (moniliasis) diaper dermatitis. Which topical ointments may be prescribed for the patient? (Select all that apply.)

Candidiasis diaper dermatitis skin lesions are treated with topical nystatin, miconazole, and clotrimazole. Bactroban and Neosporin are used to treat bacterial dermatitides.

The nurse is planning care for a child with chickenpox (varicella). Which prescribed supportive measures should the nurse plan to implement? (Select all that apply.)

Chickenpox is a virus, and acyclovir is ordered to lessen the symptoms. Benadryl and Tylenol are prescribed as supportive treatments. Vitamin A supplementation is used for treating rubeola. Zithromax is an antibiotic prescribed for bacterial infections such as pertussis.

What instructions should the nurse not include when teaching parents about injury prevention at the toddler's well-child visit?

Child should wear a seatbelt when sitting in the front passenger seat

A 10-year-old child is riding a bicycle on the grounds of the school. Which finding if observed by the school nurse would require intervention? Child is seen walking the bicycle through the crosswalk. Child is riding close to the curb. Child's shoes are ill fitting. Child is riding single file.

Child's shoes are ill fitting. Shoes that are ill fitting can result in potential injury as they can get caught up in gears and affect the ability of the child to navigate. All of the other observed behaviors are consistent with safe practice.

Which is descriptive of the social development of school-age children? Identification with peers is minimal Children frequently have "best friends" Boys and girls play equally with each other Peer approval is not yet an influence toward conformity

Children frequently have "best friends" Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with the peer group is an important milestone for the school-age child to move toward independence from families. During the school-age years, same-sex peer groups are more prevalent; therefore, there is less interaction between boys and girls. Conforming to the rules is an essential part of group membership and, therefore, an important skill for the school-age child to learn in terms of peer relationships.

Cognitive Development Sensorimotor (Piaget)

Cognitive development Reflex behavior to simple repetitive acts to imitative activity Separation Object permanence Use symbols

A lactating mother is advised to consume fenugreek with an intention to increase breast milk supply. For what possible adverse effects due to maternal use of fenugreek does the nurse assess the baby? Select all that apply.

Colic Diarrhea

What is the colon's part in constipation?

Colon absorbs too much water and stool is too hard

What is the colon's part in diarrhea?

Colon does not absorb enough water- stool is loose and watery

What should the nurse include when giving parents guidelines about helping their children in school? Help children as much as possible with their homework. Punish children who fail to perform adequately. Communicate with teachers if there appears to be a problem. Accept responsibility for children's successes and failures.

Communicate with teachers if there appears to be a problem. Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parent involvement is one factor in children's success in school. Children need to do their own homework. This cultivates responsibility. Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the "root" of the school performance problem. School-age children need to develop responsibility. Keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.

A nurse is teaching a group of parents about complications of communicable diseases. Which of the following communicable diseases may lead to pneumonia? (Select all that apply.)

Complications of rubeola include ear infections, pneumonia, diarrhea, encephalitis, and death. Complications of pertussis include: infants and children - pneumonia, convulsions, apnea, encephalopathy, and death; teens and adults - weight loss, loss of bladder control, passing out, and rib fractures. Complications of varicella include dehydration, pneumonia, bleeding problems, bacterial infection of the skin, sepsis, toxic shock syndrome, bone or joint infections, and death.

A middle age child understands that with regards to a mathematical equation that 7 can be composed of 4+3 as well as 2+5. Based on this finding, the nurse documents that the development level of the child reflects? Concrete operations Verification of latency period Conservation Accomplished industry versus inferiority

Conservation Piaget's cognitive theory development describes conservation as the ability of the child to understand that the same concept may exist as identified by a different method. Numerical relationships are understood before substance conservation. Concrete operations is the term Piaget applies to the entire stage whereby children are able to use thought processes to experience events and actions. The latency period is described by Freud as the ability of the child to go from peer relationships to heterosexual relationships. Industry versus inferiority refers to Erikson's overview of this time frame whereby children if successful master the challenges between industry and inferiority.

An infant with respiratory syncytial virus (RSV) is being admitted to the hospital. The nurse should plan to place the infant on which precaution?

Contact. (A patient with RSV is placed on contact precautions. The transmission of RSV is by contact of secretions, not by droplets or airborne. Enteric precautions are not required for RSV)

First verbal communication

Crying First few weeks- biologic End of first year- for attention (stranger fear), for frustration usually in response to developing motor skills

How is colic classified?

Crying > 3 hours for > 3 weeks more than 3 times a week

1. When caring for a child with a cleft lip, a parent asks the nurse, "Did I cause this defect in my child?" What is the best response by the nurse? A. "There are many things about embryo development we do not know; it is not you." B. "Cleft lip is an example of a disruption and occurs early in the pregnancy, often before you even know you are pregnant." C. "Is there something you took while you were pregnant?" D. "Early in the pregnancy there may be an abnormality in the developmental process; the reasons for this are largely still unknown."

D

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to A. examine the child's oropharynx and report the assessment to the healthcare provider. B. make the child lie down and rest quietly. C. auscultate the child's lungs and make preparations for placement in a mist tent. D. notify the healthcare provider immediately and be prepared to assist with a tracheostomy or intubation

D

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? A. Confirms the diagnosis of asthma B. Determines the cause of asthma C. Identifies the "triggers" of asthma D. Assesses the severity of asthma

D

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it A. liquefies secretions. B. improves oxygenation. C. promotes ventilation. D. soothes inflamed mucous membrane.

D

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? A. Atrophic changes in the mucosal wall of the intestines B. Hypoactivity of the autonomic nervous system C. Hyperactivity of the apocrine glands D. Mechanical obstruction caused by increased viscosity of exocrine gland secretions

D

Cystic fibrosis must often affects multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is which of the following? A. Hyperactivity of the sweat glands B. Hyperactivity of parasympathetic nervous system C. Sweat chloride test >60 mEq/L D. Increased viscosity of mucous gland secretions

D

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent A. otitis media. B. diabetes insipidus. C. nephrotic syndrome. D. acute rheumatic fever

D

One of the goals for children with asthma is to prevent respiratory tract infection because infections A. lessen effectiveness of medications. B. encourage exercise-induced asthma. C. increase sensitivity to allergens. D. can trigger an episode or aggravate asthmatic state.

D

The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? A. Suffocation B. Child abuse C. Infantile apnea D. Sudden infant death syndrome (SIDS)

D

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to A. determine what the child has eaten. B. administer diphenhydramine (Benadryl) PO stat. C. move the child to the nurse's office or hallway. D. have someone call for an ambulance and paramedic rescue squad or 9-1-1.

D

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

D

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? A. Barrel chest B. Wheezing C. Thermal instability D. Nasal flaring and retractions

D

Which of the following statements best represents infectious mononucleosis? A. Herpes simplex type 2 B. Leukopenia is often paired with the diagnosis C. Amoxicillin is used to treat the pharyngitis D. Physical assessment and blood tests are used as test results to establish the diagnosis

D

The nurse is guiding parents in selecting a day care facility for their child. When making the selection, it is especially important to consider: a. Structured learning environment. b. Socioeconomic status of children. c. Cultural similarities of children. d. Teachers knowledgeable about development.

D A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others; cultural similarities are not necessary.

By what age would the nurse expect that most children could understand prepositional phrases such as "under," "on top of," "beside," and "in back of"? a. 18 months b. 3 years c. 24 months d. 4 years

D At 4 years, children can understand directional phrases. Children 18 to 24 months and 3 years of age are too young.

Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe an object according to its composition d. Talks incessantly, regardless of whether anyone is listening

D Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly, regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition.

Which is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate parental concern for the degree of injury b. Absence of parents for questioning about child's injuries c. Inappropriate response of child d. Incompatibility between the history and injury observed

D Conflicting stories about the "accident" are the most indicative red flags of abuse. Inappropriate response of caregiver or child may be present, but is subjective. Parents should be questioned at some point during the investigation.

Which is the causative agent of scarlet fever? a. Enteroviruses b. Corynebacterium organisms c. Scarlet fever virus d. Group A -hemolytic streptococci (GABHS)

D GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

In terms of fine motor development, what could the 3-year-old child be expected to do? a. Tie shoelaces. b. Use scissors or a pencil very well. c. Draw a person with seven to nine parts. d. Copy (draw) a circle.

D Three-year-olds are able to accomplish the fine motor skill of drawing a circle. Tying shoelaces, using scissors or a pencil very well, and drawing a person with multiple parts are fine motor skills of 5-year-old children.

Which accomplishment would the nurse expect of a healthy 3-year-old child? a. Jump rope b. Ride a two-wheel bicycle c. Skip on alternate feet d. Balance on one foot for a few seconds

D Three-year-olds are able to accomplish the gross motor skill of balancing on one foot. Jumping rope, riding a two-wheel bike, and skipping on alternate feet are gross motor skills of 5-year-old children.

Which medication may be given to high risk children after exposure to chickenpox to prevent varicella? a. Acyclovir b. Vitamin A c. Diphenhydramine hydrochloride d. Varicella zoster immune globulin (VZIG)

D VZIG is given to high risk children to help prevent the development of chickenpox. Immune globulin intravenous may also be recommended. Acyclovir is given to immunocompromised children to reduce the severity of symptoms. Vitamin A reduces morbidity and mortality associated with the measles. The antihistamine diphenhydramine is administered to reduce the itching associated with chickenpox.

Which common childhood communicable disease may cause severe defects in the fetus when it occurs in its congenital form? a. Erythema infectiosum b. Rubeola c. Roseola d. Rubella

D Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

Characteristics of physical development of a 30-month-old child are (Select all that apply): A. anterior fontanel is open. B. birth weight has doubled. C. genital fondling is noted. D. sphincter control is achieved. E. primary dentition is complete.

D, E D. sphincter control is achieved. E. primary dentition is complete. Sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age. Primary dentition is usually completed by 30 months of age. Anterior fontanel closes between 12-18 months of age. Birth weight should double at 5-6 months of age and quadruple by 2½ years of age. Genital fondling is not a characteristic of physical development of this age group. This is part of the development of gender identity.

You are reviewing information relative to a patient's medical history for treatment of leukemia. Patient is exhibiting no clinical symptoms at this point in the treatment plan. In comparing bone marrow reports prior to and 6 months following chemotherapy, what information do you hope to obtain that would assist in evaluating the plan of care? A. Expectation that the results will be consistent indicating that goals have been met. B. Increased likelihood that atypical cells will be present suggesting a revision of the plan of care. C. Pancytopenic response indicating that chemotherapy treatment was successful. D. Determination of response to clinical therapy comparing pre and post procedure that will provide evidence to interpret whether medical treatment has been effective.

D. Bone marrow biopsies are used both to diagnose as well as evaluate clinical response to chemotherapy (therapeutic management) used in the treatment of leukemia. While one would hope that the intervention was successful, until the results are compared and read by the pathologist, there is no way to state equivocally what the results will be at the histological level. Consistent findings pre and post treatment would indicate that treatment goals have not been met. Similarly, if clinical response is favorable, then one would not expect to see atypical cells. As the patient is not experiencing any symptoms, a diagnosis of pancytopenia would not be expected as this would indicate bone marrow failure.

The best approach that would facilitate improved outcomes when using surgical treatment for operable cancers is A. when there is evidence of adjacent tissue involvement. B. performing amputation rather than attempting resection. C. using multiple excisions to remove the tumor. D. if the tumor is encapsulated and localized.

D. Tumors that are localized and encapsulated represent the best approach for improved outcomes for the surgical cancer patient as this indicates that the tumor is not showing evidence of metastasis. Evidence of adjacent tissue involvement means that the tumor has already metastasized. Resection of bone rather than amputation is associated with improved outcomes. Minimal incision surgical approach is favored to improve functioning and help maintain cosmesis.

The nurse needs to give an injection to a 4-year-old in the deltoid muscle. Based on the nurse's knowledge of preschool development, the most appropriate approach by the nurse is to: A. smile while giving the injection to help the child relax. B. tell the child that you will be so quick, the injection won't even hurt. C. explain that child will experience "a little stick in the arm." D. explain with concrete terms such as "putting medicine under the skin."

D. By using concrete terms, the nurse helps the child understand what the nurse is going to do. Facial expressions are too abstract. The young child will not correlate a smile with relaxation. Distraction techniques are more appropriate. The nurse does not know that the injection will not hurt the child. Lying or distorting the truth is never appropriate. This response will block trust, especially if the injection does hurt the child. The child may visualize an actual stick being placed in the arm. Children at this age are very literal.

A critical concept that needs to be maintained during intravenous administration of chemotherapy for a pediatric patient is? A. Positioning the patient in a semi-fowler's position. B. Not use an infusion device but rather allow for a free-flow line. C. Continue the infusion regardless if the patient develops a rash. D. Maintaining the integrity of the parenteral access line.

D. Administration of chemotherapy via parenteral access requires that the integrity of the access line be maintained and monitored by the nurse. If there is any indication that the site as infiltrated, then the infusion must be immediately stopped. Patient positioning is variable depending on patient comfort. An infusion device must be used as this is considered to be a titratable infusion. If the patient develops a rash in response to chemotherapy, this may be an indication of a hypersensitivity reaction. Intervention is required with notification of health care provider and discontinuing the infusion.

The nurse in planning care for the pediatric oncology patient anticipates implementing which action with regard to the administration of an antiemetic in a chemotherapy protocol? A. Providing the medication on a prn basis based on patient's presenting symptoms of nausea and/or vomiting. B. Administering the medication via the oral route following infusion of chemotherapy protocol. C. Providing medication with sips of water following clinical symptoms of nausea and/or vomiting. D. Administering 30 to 60 minutes prior to initiation of therapy.

D. Anticipatory management of an antiemetic is part of chemotherapy and/or radiation protocols. It is typically given 30 to 60 minutes prior to the infusion and administered in a scheduled sequence rather than based on a prn or when the patient presents symptomatically. Preferred route of administration is via parenteral route especially if the anticipated risk for nausea and/or vomiting is increased.

You are working with the parents of a pediatric oncology patient who has successfully responded to therapy. The parents have questions regarding what to expect as the child continues to grow and develop throughout the life cycle. Which response would be appropriate with regard to the parent's concern? A. As the therapy has been successful, growth and development should proceed along a normal sequence. B. It may be a good idea to schedule your child for repeat imaging studies on a yearly basis so as to make sure that the child remains in remission. C. There may be anticipated growth and developmental delays associated with chemotherapy treatments but they are typically self-limiting in nature. D. Genetic counseling may be something to consider as the child reaches adulthood and is considering having children his/herself if the type of cancer that the child had was inherited.

D. Even though medical treatment has been noted as being successful, continued observation and medical follow up is indicated. Growth and development should be monitored in accordance with recommended pediatric screening guidelines. Although imaging studies may be required at some point in time for follow up, yearly imaging studies may not be needed. Genetic counseling when the child reaches adulthood should be considered especially if the type of cancer was inherited. Growth and developmental delays are not considered to be normal and may not be self-limiting.

The nurse is assessing a pediatric oncology patient's nutritional status. Which diagnostic tests would provide best practice approach? A. Albumin, blood urea nitrogen (BUN) and daily weight B. Skinfold assessments and daily weight C. Intake and output with daily calorie count D. Serum prealbumin, albumin and transferrin

D. No one diagnostic test or measurement provides enough evidence to evaluate the nutritional well-being of an individual patient. BUN provides evidence of hydration status but typically should be viewed using a BUN creatinine ratio to provide detailed information about a patient's renal status. Skinfold assessments while important again do not provide enough evidence even with the addition of a daily weight to evaluate one's nutritional status. Intake and output measurements in combination with daily calorie count are representative of hydration and nutritional support but do not provide information relative to nutritional body stores.

A pediatric oncology patient has developed a nose bleed. Which testing parameter would be indicted in order to decide if medical treatment is needed? A. Chest X-ray B. CT of the nose C. Lumbar puncture D. Platelet count

D. Pediatric oncology patients are at an increased risk for hemorrhage and bleeding. Evidence of a nose bleed may indicate thrombocytopenia and as such a platelet count should be obtained. Imaging studies such as CT and chest x-ray will not provide information related to hemostasis. An invasive procedure such as a lumbar puncture would be indicated if there was possibility of an infectious process.

Which findings are consistent with tumor lysis syndrome? A. Hypercalcemia and hyperkalemia B. Hypochloremia and hypokalemia C. Hyponatremia and hyperphosphatemia D. Hyperuricemia and hyperkalemia

D. The hallmark characteristics of tumor lysis syndrome are: hyperuricemia, hypocalcemia, hyperphosphatemia, and hyperkalemia.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What action should the nurse take next? A. Notify the surgeon. B. Perform oral intubation. C. Try inserting a larger tracheostomy tube. D. Try inserting a smaller tracheostomy tube.

D. A smaller tracheostomy tube should be available at the bedside at all times. Insertion of the smaller tube will keep the stoma open until further action can be taken. Notification of the surgeon should be done after the emergent situation is handled. Oral intubation is done if a tracheostomy tube cannot be inserted. A larger tracheostomy tube would cause trauma to the trachea and, therefore, is not used.

The nurse is preparing a plan to teach a mother how to administer 11/2 teaspoons of medicine to her 6-month-old child. Based on the nurse's knowledge of administering pediatric medications, the nurse teaches the parent to use a A. household measuring spoon. B. regular silverware teaspoon. C. paper cup measure in 5-ml increments. D. plastic syringe (without needle) calibrated in milliliters.

D. Plastic calibrated syringes, without a needle, offer the most accurate measurement for medication administration in the infant. The nurse should teach the mother to give the child 7.5 mL of the medication. Household measuring spoons can be used if other, more precise devices are not available, but they are not the preferred method of medication administration for an infant. Regular silverware teaspoons are not acceptable for medication administration, because household teaspoons vary greatly in size. A paper cup marked with 5-mL increments does not contain calibration for the additional 2.5 mL that is needed for this infant's required dosage, and its use would therefore limit the accuracy of the dosage.

The nurse needs to take the blood pressure of a preschooler for the first time. What action would be best for gaining the child's cooperation? A. Take the blood pressure when a parent is there to comfort the child. B. Tell the child that this procedure will help the child to get well faster. C . Explain to the child how blood flows through the arm and why taking the blood pressure is important. D. Permit the child to handle equipment and see the dial move before putting the cuff in place.

D. The best approach for a preschooler is to allow the child to play out the experience ahead of time, thereby decreasing the child's anxiety. The parent's presence will be helpful, but it will not alleviate fear of the unknown. Telling a child that the procedure will help the child to get well faster is not a true statement, and the child will not be able to understand the relationship between the blood pressure and feeling better. The explanation of how blood pressure is determined physiologically is too complex an explanation for this age group.

The nurse is doing preoperative teaching with a child and the parents. The parents say the child "is dreading the shot for before surgery." On which of the following facts should the nurse's response be based? A. Preanesthetic medication can only be given intramuscularly. B. In children, the intramuscular (IM) route is safer than the intravenous (IV) route. C. The child will have no memory of the injection because of amnesia. D. Preanesthetic medication should be "atraumatic," using oral, existing IV, or rectal routes

D. The necessity of premedication is being investigated. If necessary, numerous drug regimens and routes exist; the route is not limited to the IM route. Preanesthetic medicines can be given in a variety of routes other than intramuscularly. The IV route is preferable to the IM route for premedication. The muscle may be sore after the injection. Therefore, the child may have a memory, and telling the child otherwise will create distrust between the nurse and the child or family.

A parent brings a 2-year-old to 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? A. "We locked all the medicines in the bathroom cabinet." B. "We turned the thermostat down on our hot water heater." C. "We placed gates at the top and bottom of the basement steps." D. "We stopped using the car seat and put our child in the seat belt now that he is older."

D. "We stopped using the car seat and put our child in the seat belt now that he is older." A car seat should be used until the child weighs 18 kilograms (40 pounds) and is approximately 4 years old. Locking up medicines and any other harmful household products is an appropriate action; therefore, there is no need for further instruction. Turning down the thermostat on the hot water heater is an appropriate action; therefore, there is no need for further instruction. Placing gates at the top and bottom of the basement stairs is an appropriate action; therefore, there is no need for further instruction.

The nurse would expect that most children would be using sentences of six to eight words by age: A. 18 months. B. 24 months. C. 3 years. D. 5 years.

D. 4.5-5 years Children ages 4 to 5 years use sentences of four or five words. An 18-month-old child has a vocabulary of approximately 10 words. A 24-month-old child uses two- or three-word phrases. A 3-year-old child uses sentences of three or four complete words.

When applying wet compresses or dressings to the skin, what should the nurse do? A. Apply the dressing so that the area is totally immobilized. B. Apply the dressing when it is saturated and dripping. C. Pour or syringe a new solution over a dressing that has become dry. D. Apply the desired solution on cotton gauze or soft cotton cloths, such as clean cloths.

D. Apply the desired solution on cotton gauze or soft cotton cloths, such as clean cloths. The desired solution should be applied to Kerlix gauze; soft cotton cloths; or strips from cloth diapers, sheets, or pillowcase material. The moist dressing should be laid flat on the area with an attempt to not restrict movement. After immersion in the solution, the dressings are wrung out to avoid dripping. The material should be moistened and then reapplied. When the solution dries, concentrated residue is left in the dressing. The addition of fluid may result in a more concentrated soak being placed on the sensitive tissue.

What is most descriptive of atopic dermatitis (eczema) in the infant? A. Eczema is worse in summer months. B. Eczema is worse in humid climates. C. Eczema is associated with upper respiratory tract infections. D. Eczema is associated with hereditary allergies.

D. Eczema is associated with hereditary allergies. The majority of children with atopic dermatitis have a family history of eczema, asthma, food allergies, or allergic rhinitis. This suggests a genetic predisposition. Atopic dermatitis worsens in fall and winter months. Eczema improves in humid climates. Eczema is associated with allergies.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? A. Help the toddler complete tasks. B. Provide opportunities for the toddler to play with other children. C. Help the toddler learn the difference between right and wrong. D. Encourage the toddler to do things for himself or herself when he or she is capable of doing them.

D. Encourage the toddler to do things for himself or herself when he or she is 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. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy.

20. What is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Inadequate perfusion

D. Inadequate perfusion the most common cause of acute renal failure in children is poor perfusion that may respond to restoration of fluid volume. Pylonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause renal failure but it is not the most common case.

A 4-year-old female child is afraid of dogs. What should the nurse recommend to her parents to help her with this fear? A. Keep her away from dogs B. Buy her a stuffed dog toy C. Force her to touch a dog briefly D. Let her watch other children play with a dog

D. Let her 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 adapt. Keeping their child away from dogs avoids the object of fear rather than addressing the fear and finding solutions. Buying a child a stuffed dog toy avoids the object of fear rather than addressing the fear and finding solutions. Forcing the child to touch a dog without working up to it may increase the level of fear.

Which factor promotes wound healing? A. Antiseptics B. Eschar formation C. Dry wound environment D. Moist, crust-free wound environment

D. Moist, crust-free wound environment This environment enhances the migration of epithelial cells across the wound and facilitates healing. Antiseptics, such as hydrogen peroxide and povidone-iodine, have a cytotoxic effect on healthy cells and little effect on controlling infections. Eschar formation does not promote wound healing. Eschar is burn crust or dead tissue that inhibits wound healing. A dry wound environment does not facilitate wound healing.

The nurse is gavage feeding a preterm neonate. Which nursing intervention should be introduced prior to and during the gavage feeding? A. Position the neonate on the abdomen between feedings B. Provide blow-by oxygen prior to feedings C. Warm the gavage tube prior to insertion D. Provide a pacifier during feedings

D. Provide a pacifier during feedings Providing a pacifier directly before and during the feedings is considered nonnutritive sucking and may help prepare the infant for feeding. It may also improve weight gain, improve milk intake, and possibly increase full oral feedings. Position the infant on the right side. Oxygen is not generally needed during gavage feeding. There is no need to warm the tube prior to insertion.

A newborn is delivered at 33 weeks' gestation and is admitted to the special care nursery after administration of exogenous surfactant in the delivery room. The diagnosis associated with the use of surfactant is: A. Meconium aspiration syndrome B. Apnea of prematurity C. Persistent pulmonary hypertension D. Respiratory distress syndrome

D. Respiratory distress syndrome Respiratory distress syndrome (RDS) is a respiratory disorder often associated with premature development of the lungs and lack of natural surfactant secondary to prematurity. Surfactant is administered as the treatment for RDS. Meconium aspiration syndrome is not associated with surfactant. Apnea of prematurity is not associated with the use of surfactant. Persistent pulmonary hypertension is not associated with the use of surfactant.

Which statement characterizes toddlers' eating behavior? A. They have increased appetites. B. They have few food preferences. C. Their table manners are predictable. D. They become fussy eaters.

D. They become fussy eaters. Toddlers have physiologic anorexia, which contributes to picky, fussy eating. This usually begins at about 18 months of age. They have a decrease in appetite known as physiologic anorexia at this age. They have strong taste preferences at this age. Use of finger foods contributes to the unpredictable table manners of toddlers.

The nurse in the delivery room should anticipate that which of the following measures will be taken first for an infant delivered with meconium-stained fluid? A. Bag-and-mask ventilations B. Immediate intubation after delivery C. Oxygen applied by mask D. Use of a bulb syringe to suction the mouth and nose before the shoulders are delivered

D. Use of a bulb syringe to suction the mouth and nose before the shoulders are delivered Using a bulb syringe to suction the mouth and nose before the shoulders are delivered will prevent the possibility of aspiration of meconium into the lungs once the first breath is taken. The other measures may be performed after this initial step as needed. Bag-and-mask ventilations are not administered unless needed. Immediate intubation after delivery is not performed unless needed. Oxygen applied by mask is not performed unless needed.

The school nurse is conducting an assessment for pediculosis capitis (head lice) on a group of school-age children. Which describes a child with a positive head check? A. Maculopapular lesions behind the ears B. White, flaky particles throughout the entire scalp area C. Lesions in the scalp extending from the hairline to the neck D. White sacs attached to the hair shafts in the occipital area

D. White sacs attached to the hair shafts in the occipital area Evidence of pediculosis capitis includes white sacs (nits) attached to the hair shafts and usually located in the occipital area. Lesions may be present from itching, but the positive sign is evidence of the nits. White flaky particles appear with dandruff, and lice nits must be distinguished from dandruff. Lesions may be present from itching, but the positive sign is evidence of the nits.

An appropriate nursing intervention for a child with nephrotic syndrome on bed rest is to: A. restrain the child as necessary B. discourage the parents from holding the child C. do passive range-of-motion exercises once a day D. adjust activities to the child's tolerance level

D. adjust activities to the child's tolerance level The child will have a variable level of tolerance for activity. The activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child that are age appropriate. Restraints should not be used to confine a child to bed unless the child is a potential threat to self or others. Parents should be encouraged to hold the child. The child should be encouraged to move all extremities while in bed to prevent the potential complications of immobility.

The most appropriate comfort intervention for a child with itching related to chickenpox is: A. encourage frequent warm baths. B. give aspirin or acetaminophen (Tylenol). C. apply thick coat of pramoxine (Caladryl) lotion over open lesions. D. give an antipruritic medication such as diphenhydramine (Benadryl). E. apply thick coat of pramoxine (Caladryl) lotion over open lesions.

D. give an antipruritic medication such as diphenhydramine (Benadryl). Antipruritic medicines such as diphenhydramine are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Cool baths, not warm ones, are recommended for relief of itching secondary to chickenpox. Neither drug provides antipruritic effects, nor should aspirin ever be given to children with chickenpox, because there is an increased risk of developing Reye syndrome.

The nurse is assessing a child with herpetic gingivostomatitis. The nurse wears gloves when examining the lesions. This nursing action is: A. unnecessary because the virus is sexually transmitted. B. unnecessary because the virus is not easily spread. C. necessary only if the nurse touches his or her own mouth after touching the child's mouth. D. necessary because virus can easily enter breaks in the skin.

D. necessary because virus can easily enter breaks in the skin. HSV easily enters breaks in the skin and can cause herpetic whitlow on the fingers. Herpetic gingivostomatitis is usually caused by herpes simplex virus (HSV) 1. HSV 2 is usually transmitted through sexual activity. Gloves are always necessary because the virus is easily spread. Gloves are always necessary because the virus is easily spread.

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include: A. wearing safety belts snugly over the toddler's abdomen. B. placing the car seat in the front passenger seat if there is an airbag. C. using lap and shoulder belts when child is over 3 years of age. D. placing the car seat in the back seat of the car facing forward.

D. placing the car seat in the back seat of the car facing forward. Car seats are required for toddlers to prevent injury in case of a motor vehicle accident. The car seat should be placed in the back seat, forward facing. Safety belts can cause injuries if they are placed over a toddler's abdomen. Car seats should be in rear of the car because airbags can injure the toddler. Three-year-olds should be restrained in car seats.

A child is being seen in the emergency department with multiple facial abrasions and lacerations. A combination agent containing lidocaine, adrenaline, and tetracaine (LAT gel) is applied topically to the wounds. The purpose of this combination therapy is to: A. cleanse the wound. B. promote scab formation. C. prevent infection of the wound. D. provide anesthesia to the wound.

D. provide anesthesia to the wound. The combination of lidocaine, adrenaline, and tetracaine provides anesthesia within 10 to 15 minutes of application. LAT does not have a cleansing effect. LAT has no effect on scab formation. LAT has no antibacterial effect.

A nurse should explain that ringworm is: A. a noncontagious disorder. B. a sign of uncleanliness. C. expected to resolve spontaneously. D. spread by direct and indirect contact.

D. spread by direct and indirect contact. Ringworm is spread by both direct and indirect contact. Children should wear protective caps at night to avoid transfer of ringworm to bedding. Ringworm is an infectious disorder. Because ringworm is easily transmitted, it is not a sign of uncleanliness. It can be acquired from theater seats or gym mats and by animal-to-human transmission. The drug griseofulvin (Fulvicin) is indicated for a prolonged course, possibly several months.

A 4-month-old infant comes to the clinic for a well-infant checkup. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations should include which?

DTaP and IPV can be safely given. (These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines, so they do not pose a risk to her sister.)

What is constipation?

Decrease in bowel movement frequency or trouble defecating > 2 weeks

What is gastroschisis?

Defect in the anterior wall through which the abdomen contents freely protrude, there is NO OVERLYING sac to protect the exposed organs.

What is physiology of lactose intolerance?

Deficiency in hydrolysis by the enzyme lactase

What are complications of diarrhea?

Dehydration (*#1), acidosis from the acid base imbalance, then shock

An infant who does not pull to a standing position by 11 to 12 months of age should be further evaluated for what?

Developmental dysplasia of the hip

The nurse, while performing an assessment of a 12-month-old infant, discovers that the infant cannot pull himself to a standing position. For what should the infant be further evaluated?

Developmental dysplasia of the hip

A school nurse finds that many adolescents in the school are overweight. Being overweight predisposes these adolescents to which conditions? Diabetes Hypertension Heart diseases Fractures Headaches

Diabetes, Hypertension, Heart Disease Rationale: Overweight individuals are at high risk of developing diabetes due to increased insulin resistance. The risk of hypertension and heart disease is also high due to atherosclerosis. The risk of fractures and headaches is not dependent on body weight.

Parenting Styles

Dictatorial or authoritarian = control child's behaviors thru unquestioned rules & expectations Permissive = little or no control over behaviors Democratic or authoritative = direct behavior by setting rules & explaining the reason for each rule setting Passive = uninvolved, indifferent, emotionally removed

What is hydrolysis?

Digestion of lactose in SI

Authoritative parents' realistic standards and reasonable expectations produce children with high self-esteem who are self-reliant, assertive, inquisitive, content, and highly interactive with other children.

Discipline means to teach or refers to a set of rules governing conduct. In a narrower sense, it refers to the action taken to enforce the rules after noncompliance.

The nurse is guiding an infant's parents in selecting a daycare facility for their child. What are the most important areas that the nurse should encourage the parents to evaluate before they choose a facility? Select all that apply.

Discipline policy Safety measures Caregiver-to-student ratio Infection-conrtol procedures

Which muscle is contraindicated for the administration of immunizations in infants and young children?

Dorsogluteal (The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. The ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants.)

If a patient with acute diarrhea is stable what do you give to replace the deficit?

Drink

more than 3 hours per day, more than 3 days per week, for more than 3 weeks

During colic, the crying manifests as ___________.

In working with children, the nurse must include family members in their care plan. Research confirms parents' desire and expectation to participate in their child's care.

Duvall's Developmental Stages of the Family, Stage 1 - Marriage and an independent home: The joining of families. Reestablish couple identity, and realign relationships with extended family,

Duvall's Developmental Stages of the Family, Stage 2 - Families with infants. Integrate infants into the family unit, accommodate to new parenting and grandparenting roles, and maintain the marital bond.

Duvall's Developmental Stages of the Family, Stage 3 - Families with preschoolers. Socialize children and parents and children adjust to separation.

Duvall's Developmental Stages of the Family, Stage 4 - Families with schoolchildren. Children develop peer relationships and parents adjust to their children's peer and school influences.

Duvall's Developmental Stages of the Family, Stage 5 - Families with teenagers. Adolescents develop increasing autonomy, parents refocus on midlife marital and career issues, and parents begin a shift toward concern for the older generation.

Duvall's Developmental Stages of the Family, Stage 6 - Families as launching centers. Parents and young adults establish independent identities and parents renegotiate the marital relationship.

Duvall's Developmental Stages of the Family, Stage 7 - Middle-aged families. Reinvest in couple identity with concurrent development of independent interests, realign relationships to include in-laws and grandchildren, and deal with disabilities and the death of the older generation.

How to diagnose parasitic gastroenteritis?

ELISA

At what age would orthodontic treatment be considered to have the most potential for successful outcome? When the adolescent growth period has stopped. Early referral if malocclusion presents regardless of age. Treatment differs based on gender due to difference in growth and development. When all primary teeth are present.

Early referral if malocclusion presents regardless of age. If malocclusion is present, best practice would be to have early referral for evaluation and treatment. Orthodontic treatment should be started prior to the growth period stopping. Orthodontic treatment is based on individual presentation and not gender based variables. Orthodontic treatment is typically not started when all primary teeth are still present.

The school nurse is discussing dental health with some children in first grade. Which should be included? Teach how to floss teeth properly. Recommend a toothbrush with hard nylon bristles to get in between the teeth. Emphasize the importance of brushing before bedtime. Recommend nonfluoridated toothpaste.

Emphasize the importance of brushing before bedtime. Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries. Parents should help with flossing until children develop the dexterity required, when they are in about the third grade. A toothbrush with soft nylon bristles is recommended to prevent damage to the gums. The American Dental Association recommends fluoridated toothpaste for this age-group.

What should be the nurse's instruction to the parent of a child who is overweight? Inform the parent that the baby is well nourished. Advise the parent to put the child on a temporary fast. Tell the parent to reduce the quantity of food supplied to child. Emphasize the importance of physical activity for the child.

Emphasize the importance of physical activity for the child. Rationale: Childhood obesity is the major risk factor for the development of type 2 diabetes. Weight-loss measures such as increased physical activity and avoiding a sedentary lifestyle play an important role in prevention of diabetes. Overweight is also a sort of malnourishment. A fast is merely a temporary measure of weight reduction and is not appropriate for children. Modification of food habits is more important than reducing food intake.

Care for cleft lip/palate?

Encourage breast feeding

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? Help the toddler complete tasks. Provide opportunities for the toddler to play with other children. Help the toddler learn the difference between right and wrong. Encourage the toddler to do things for himself or herself when he or she is capable of doing them.

Encourage the toddler to do things for himself or herself when he or she is 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. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy.

Which action would improve dental health in the school-age child? Limiting brushing of teeth to three times a day following meals. Encouraging the child to floss. Have the parent brush the child's teeth in order to make sure it is done properly. Have the child consume fruit juice rather than soda.

Encouraging the child to floss. Flossing is a critical activity that has been shown to improve dental health. Brushing teeth following meals as well as following snacks has also been shown to improve dental health. At this age, the child should be able to brush their own teeth. Whereas soda should be avoided, the use of fruit juice may contribute to dental caries as it is considered to be a sugar source and example of a fermentable carbohydrate. Water as a drink should be promoted to improve dental health.

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

Encouraging the toddler to do things for himself or herself when capable PG 355-356

How is ulcerative colitis diagnoses?

Endoscopy or colonoscopy

How to manage intussusception?

Enema to reduce intussusception (air or saline)

Which characterizes the development of a 2-year-old child? Engages in parallel play Fully dresses self with supervision Has a vocabulary of at least 500 words Has attained one third of his or her adult height

Engages in parallel play Two-year-olds play alongside each other, otherwise known as parallel play. Toddlers need help with dressing because this is a task they are just beginning to learn; learning this extends into the preschool years. A toddler commonly has a vocabulary of 300 words. A toddler has attained one half of his or her adult height.

What is esophageal atresia?

Esophagus does not develop as a continuous passage

A 2-year-old child has recently started having temper tantrums, holding her breath and occasionally fainting. What is the most appropriate action by the nurse?

Explaining to the parent that this is not harmful PG 364

A mother with a newborn baby has to leave her baby for several days due to professional obligations. How does the nurse educate this mother about proper utilization of expressed breast milk? Select all that apply.

Expressed breast milk can be stored up to 6 months by freezing it. Milk can safely be stored up to 5 days in the refrigerator at 4° C (39° F). The milk should be stored in an airtight glass or plastic container.

In which place in the birth order are feelings of sibling rivalry most pronounced?

FIrstborn PG 363

The nurse is educating the mother of a 2-month-old infant about the importance of safety promotion and injury prevention during infancy. What types of injuries are common in this age group? Select all that apply.

Falls Aspiration Suffocation Motor vehicle crashes

A nurse is presenting a class on injury prevention to parents of preschoolers. Which injuries should the nurse identify as occurring in this age group? Select all that apply. Falls Drowning Poisoning Sports injuries Tricycle and bicycle accidents

Falls Drowning Poisoning Tricycle and bicycle accidents

Injury Prevention

Falls, ingestion injuries, and burns Aspiration of foreign objects Suffocation (latex balloons, adults sleeping in the same bed, plastic bags, cords, etc.) Motor vehicle injuries U.S. federally approved restraint Face the rear from birth to 20 pounds Falls, more common after 4 months

A local community has recently experienced a tornado that resulted in loss of homes and many injuries. Community health initiatives have provided counseling to assist families in coping with the sequelae of this natural disaster. This example represents primary prevention. True False

False This is an example of secondary prevention. Secondary prevention includes screening for tuberculosis as well as mental health counseling for stressful events such as natural disasters. Primary prevention focuses on health promotion and disease prevention such as car seat safety and immunizations.

Family Theories

Family systems: family is viewed as a whole system, instead of the individual members. A change to one member affects the entire system. Family stress: stress is inevitable - expected or unexpected. Developmental: views families as small groups that interact with the larger social system. Emphasized similarities & consistencies in how family develop and change. Uses Duvall's family life cycle stages to describe the changes a family goes through over time.

How does diarrhea spread?

Fecal-oral route through contaminated food/water/person to person

Which is characteristic of the psychosocial development of school-age children? A developing sense of initiative is important. Peer approval is not yet a motivating factor. Motivation comes from extrinsic rather than intrinsic sources. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

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. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age-group of industry versus inferiority. Initiative versus guilt is the stage characteristic of preschoolers. Peer group formation is one of the major characteristics of school-age children. School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.

Hematopoietic changes

Fetal hgb present in first 5 months With increased fetal hgb, RBCs have a shortened survival = physiologic anemia Maternal iron stores are present for the 1st 6 months

An adolescent patient is admitted to the emergency room with complaints of pain in her right knee. The knee is swollen and warm to the touch. No exudate is noted. Patient is febrile. Which disease process would be included as part of the patient's differential diagnosis? Juvenile diabetes Lyme disease Congestive heart failure Rheumatoid arthritis

Final stages of Lyme disease include a variety of presentations in cardiac, neurological and musculoskeletal systems. Lyme arthritis is often seen in the knee. Cardiac complications can cause heart block. Endocrine abnormalities do not typically present with effusion of a joint.

When is pyloric stenosis usually diagnosed?

First 2-5 weeks of life

What should be the primary goal of a nurse while providing atraumatic care to a child? First, do no harm to the child. Restrain the child. Repress the parents. Anesthetize the child

First, do no harm to the child. Rationale: The most important goal for providing a traumatic care is first, do no harm to the child. Restraining the child, repressing the parents and anesthesia are not primary goals of a traumatic care.

How to treat parasitic gastroenteritis?

Flagyl

The mother of a 3-month-old breastfed infant asks about giving the baby water because it is summer and very warm. What should the nurse tell the mother?

Fluids in addition to breast milk are not needed.

What is vomiting?

Forceful ejection of stomach contents (by CNS), can be bilious or non-bilious

What is the difference between GER and GERD?

GERD is the tissue damage that results from GER

What is GER?

Gastric contents go into the esophagus

What is the most common parasite that causes gastroenteritis?

Giardia

A toddler is given pasta, but refuses the dish because it does not taste good to the child. The nurse then gives the child a banana to eat, but the child refuses to try it, because he doesn't think it will taste good. What is the nurse's next step?

Give the banana to the child later.

What should the nurse recommend to the parents to help a toddler cope with the birth of a new sibling? Give the toddler a doll with which he or she can imitate the parents. Discourage the toddler from helping with care of the new sibling until the baby is much older. Prepare the toddler about 1 to 2 weeks before the birth of a new sibling. Explain to the toddler that a new playmate will soon come home.

Give the toddler a doll with which he or she can imitate the parents. The toddler can participate in the activity of caring for a new family member, which will make him or her feel included and important. The child should be encouraged to participate within his or her capabilities. The toddler should never be discouraged, because this will make him or her feel isolated and left out. Preparation should begin when obvious changes begin to happen to the mother's body and at home. This will establish unrealistic expectations for the toddler. Toddlers take language literally, and therefore will be disappointed when the new baby cannot play when he or she arrives home.

A toddler is admitted to the hospital for chemotherapy. The parent gives a toy to the child to play with whenever the parent is away from the child. The child likes the toy and when someone tries to take the toy away, the child starts throwing tantrums. What statement by the nurse is appropriate regarding the child's behavior?

Give the toy to the child to minimize loneliness

Which statement about bottle-mouth caries should be taught to the parents? This syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. This syndrome can be completely prevented by breastfeeding. Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. Sweet liquids, or the sugars in milk and even breast milk, pooling in a toddler's mouth during sleep increase the incidence of dental caries. Changes in the positioning of the teeth may result from pacifier use or thumb sucking and are not related to bottle-mouth caries. Frequent breastfeeding before sleep can cause bottle-mouth caries, since breast milk does contain lactose, which is present in higher concentrations than in cow's milk-based formula. Juice, which contains varying concentrations of sugar, in bottles before sleep contributes to bottle-mouth caries.

What is Celiac disease?

Gluten allergy

Fine Motor Development

Grasp 2-3 months as a reflex 5 months voluntarily grasps object 8-10 months uses a crude pincer grasp 6 months holds bottle 7 months object from one hand to the other 11 months put object in a container

What is given for one time exposures to Hep B?

HBIG

Which of the following vaccinations are included in health promotion during infancy? (Select all that apply.)

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

What is the most important factor in determining the degree of fit between an infant's temperament and the interactions between the child and parents?

Harmony between the parent's expectations and the child's actual temperament

Which observation is associated with nightmares as opposed to sleep terrors? Child has no memory of the event or dream like state. Has a hard time returning to sleep following the event. Thrashing type behaviors continue when the child awakens. Is not comforted by traditional methods of contact.

Has a hard time returning to sleep following the event. Nightmares are associated with difficulty returning to sleep as opposed to sleep terrors where the individual easily goes back to sleep. With the advent of a nightmare, the child has a memory of the dream like state, is comforted by traditional methods of contact and thrashing type behaviors cease upon awakening. In sleep terrors, the child has no memory of the event, continues thrashing behaviors when awaken, and is not comforted by traditional methods of contact.

Sinus Arrhythmia

Heart rate increases when baby takes a deep breath

this disease is commonly spread via oral/fecal route and from person to person. often unwashed veggies, contaminated water. Has an abrupt onset; fever, malaise, abdominal discomfort, jaundice

Hep A

A majority of the population is vaccinated, and the spread of certain diseases is stopped

Herd immunity

Which statement best represents infectious mononucleosis? Human herpesvirus type 2 is the principal cause. Herpes-like Epstein-Barr virus is the principal cause. Diagnosis is established by a complete blood count, which reveals a characteristic leukopenia. Diagnosis is established by clinical manifestations because diagnostic tests cannot confirm the diagnosis.

Herpes-like Epstein-Barr virus accounts for most cases of mononucleosis and is considered to be the principal cause. A complete blood count in an adolescent with mononucleosis would indicate a lymphocytic leukocytosis with atypical lymphs, not leukopenia. The monospot test is a highly specific test for mononucleosis.

Physiologic anemia

High levels of fetal hemoglobin are thought to depress the production of erythropoietin, a hormone released by the kidneys that stimulates RBC production

What does constipation normally lead to?

Hirschsprung disease, hypothyroidism, chronic lead poisoning, spinal cord lesions, use of diuretics, etc.

Family Assessment

History Structure Developmental tasks Family characteristics Family stressors Environment Family support system

Parents are concerned about the behavior of their preschool child as he is exhibiting aggressive behavior in interactions with other children. Which information would be relevant in determining if the behavior represents an abnormal pattern? Select all that apply. How many times this type of behavior has occurred in recent weeks? Does the behavior seem to be escalating? How long has this behavior been going on? Do you think that the behavior is warranted considering the situation that has occurred?

How many times this type of behavior has occurred in recent weeks? Does the behavior seem to be escalating? In terms of making an evaluation as to whether or not this aggressive behavior is a problem, the nurse would want to obtain information related to quantity, severity, distribution, onset and duration. Asking the parent if they think the behavior is justified given the situation does not address any of the aforementioned variables of concern but rather reflects a judgment value.

What is the causative agent for erythema infectiosum (fifth disease)? Paramyxovirus Human parvovirus B19 Human herpesvirus type 6 Group A β-hemolytic streptococcus

Human parvovirus B19 is the causative agent of fifth disease. Paramyxovirus causes mumps. Human herpesvirus types 1 and 2 are the major causes of herpetic infections in humans. Group A β-hemolytic streptococcus is the causative agent for scarlet fever.

where and how is hepB vaccine given?

IM, vastus lateralis

colic

If an infant has abdominal pain, cramping, crying "3's," drawing legs to abdomen, symptoms are increased in late afternoon, and they are younger than 3 months, what disorder will you suspect?

C. albicans

If diaper rash appears to have small circular satellite pustules with perineal and maculopapular rash across inguinal folds, you should suspect what?

How to figure out how much fiber is needed for a child?

If over 3, take their age and at 5g

How to treat GER?

If the baby is okay, then they're okay

Inability of immune system to produce _________________ in mucosal lining provides less protection against infection in infancy.

IgA

What is most common site of intussusception?

Ileocecal valve

The nurse is concerned with the prevention of communicable disease. Primary prevention results from A. Immunizations B. Early diagnosis C. Strict isolation D. Treatment of disease

Immunizations Communicable diseases are prevented through immunizations, which constitute primary prevention. Early diagnosis can prevent the spread of communicable disease by initiating treatment and isolation if necessary; this would be considered secondary prevention. Strict isolation would be considered part of the treatment regimen and would constitute tertiary prevention, which is the prevention of complications or sequelae. Treatment of disease would not prevent communicable disease.

The nurse notices that a toddler is more cooperative taking medicine from a small cup than from a large cup. This is an example of which characteristic of preoperational thought? Egocentrism Irreversibility Inability to conserve Transductive reasoning

Inability to conserve The smaller cup makes it look like less medicine to the child at this stage of cognitive development. The inability to see situations from other perspectives, besides their own, does not facilitate medication administration. The inability to reverse or undo actions physically initiated does not facilitate medication administration. Focusing on particulars does not explain the cooperation with the smaller medication cup.

What is failure to thrive technically?

Inability to obtain or use calories required for growth -in < 5% for age

What is chronic diarrhea?

Increase in stool frequency and water content lasting longer than 14 days

Which behavior is most characteristic of the concrete operations stage of cognitive development? Progression from reflex activity to imitative behavior Inability to put oneself in another's place Increasingly logical and coherent thought processes Ability to think in abstract terms and draw logical conclusions

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. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.

What is acute appendicitis?

Inflammation of the appendix

What is appendicitis?

Inflammation of the appendix

The nurse is giving anticipatory guidance to the parent of a 5-year-old. What is the most appropriate information to include? Prepare the parent for increased aggression. Encourage the parent to offer the child choices. Inform the parent that he or she can expect a more tranquil period at this age. Advise the parent that this is the age when stuttering may develop.

Inform the parent that he or she can expect a more tranquil period at this age. The end of preschool and the beginning of school age is a more tranquil period. Preparing the parent for increased aggression is anticipatory guidance for 4-year-old children. Encouraging the parent to offer the child choices is anticipatory guidance for 3-year-old children. Advising the parent that this is the age when stuttering may develop is anticipatory guidance for 3-year-old children.

A child is brought into the hospital following a fire at his home. The child appears to be sleeping on the stretcher bed. No observable burn injuries are noted based on preliminary survey. However, the nurse would place a priortiy observation on the possiblity of the child having? Inhalation Injury Thermal burns Decreased metabolism leading to hypovolemic shock Chemical burns

Inhalation Injury Inhalation injury in the form of carbon monoxide poisoning or smoke inhalation should be considered in this situation. It is critical for the nurse to make these observations in order to prevent further complications. Thermal and chemical burns would cause evident tissue destruction which would be foun on preliminary survery. In burn states, incresaed metabolism would occur.

What is the most common cause of death and disability in children in the United States? Injuries Violence Drowning Mental health problems

Injuries. Rationale: Injuries account for the most common cause of death and disability to children in the United States. Violence, drowning, and mental health problems are not the most common causes of death and disability in children in the United States.

What is failure to thrive?

Insufficient weight gain or inappropriate weight loss

What is an umbilical hernia?

Intestines protrude out through the belly button

The mother of a 12-month-old boy tells the nurse that she is very concerned because her child is still sucking his thumb. She asks the nurse how she can get her child to stop this "annoying behavior." Before giving advice, what should the nurse do?

Investigate the mother's feelings regarding her son's behavior.

Which is usually the only symptom of pediculosis capitis (head lice)?

Itching .(Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft. Vesicles, scalp rash, and localized inflammatory response are not symptoms of head lice.)

What is a tell tale sign of intussusception?

Jelly like stools

What is a tell tale sign of Meckel Diverticulum?

Jelly-like stools from blood in stool

The school nurse is teaching a class on safety. Which activities require protective athletic gear? Select all that apply. Lacrosse Football Swimming Gymnastics Skateboarding

Lacrosse Football Skateboarding Any sport that involves body contact such as lacrosse, football, and skateboarding requires a child to wear protective equipment. Swimming does not involve body contact and requires no protective equipment. Gymnastics does not require protective equipment.

What is Hirschsprung Disease?

Large intestine causes difficulty passing stool

When is colic the worst?

Late afternoon or evening is the worst because most full

Complete maturation of kidneys occurs at

Latter half of the 2nd year. (Until then, infant cannot concentrate urine very well.) *15 to 60 ml/kg/24hr U/O

After recording the weight of a newborn child, the nurse concludes that it is a low-birth-weight (LBW) baby. What is the weight of the baby? More than 4.5 kg More than 3.5 kg Less than 2.5 kg Less than 5.0 kg

Less than 2.5 kg Rationale: LBW is a major cause of neonatal death. LBW is defined as a birth weight of a live born infant less than 2.5 kg (5.5 pounds). Birth weights of more than 4.5 kg, more than 3.5 kg, and less than 5.0 kg are normal.

Ashley, age 4½ years, is afraid of dogs. What should the nurse recommend to her parents to help her with this fear? Keep her away from dogs. Buy her a stuffed dog toy. Force her to touch a dog briefly. Let her watch other children play with a dog.

Let her 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 adapt. Keeping their child away from dogs avoids the object of fear rather than addressing the fear and finding solutions. Buying a child a stuffed dog toy avoids the object of fear rather than addressing the fear and finding solutions. Forcing the child to touch a dog without working up to it may increase the level of fear.

________ is most immature of all gastrointestinal organs throughout infancy

Liver

What is important to look out for in vomitus?

Look for the color

The nurse determines that a 3-month-old baby is being fed with low-fat milk. About what does the nurse teach the parents with regard to the drawbacks of low-fat milk? Select all that apply.

Low-fat milk is high in sodium. Low-fat milk contains inadequate essential fatty acids.

A community health nurse is educating mothers about infant safety and injury prevention. Which information should the nurse include in the teaching?

Maintain one hand on the infant at all times while in the bath tub.

Parents of a preschooler relate that their child is having some difficulties falling asleep. This is a recent occurrence and the parents report that they have tried virtually everything to get their child to go to sleep. Based on this self-report, the nurse would advise the parents to? Do not feed the child 2 hours before sleep as food might be causing excess stimulation. Do not let the child watch any television in the evening as this may cause stimulation. Have the child fall asleep on the couch and then transfer the child to the bed. Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns.

Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns. Children in this age group often experience changes in their sleep patterns but consistent approaches in bedtime rituals may help to promote sleep patterns. By the parents self-report that they have "tried virtually everything" may have contributed to the child's altered sleep pattern. There is no enough information provided for the nurse to make any other of the provided options.

Reactive Attachment Disorder

Maladaptive or absent attachment between the infant & parent Two patterns Emotionally withdrawn-inhibited Indiscriminate-disinhibited Child behaviors - not being cuddly with parents, failing to make eye contact, poor impulse control, & destructive to self & others Some may fail to develop a conscience, suffer from antisocial personality disorder, and lead to criminal acts

An 18-month-old child has been diagnosed with pediculosis capitis (head lice). Which prescription should the nurse question if ordered for the child?

Malathion (Ovide) .(The nurse should question malathion for an 18-month-old child. Malathion contains flammable alcohol, must remain in contact with the scalp for 8 to 12 hours, and is not recommended for children younger than 2 years of age. The drug of choice for infants and children is permethrin 1% cream rinse (Nix) or pyrethrin with piperonyl butoxide, which kill adult lice and nits. Benzyl alcohol 5% lotion has been approved by the Food and Drug Administration for the treatment of head lice in children as young as 6 months.)

Examination of a child's mouth reveals that teeth do not line up properly upon attempts to have the child bite down. This finding is noted as? Malocclusion Gingivitis Evidence of dental caries Dental injury

Malocclusion Malocclusion occurs when upper and lower teeth do not approximate when a child bites down. Gingivitis refers to inflammation of the gums. Evidence of dental caries would refer to the presence of a cavity. Dental injury refers to evidence of chipping or dislocation as a result of trauma.

What is the spot to diagnose acute appendicitis?

McBurney's Point

How to diagnose Meckel Diverticulum?

Meckel scan but is less reliable with bleeding

Firstborn children are more achievement oriented, more dominant, receive more physical punishment, are allowed to show more aggression to siblings, have stronger consciences, are more self-disciplined and inner directed, are more socially anxious, prone to feelings of guilt, identify more with parents than with peers, are more conservative, subject to greater parental expectations, begin to speak earlier in life, demonstrate higher intellectual achievement, plan better and experience fewer frustrations, and are likely to be most wanted.

Middle children have more demands made on them for household help, are praised less often, receive less of the parents' time, learn to compromise and be adaptable, are less stimulated toward achievement, and are more difficult to characterize because of a variety or positions in the family.

How are babies under 3 months protected against rotavirus?

Mom's antibodies

Why is colic hard to diagnose?

Most of the time babies are gaining weight but still thrives

A toddler is admitted to the emergency room with a possible diagnosis of accidental poisoning. Which information if noted on the admission form would indicate a potential cause for this clinical diagnosis? Parents do not take any prescribed medications. Cleaning supplies are kept in locked cabinets in the child's home. Mother has been taking Tylenol OTC for sinus headaches for several days and keeps medication in a tote handbag Toddler has just finished treatment with oral antibiotics for ear infection 1 week ago.

Mother has been taking Tylenol OTC for sinus headaches for several days and keeps medication in a tote handbag The fact that the Tylenol is being kept in a handbag may pose concern as access to the tote handbag is not restrictive. The toddler may have been able to access the medication. The other options do not pose a significant concern as a possible etiology for this clinical diagnosis.

A nurse is delivering a lecture to a group of parents on child health and diseases. What is the most common cause of death in children older than 1 year? Obesity Type 2 diabetes Motor vehicle accidents Heart disease

Motor Vehicle Accidents Rationale: Motor vehicle accidents are the most common cause of death in children over 1 year of age. Obesity is the most common nutritional problem in children and can lead to type 2 diabetes. Incidents related to death due to heart diseases, such as coronary heart disease, in children are not that common.

What is an important care to implement with vomiting?

Mouth care = acidity from the stomach contents in the vomit will cause the breakdown of enamel

A 4-year-old child is seen playing with his father while waiting in the clinic area for a well checkup visit. The nurse observing the interaction notes that this behavior as being an example of? Imaginative play Mutual play Dramatic play Avoidance play

Mutual play Children playing with a parent is an example of mutual play. Play can be described as being imaginative or dramatic as a characteristic but there is no specific information given that defines the type of play interaction that is occurring. The concept avoidance play does not exist as a characteristic term describing play behaviors.

What vaccine for Hep B goes to whom?

NB- HBIG Pos moms- HbsAg

What is lactose intolerance?

NO MILK

food intolerance

NOT an immunological response to a substance (ex. lactose)

What is a stricture?

Narrowing of the lumen, causing incontinence and a need for dilation and retaining of the bowel

Innate immunity or resistance to infection or toxicity

Natural immunity

What are s/s of vomiting?

Nausea and retching

Limit Setting and Discipline

Need to set safe limits to protect the child & establish positive & supportive parent-child relationship Time-out in a playpen The earlier effective disciplinary methods are employed, = easier to continue these approaches Do not understand a cause-and-effect between objects & physical harm Fussy or irritable infant is a potential victim of shaken baby syndrome

A mother tells the nurse that her toddler always says no to her requests. How does Erikson describe this toddler's behavior?

Negativism PG 355

A 4-month-old baby sustained minor oral burns from drinking hot milk. The nurse learns that the parent had warmed the expressed breast milk in a microwave for 3 minutes before giving it to the baby. What should the nurse advise the parent?

Never use a microwave for warming the expressed breast milk.

What does impetigo ordinarily results in?

No scarring. (Impetigo tends to heal without scarring unless a secondary infection occurs.)

The nurse is assessing a 4-month-old baby for social skills and cognition development. The parent expresses that the baby has become fussy during bottle feeding. The baby is unable to roll from back to side and does not recognize the parent or the feeding bottle. What findings in the baby should raise concern regarding the development of social skills and cognition?

Not recognizing feeding bottle

Limit setting refers to establishing the rules or guidelines for behavior. The clearer the limits that are set and the more consistently they are enforced, the less need there is for disciplinary action.

Nurses can help parents establish realistic and concrete "rules." Limit setting and discipline are positive, necessary components of childrearing and serve several useful functions as they help children: test their limits of control, achieve in areas appropriate for mastery at their level, channel undesirable feelings into constructive activity, protect themselves from danger, and learn socially acceptable behavior.

breastfeeding

Nurses should encourage _______ in order to reduce SIDS.

The parent of a 3-year-old child tells the nurse, "I offer food as a reward for appropriate behavior. I'm very pleased, because it works very well." The nurse informs the parent that the child may be at risk for which condition?

Obesity PG 365

An 8-month-old baby is on supplemental iron. The nurse learns that the baby is fed with broiled chicken liver, mashed hard boiled egg yolk and iron-fortified cereal. What advice should be given to the parents of the baby? Select all that apply.

Obtain order to stop iron supplement Continue broiled chicken liver in diet.

A nurse is teaching a group of parents about communicable diseases. Which of the following is the most appropriate method to prevent a communicable disease?

Obtaining immunizations has decreased the rate of communicable diseases and is the best method to prevent further spread of illness.

What is secondary encopresis?

Occurring in a child > 4 years AFTER they have achieved continence

What is intussusception (2nd def)?

One segment of the bowel telescopes into another segment and pulls the mesentery with it -unknown cause

Youngest children are less dependent than firstborn children, are less tense, more affectionate, and more good-natured, tend to identify more with peer groups than with parents, are more flexible in their thinking, are popular with classmates, and have fewer demands placed on them for household help.

Only children have many of the same characteristics as firstborn children, are more mature and cultivated, experience greater parental pressure for mature behavior and achievement, demonstrate superiority in language facility, rarely develop into the stereotype spoiled, selfish child, and often enjoy a rich fantasy life as a result of isolation.

Which benchmark serves as the ending period for the middle year period of development? Beginning school Onset of puberty Wisdom teeth appearing Loss of deciduous teeth

Onset of puberty The onset of puberty signals the end of the middle year period. Beginning school and loss of deciduous teeth are associated with the beginning of the middle year period. Appearance of wisdom teeth occurs later on in life.

What is pyloric stenosis?

Opening between the stomach and the small intestine, thickens

What is Omphalocele?

Organs are placed outside of the body, located ON UMBILICUS and IS ENCASED in a visceral peritoneum.

Based on the nurse's knowledge of wounds and wound healing, what are factors that can delay or cause dysfunctional wound healing? Select all that apply. Overweight Hypoxemia Hypervolemia Prolonged infection Corticosteroid therapy

Overweight Corticosteroid therapy Poor nutrition without proper protein and calorie intake affects healing more than being overweight itself. Corticosteroid therapy or other immunocompromising therapy prevents macrophages from migrating to the site of injury, thus suppressing epithelialization. Hypovolemia, not hypervolemia, inhibits wound healing due to low circulating blood volume and oxygenation of tissues. Hypoxemia makes tissues more susceptible to infection due to insufficient oxygenation. Prolonged infection affects the healing process and causes increased scarring.

Which type of play is characteristic of toddlers?

Parallel PG 359

What factors place an infant at risk for reactive attachment disorder? Select all that apply.

Parental alcoholism Parental mental illness Being a victim of neglect Having been in foster care

Sleep and Activity

Parents establish bedtime rituals that do not foster problematic patterns Place infants awake in their own cribs Bed used for sleeping, not a playpen

When preparing parents to teach their preschool child about human sexuality, what should the nurse emphasize? A parent's words may have a greater influence on the child's understanding than the parent's actions. Parents should determine exactly what the child wants to know before answering a question about sexuality. Parents should avoid using correct anatomic terms because they are confusing to the preschooler. Parents should encourage preschoolers to satisfy their sexual curiosity by playing "doctor."

Parents should determine exactly what the child wants to know before answering a question about sexuality. It is important that the parent answer the question that the child is asking. Actions may have a greater influence because language is not fully developed in the preschool years. Using correct terminology lays the foundation for later discussion of human sexuality. Parents should encourage children to ask questions to provide accurate information at their cognitive level.

What is intussusception?

Part of the intestine telescopes itself

The nurse is teaching parents about developmental milestones of a child. Arrange different milestones in order of their occurrence in a child from birth to 3 years.

Participates in solitary play Creeps upstairs Builds a tower of four cubes Engages in parallel play Jumps with both feet

Temporary immunity from the mother to the fetus via the placenta

Passive immunity

How is hep B in children usually acquired?

Perinatally during birth process

Children of authoritarian parents tend to be sensitive, shy, self-conscious, retiring, and submissive. They are more likely to be courteous, loyal, honest, and dependable but docile. These behaviors are more typically observed when close supervision and affection accompany parental authority. If not, this style of parenting may be associated with both defiant and antisocial behavior.

Permissive parents exert little or no control over their children's actions. They avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. If rules do exist, the parents explain the underlying reason, elicit the children's opinions, and consult them in decision-making processes. They use lax, inconsistent discipline; they do not set sensible limits; and do not prevent the children from upsetting the home routine. These parents rarely punish the children.

Around 18 months of age most toddlers manifest a decreased nutritional need and a diminished appetite. This condition is known as what?

Physiologic Anorexia PG 365

A parent works the night shift and keeps the expressed breast milk in the freezer at the office and brings frozen milk home to feed the baby. What is the best way to warm the frozen milk before feeding the baby?

Place the container with frozen milk in a lukewarm water bath to warm it.

supine

Placing infant in ______ position while sleeping reduces risk of SIDS.

During a home visit to a toddler, the nurse finds that the home has a balcony with rails, and the opening between the rails is 3 inches. There is a carbon monoxide detector in the home. Cough syrup has been placed in a childproof container on a high level shelf. The house has an old refrigerator in a storage room, and its doors have been removed. Which finding in the home should be addressed by the nurse?

Placing of cough syrup in a container at high level

The nurse assesses a toddler and finds that the child is in a growth spurt. What should the nurse tell the family regarding feeding the child to meet his or her nutritional needs? Select all that apply.

Plan a nutritionally balanced week. Serve food in various physical forms.

Major socializing agent

Play - learn from and interact with the environment

Injury Prevention cont

Poisoning (improper storage, plants, button-sized batteries, inhalation) Do not store in any type of food container Keep in a locked cabinet Burns Water heater set at 120 degrees or lower Sunburn - avoid direct sunlight for the first 6 months Cover electrical outlets

Herpes zoster is caused by the varicella virus and has an affinity for which?

Posterior root ganglia and posterior horn of the spinal cord. (The herpes zoster virus has an affinity for posterior root ganglia, the posterior horn of the spinal cord, and the skin. The zoster virus does not involve the nerve fibers listed)

A 2-year-old child resists going to bed and has the habit of banging his or her head against the wall and crying when a parent tries to place the child in the bed. What advice should the nurse to the parent?

Praise the child after the temper tantrum for any positive, appropriate behavior.

When teaching safety and injury prevention, the nurse explains that children are at risk for different injuries based on their developmental stage. Which group of children is at the greatest risk of street accidents? Small infants Crawling infants Mobile toddler Preschooler

Preschooler Rationale: The type of injury mostly depends on the developmental stage of the child and the activities related to that developmental age. Preschoolers may become too absorbed in their play activities to be aware of environmental hazards such as street traffic and water. Small infants do not move much, but when they try to move or roll, they can fall from unprotected surfaces. Crawling infants tend to put objects in their mouth and are thus at high risk of aspiration and poisoning. Mobile toddlers are at high risk of falls, burns, and collision with objects due to their newfound capability to run and climb.

What is management of vomiting?

Prevent dehydration, maintain strict I&Os, elevate the HOB 30 degrees

What should be given alongside the antibiotic to prevent antibiotic associated diarrhea?

Probiotics

What is described as the time interval between early manifestations of a disease and the overt clinical syndrome? A. Incubation period B. Prodromal period C. Desquamation period D. Period of communicability

Prodromal period The prodromal period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms. The incubation period is the time from exposure to the appearance of the first symptom. The desquamation period refers to the shedding of skin when applicable for a syndrome or disorder. The period of communicability describes the period when the child is infectious.

What is the first symptom of pyloric stenosis?

Projectile vomiting after 30-60 minutes after eating

Which position is best for GER?

Prone, but it causes SIDS

A child has sustained an injury and lost a primary tooth. Which priority action should be taken by the nurse at this time? Provide comfort measures and assess for bleeding. Referral to the dentist for immediate consultation. Recover the tooth and prepare for reimplantation. If the tooth is dirty, rinse it off and cover in gauze until needed for reimplantation.

Provide comfort measures and assess for bleeding. Avulsed primary teeth are usually not reimplanted. Therefore the nurse should focus on assessment of the site and comfort measures. All of the other options would be indicated if an avulsed tooth were to be reimplanted.

What is the tx for pyloric stenosis?

Pyloromyotomy (surgery) relieves obstruction -Baby can feed 4-6 hours POST surgery

The nurse understands that respiratory hygiene and cough etiquette is recommended by the Centers for Disease Control and Prevention (CDC) to prevent which of the following?

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

Weaning

Relinquishing the breast or bottle for a cup Replace one bottle or breast feeding at a time Nighttime feeding is usually the last feeding Wean to a cup by 12-14 months

A child has been stung by a bee and the parents call the walk in clinic asking for instructions on what to do as they make their way to the clinic. The nurse responds by stating? Tell the parents to remove all of the child's clothing and apply warm water to the affected area. Remove the stinger from the site. Encourage the child to take slow deep breaths to minimize associuated anxiety that has occured due to the event. Have the parents offer the child water.

Remove the stinger from the site. First action is to remove the stinger, then cleanse the area with soap and water and apply a cool compress. There is no need to remove the child's clothing or provide fluid hydration. There is no indication tha the child is experiencing any evidence of anxiety provided by the parent's communication.

What is chelation therapy?

Removing lead from the blood

The nurse is caring for a 12-year-old who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action related to this? Request a psychological consultation. Ask the child why the child does not have pain. Praise the child for the ability to withstand pain. Encourage continued bravery as a coping strategy.

Request a psychological consultation. A psychological consultation will assist the child in verbalizing fears. This age group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying his or her fears and pain. If the child is feeling pain, the nurse should not praise the child for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.

The longest relationship one will share with another human being is the sibling relationship.

Researchers have observed that the birth position of children affects their personalities. Parents treat children differently, and sibling interactions are different, depending on the child's position within the family.

What do probiotics do?

Restore normal flora

The nurse is performing a routine assessment of a 6-month-old infant. What should the nurse tell the mother about the introduction of solid foods?

Rice is a good first food because it is easily digested and low in allergenic potential.

The parent of a toddler, concerned that the child is not getting enough calories, tells the nurse, "She'll only eat crackers, cheese, and turkey." How can the nurse characterize the typical toddler's eating behavior?

Ritualism PG 356

What is the most common agent that causes the stomach virus (gastroenteritis)?

Rotavirus

What is diarrhea?

SYMPTOM not a disease, caused by abnormal water and electrolyte transport

What are the common bacteria that cause gastroenteritis?

Salmonella, shigella, campylobacter

How do you treat vomiting?

Same as diarrhea

Reasoning involves explaining why an act is wrong and is usually appropriate for older children, especially when moral issues are involved.

Scolding, which sometimes accompanies reasoning, can take the form of shame or criticism.

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which of the following suggestions should the nurse include? Send the child to his or her room. If the child cries, refuses, or is more disruptive, try another approach. Select an area that is safe and nonstimulating, such as a hallway. The general rule for length of time is 1 hour per year of age.

Select an area that is safe and nonstimulating, such as a hallway. The area must be nonstimulating and safe. The child becomes bored in this environment and then changes his or her behavior to rejoin activities. The child's room may have toys and other forms of amusement that may negate the effect of being separated from family activities. When the child engages in this type of behavior, the timeout begins when the child quiets. The general rule is 1 minute per year. An hour per year is excessive.

In what phase of cognitive development are infants, according to Piaget?

Sensorimotor

What are babies with colic at risk for?

Shaken baby syndrome

What gross motor skill are infants able to perform at 7 months of age?

Sitting erect momentarily

_____ acts as a barrier to infection, assists in thermal regulation, and prevents water loss in term infants

Skin

______ is an early step in social communication

Social Smile

What is an important consideration related to childhood stress? Children should be protected from stress. Children do not have coping strategies. Parents cannot prepare children for stress. Some children are more vulnerable to stress than others.

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. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.

Teething

Some discomfort is common as the crown of the tooth breaks through Generally, signs of illness are not signs of teething Fever higher than 100.4 F Ill appearing infant Cold is soothing Nonprescription topical anesthetic ointments Acetaminophen or ibuprofen

What is gastroenteritis?

Stomach flu (diarrhea, cramps N/V, fever)

What is viral gastroenteritis?

Stomach virus

What is character of encopresis?

Stool sneaks around the impacted stool and causes accidental soiling -Associated with stool withholding

The parent of a 10-month-old infant tells the nurse that the baby cries and screams whenever being left with the grandparents. What is the nurse's best response?

Stranger anxiety is common for an infant of this age.

An 8-month-old infant who clings to the parent, cries, and turns away from a new babysitter is exhibiting what?

Stranger fear

What often causes cellulitis?

Streptococci or staphylococci. (Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. C. albicans is associated with candidiasis, or thrush. Human papillomavirus is associated with various types of human warts.)

What does Hirschsprung Disease lead to?

Strictures

Thumb Sucking/Pacifier

Sucking is the infant's chief pleasure Research varies on the benefits or risks of pacifier use (e.g., reduced SIDS) 4-6 yrs = malocclusion may occur Continued dependency may influence social & speech development 18-20 months - thumb sucking reaches its peak Persistent thumb sucking in a listless, apathetic child warrants investigation

What is ACUTE diarrhea?

Sudden increase in frequency and change in consistency -leading illness in < 5 years

What is short gut syndrome?

Surgical removal of large portion of the small intestine die to lack of function of the SI

What is the tx for Meckel Diverticulum?

Surgical removal of said diverticulum

Parents of a toddler are worried because their child touches the genitalia in public. What should the nurse advise?

Teach that genital stimulation in private is acceptable but not in public. PG 358

Which clinical finding would alert the nurse to the possibility that the pediatric patient has conjunctivitis as a result of a foreign object body? Bilateral swollen lids Tearing of the right eye Crusting of eyelids Inflamed conjunctiva of both eyes

Tearing of the right eye Conjunctivitis as a result of a foreign object body typically presents with clinical symptoms in the affected eye. Bilateral presentation of symptoms rules is seen in conjunctivitis occurring from other sources such as viral, allergic or bacterial. Crusting of eyelids is typically seen with bacterial etiology.

While caring for a 3-year-old child, the nurse finds that the toddler hits the parent and laughs. What is the appropriate reaction to the toddler in this situation?

Tell the child to stop hitting, because people are not supposed to hit others.

soy

The National Institute of Allergy and Infectious Diseases guidelines recommend that: _____ formula is not recommended to prevent the development of food allergy.

hydrolyzed formula

The National Institute of Allergy and Infectious Diseases guidelines recommend that: ______ formula may be used in at-risk infants to prevent or modify food allergy.

maternal diet

The National Institute of Allergy and Infectious Diseases guidelines recommend that: _________ during pregnancy or lactation should not be restricted to prevent food allergy.

MMR, MMRV

The National Institute of Allergy and Infectious Diseases guidelines recommend that: children should be vaccinated with what 2 vaccines even with an egg allergy?

influenza

The National Institute of Allergy and Infectious Diseases guidelines recommend that: children with severe egg allergy should not receive what vaccine?

4-6 months

The National Institute of Allergy and Infectious Diseases guidelines recommend that: infants should exclusively be breastfed until what age?

6 months

The National Institute of Allergy and Infectious Diseases guidelines recommend that: introduction of complementary foods should occur at what age?

The nurse is educating a group of new mothers about the proportional changes that occur in newborns. Which of the nurse's claims pertaining to proportional changes is appropriate? Select all that apply.

The average height attained by 6 months is 65 cm (25.5 inches). The average size of the head is 46 cm (18 inches) at 12 months. Babies gain up to 210 g (7 oz) weekly until they are 5 months old.

A hospitalized toddler clings to a worn, tattered blanket. The toddler screams when anyone tries to take it away. Which is the best explanation for the toddler's attachment to the blanket? The blanket encourages immature behavior. The blanket is an important transitional object. The developmental task of individuation-separation has not been mastered. The child and mother have inadequate bonding.

The blanket is an important transitional object. The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are important to help toddlers separate, and attachment to them does not indicate immature behavior. Transitional objects are helpful when a toddler experiences increased stress such as hospitalization. The attachment to the blanket does not reflect inadequate bonding with the mother.

What is encopresis?

The child RESISTS having bowel movements

The school reviewed the pediculosis capitis (head lice) policy and removed the "no nit" requirement. The nurse explains that now, when a child is found to have nits, the parents must do which before the child can return to school?

The child can remain in school with treatment done at home. (Many children have missed significant amounts of school time with "no nit" policies. The child should be appropriately treated with a pediculicide and a fine-tooth comb. The environment needs to be treated to prevent reinfestation. The treatment with the pediculicide will kill the lice and leave nit casings. Cutting the child's hair is not recommended; lice infest short hair as well as long. With a "no nit" policy, treating the child with a shampoo to treat lice and combing the hair with a fine-tooth comb every day until nits are eliminated is the correct treatment. The policy change recognizes that most nits do not become lice.)

The nurse is preparing to administer a measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a contraindication associated with administering this vaccine?

The child has a disorder that causes a deficient immune system. (The MMRV (measles, mumps, rubella, and varicella) vaccine is an attenuated live virus vaccine. Children with deficient immune systems should not receive the MMRV vaccine because of a lack of evidence of its safety in this population. Exposure to an infectious disease, symptoms of a cold, or intermittent episodes of diarrhea are not contraindications to receiving a live vaccine.)

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? Select all that apply. The child's bruises are located only on the right arm and leg. The child is brought to the emergency department by an unrelated adult. The child has a history of a broken arm last year from falling off a swing. The child's caregiver is anxious that the child get immediate medical attention. The child has red, green, and yellow bruises on more than one plane of the body.

The child is brought to the emergency department by an unrelated adult. The child has red, green, and yellow bruises on more than one plane of the body. A child brought to a health care provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse. Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse. Falling down stairs can be an unintentional injury. A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse. An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.

The parent of a 20-month-old toddler tells the nurse, "I don't understand my child's eating habits. Sometimes my child eats a lot and the next day nothing at all. Sometimes my child may push away the plate and reject a favorite food for no reason." What does the nurse understand from the child's behavior?

The child is influenced by the psychologic components of food.

During an assessment of an 18-month-old child, the nurse finds that the child can say four to six words and can build a tower of four cubes. . The child also throws temper tantrums occasionally. Which statement describes the child's development?

The child may have delayed language development. PG 359

A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and immunization doses. The nurse knows that the most appropriate action is what?

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

6

The majority of cases of SIDS occur by _____ months.

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to do what?

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to do what? PG 371

How does the nursing diagnosis phase of the nursing process help the nurse make decisions about the patient's care? The nursing diagnosis phase of the nursing process is completed once the outcome has been met. The nursing diagnosis phase of the nursing process occurs when the nurse puts the selected intervention into action. The nursing diagnosis phase of the nursing process operates at all phases of problem-solving and is the foundation for decision-making. The nursing diagnosis phase of the nursing process helps the nurse make a clinical judgment about the patient's response to an actual or potential health problem.

The nursing diagnosis phase of the nursing process helps the nurse make a clinical judgment about the patient's response to an actual or potential health problem. Rationale: Nursing diagnoses help the nurse make a clinical judgment about the patient's response to an actual or potential health problem. Evaluation, rather than nursing diagnosis, is the phase of the nursing process that is complete once the outcome has been met. Implementation, rather than nursing diagnosis, is the phase of the nursing process in which the nurse puts the selected intervention into action. Assessment, rather than nursing diagnosis, is the phase of the nursing process that operates at all phases of problem-solving and is the foundation for decision-making.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which instruction should be included? Flossing is not recommended at this age. Toddlers are old enough to brush their teeth effectively. The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. The toddler's toothbrush should be small and have hard, rounded, nylon bristles.

The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. Some toddlers do not like the flavor of toothpaste, so water can be used for teeth brushing at this age. Flossing should be done after brushing to establish it as part of dental care for the toddler. Two-year-olds cannot effectively brush their own teeth; parental assistance is necessary. Soft multitufted bristled toothbrushes are recommended to avoid damaging a toddler's teeth or gums.

A nurse understands that moral values are important in any decision making. What does the moral value autonomy refer to? The obligation to prevent or minimize harm The patient's right to be self-governing The concept of fairness The obligation to promote the patient's well-being

The patient's right to be self-governing. Rationale: Autonomy refers to the patient's right to be self-governing and make decisions about his or her own healthcare. The obligation to prevent or minimize harm is called nonmaleficence. The concept of fairness is called justice. The obligation to promote the patient's well-being is called beneficence.

emotional support of family (parents have many questions so provide silence; do not try and answer about cause of death; allow them to express feelings/angers; provide support to other children)

The primary nursing responsibility in care associated with SIDS and other conditions of unknown etiology is ________.

Which is descriptive of the nutritional requirements of preschool children? The quality of the food consumed is more important than the quantity. Nutritional requirements for preschoolers are different from requirements for toddlers. The requirement for calories per unit of body weight increases slightly during the preschool period. The average daily intake of preschoolers should be about 3000 calories.

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; the amount of food is less important than the quality of the food. Requirements are similar for both toddlers and preschoolers. The caloric requirement decreases slightly for preschoolers. The average intake is about 1800 calories each day for preschoolers.

Children want and need limits. Unrestricted freedom is a threat to their security and safety. By testing the limits imposed on them, children learn the extent to which they can manipulate their environment and gain reassurance from knowing that others are there to protect them from potential harm.

The reasons for misbehavior may include attention, power, defiance, and a display of inadequacy. Children may also misbehave because the rules are not clear or consistently applied. Acting-out behavior, such as temper tantrums, may represent uncontrolled frustration, anger, depression, or pain. The best approach is to structure interactions with children to prevent or minimize unacceptable behavior.

A family theory makes assumptions about a family and has inherent strengths and limitations.

The resiliency model of family stress, adjustment, and adaptation emphasizes that the stressful situation is not necessarily pathologic or detrimental to the family but demonstrates that the family needs to make fundamental structural or systemic changes to adapt to the situation.

Positive and negative reinforcement is the basis of behavior modification theory. Behavior that is rewarded will be repeated and behavior that is ignored will be extinguished or minimized.

The strategy of consequences involves allowing children to experience the results of their misbehavior. It includes three types: Natural, those that occur without any intervention; Logical, those that are directly related to the rule; and Unrelated, those that are imposed deliberately.

An extended family or household includes at least one parent, one or more children, and one or more members other than a parent or sibling. Parent-child and sibling relationships may be biologic, step, adoptive, or foster.

The term binuclear family refers to parents continuing the parenting role while terminating the spousal unit.

The parents of a toddler want to know when they can start toilet training their child. Which behavior of the toddler may indicate a readiness for toilet training? Select all that apply.

The toddler is able to recognize the urge to defecate or urinate. The toddler is able to verbally communicate when wet or soiled. The toddler is able to remove the clothes without any help. The toddler expresses willingness to please the parents. PG 360

Which statement is most characteristic of the motor skills of a 24-month-old child? The toddler walks alone but falls easily. The toddler's activities begin to produce purposeful results. The toddler is able to grasp small objects but cannot release them at will. The toddler's motor skills are fully developed but occur in isolation from the environment.

The toddler's activities begin to produce purposeful results. Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new toy. By 2 years of age, children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is a task of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

Which of the following is the appropriate site to administer an intramuscular (IM) vaccine to a newborn?

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

Tradition, rather than rational planning, furnishes the chief norms for childrearing. Experience in having been nurtured as a child is an essential component of successful parenting.

Their own parents are probably the only persons whom parents observe intimately in the parental role. This results in a generational continuity - parents rear their own children in much the same way that they themselves were reared.

theophylline, caffeine

Therapeutic managements of apnea of infancy includes usage of what (2) drugs?

Which statement by a student nurse indicates that additional instruction is needed regarding topical agents being used to treat burns? They eliminate bacterial growth but do not remove the bacteria from the skin They are not considered to be toxic substances They are associated with electrolyte derangement of surronding tissues They are able to penetrate through eschar levels to reach the wound

They are associated with electrolyte derangement of surrounding tissues Topical agents used in the treatment of burns should provide minimal electrolyte derangement. The other options stated are all consistent with the expceted actions of topical agents uised in the treatment of burns.

Which statement characterizes toddlers' eating behavior? They have increased appetites. They have few food preferences. Their table manners are predictable. They become fussy eaters.

They become fussy eaters. Toddlers have physiologic anorexia, which contributes to picky, fussy eating. This usually begins at about 18 months of age. They have a decrease in appetite known as physiologic anorexia at this age. They have strong taste preferences at this age. Use of finger foods contributes to the unpredictable table manners of toddlers.

Which statement is correct about young children who report sexual abuse by one of their parents? They may exhibit various behavioral manifestations. In most cases, the child has fabricated the story. Their stories are not believed unless other evidence is apparent. They should be able to retell the story the same way to another person.

They may exhibit various behavioral manifestations. There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.

Which food activities would be considered to be normal adaptations for toddlers? Select all that apply. They often pick up many types of foods, preferring snacking rather than eating just at mealtimes. Appetite and food choices exhibit a consistent pattern. Toddlers often exhibit "picky" eating behaviors which is considered to be a normal abnormal. Children tend to eat more when they are growing. Foods should not be given to children during playtime.

They often pick up many types of foods, preferring snacking rather than eating just at mealtimes. Toddlers often exhibit "picky" eating behaviors which is considered to be a normal abnormal. Foods should not be given to children during playtime. Toddlers exhibit grazing or nibbling behaviors and sometimes prefer to snack throughout the day. Toddlers often exhibit "picky" preferential behaviors in their food choices. Foods should not be given to children during playtime as a safety measure to prevent possible choking or aspiration. Appetite and food choices are inconsistent during this time frame. Toddlers will eat more during growth spurt periods.

An infant who is treated with iron supplements has developed constipation. The parents ask the nurse if they can use the low-iron containing formula to help the child. What should the nurse tell them?

They should not switch to low-iron containing formula or whole milk.

Whats happens to the kid if going to the bathroom hurts them too much?

They will get scared and thus hold in their stool creating more impaction

Which infant is at risk for vitamin D-deficiency rickets?

Those in whom yogurt is used as a primary source of milk

Which toddler behavior indicates negativism?

Throwing a temper tantrum when unable to open the door PG 355

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. On what knowledge should the nurse's reply be based?

Thumb-sucking should be discouraged when permanent teeth begin to erupt.

A nurse instructs the mother of a 7-month-old infant to refrain from using a pacifier. What is the rationale for this teaching?

To prevent otitis media

The nurse instructs a mother to not give honey to the baby until the child is 1 year old. Why does a nurse discourage the use of honey until a baby attains 12 months of age?

To reduce the risk of botulism in the child

The nurse is assessing gross motor skills in a 24-month-old child. Which action does the nurse ask the toddler to perform?

To walk up and down the stairs PG 361

A nurse explains to a young patient's parent that, in children, the frequency of certain diseases decreases with age. Which condition should the nurse state as an example to prove her point? Headaches Acne Type 1 diabetes mellitus Tonsillitis

Tonsillitis Rationale: The types of illnesses that children contract are dependent on age. The incidence of upper respiratory tract infections like tonsillitis decreases with age. Headaches and acne increase in frequency with age. Type 1 or juvenile diabetes is not associated with a specific age.

What can ulcerative colitis lead to?

Toxic megacolon: most dangerous form of UC, where the colon is too big and has way too much stuff in it

What is tracheoesophageal fistula?

Trachea and esophagus do not separate

Family Composition

Traditional nuclear family = married couple & biological children. Nuclear family = 2 parents & their children (biologic, adoptive, step, foster) Single-parent family Blended family = at least one stepparent, step-sibling, or half-sibling Extended family = at least one parent, one or more children, and other individuals (Might not be related) gay/lesbian family Foster family Binuclear family = parents who have terminated spousal roles but continue their parenting roles Communal family = Individuals who share common ownership of property & goods, & exchange services w/o monetary consideration

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? Changing self-esteem is difficult after about age 5 years. Self-esteem is the objective judgment of one's worthiness. Transitory periods of lowered self-esteem are expected developmentally. High self-esteem develops when parents show adequate love for the child.

Transitory periods of lowered self-esteem are expected developmentally. Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.

Managing poisoning or ingestion of injurious agent?

Treat child first NOT the poison -Vitals, neuro status, resp, cardiac

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

Trust

colic carry

Usage of _______ seems to calm down colic children.

For a toddler with sleep problems, what should the nurse suggest that the parents do?

Use a transitional object at bedtime. PG 368

When is the rotavirus vaccine usually given?

Vaccine given at 2 months in a 2-3 dose series

An immunocompromised child has been exposed to chickenpox. What should the nurse anticipate to be prescribed to the exposed child?

Varicella-zoster immune globulin. (The use of varicella-zoster immune globulin or immune globulin intravenous (IGIV) is recommended for children who are immunocompromised, who have no previous history of varicella, and who are likely to contract the disease and have complications as a result. The antiviral agent acyclovir (Zovirax) or valacyclovir may be used to treat varicella infections in susceptible immunocompromised persons. It is effective in decreasing the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. Symmetrel is an antiviral used to treat influenza)

The nurse is preparing an airborne infection isolation room for a patient. Which communicable disease does the patient likely have?

Varicella. (An airborne infection isolation room is the isolation for persons with a suspected or confirmed airborne infectious disease transmitted by the airborne route such as measles, varicella, or tuberculosis. Pertussis, influenza, and scarlet fever require droplet transmission precautions.)

Which is described as an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid?

Vesicle. (A vesicle is elevated, circumscribed, superficial, smaller than 1 cm in diameter, and filled with serous fluid. A cyst is elevated, circumscribed, palpable, encapsulated, and filled with liquid or semisolid material. A papule is elevated; palpable; firm; circumscribed; smaller than 1 cm in diameter; and brown, red, pink, tan, or bluish red. A pustule is elevated, superficial, and similar to a vesicle but filled with purulent fluid. )

Which vitamin supplementation has been found to reduce both morbidity and mortality in measles?

Vitamin A (Evidence suggests that vitamin A supplementation reduces both morbidity and mortality in measles.)

What vitamin is also lost when calcium is lost with Lactose intolerance?

Vitamin D

What should the nurse expect a 24-month-old toddler to be able to do?

Walk alone by using a wide stance for extra balance

What gross motor developmental milestone should the nurse expect to see achieved by children who are 12 to 13 months of age?

Walking alone, using a wide stance PG 355

A parent calls the health clinic stating that her child was just exposed to poison ivy and asks what she should do to prevent further complications? Have the parent contact the Health Department so they will be aware of a possible outbreak of this event. Quarnetine the child until the rash disappears as the child is considered to be contagious. Wash the exposed area of contact with cold water to neutralize effects of oil exposure. Suggest to the parent that a tetanus booster is necessary to prevent further complications from this puncture exposure.

Wash the exposed area of contact with cold water to neutralize effects of oil exposure. Best practice if this is a recent exposure is to wash the affected area with cold running water to minimize the effects by neutralizing the oil and possible bonding to skin areas. The Health Deparment does not have to be contacted as this is not considredd to be a public health issues. The child does not have to be quarentined as posion ivy can only be spread by direct contact of oils assocaited with the plant. Tetanus booster is not required as this is associated with contact and not puncture.

How to diagnose failure to thrive?

Weight and height measurement pattern, 24 hour dietary intake record, history of food consumed over 3-5 days, diet restrictions enforced, reorganize mealtime behaviors

The nurse is assessing the health records of a year old infant. The recordings of the infant's weight at birth and at 7 months of age were 3250 g and 5000 g respectively. The infant's current weight is 9800 g. The infant was 67 cm tall at 6 months of age. What should the nurse tell the mother regarding the gain of weight and height? Select all that apply.

Weight gain from birth to 6 months is poor in the infant. Weight gain from 6 months to 12 months is good in the infant.

co-sleeping, supine

What (2) factors most contribute to SIDS?

Indian and African males

What (2) groups are most at risk for SIDS?

sedative, antispasmodic, antihistamine, antiflatulent

What (4) drug categories are commonly prescribed for colic?

changing diaper ASAP, air dry, superabsorbent disposable paper diapers

What are (3) common methods for treating diaper dermatitis?

soy, amino acid based, boiled

What are (3) types of formulas/milk that are cited as therapeutic management of cow's milk allergy?

hypoglycemia, hypothermia

What are 2 primary conditions that we try to prevent during the acute phase of protein malnutrition treatment?

convex surfaces, in folds

What are the (2) most common places where diaper dermatitis is seen?

firm mattress, fitted sheet

What are the (2) most important factors in bedding that can reduce likelihood of SIDS?

rehydration, treatment of diarrhea

What are the (2) primary focuses of the acute phase of protein malnutrition treatment?

reverse cause of growth failure, nutritional support

What are the (2) therapeutic managements of failure to thrive?

maintains pH, reduces wetness, provides buffer to prevent mixing of urine & feces

What are the (3) benefits to using superabsorbent disposable paper diapers?

cow's milk allergy, intussusception, GI issue

What are the (3) common organic causes of colic?

inadequate caloric intake (similar to marasmus), inadequate absorption (pyloric stenosis, GI disturbance, small or large intestine/resection), excessive expenditure (congenital heart disease, hyperthyroidism, consistent fever, or infection)

What are the (3) pathophysiological categories used to classify failure to thrive/growth failure?

apnea, cyanosis or pallor, muscle tone change, choking/coughing/gagging

What are the (4) key characteristics of an infant experiencing ALTE?

acute --> rehabilitation --> follow-up

What are the phases, in order, of how we treat protein malnutrition?

growth chart

What is one of the easiest ways to confirm diagnosis of failure to thrive?

small circular satellite pustules with perineal and maculopapular rash across inguinal folds

What is the criteria for detecting C. albicans?

iron deficiency anemia

What is the most common mineral imbalance in infants especially if they are exclusively breastfed?

weight gain

What is the primary focus of the rehabilitation phase of protein malnutrition treatment?

brainstem abnormality affecting arousal

What is the theoretical cause of SIDS?

failure to thrive

What nursing diagnosis corresponds to inadequate growth from inability to obtain or use calories required for growth?

vegetarian

What type of diet can cause mineral imbalances?

routine

When feeding children with FTT, it is important to develop a ______.

slowly

When feeding children with FTT, it is important to introduce new foods _______.

calm, even

When feeding children with FTT, it is important to maintain a ______, ______ temperament.

quiet, unstimulating

When feeding children with FTT, it is important to provide a ______, ______ environment.

directions

When feeding children with FTT, talk to the child by giving ______ about eating.

child is awake and someone is watching them

When is appropriate "tummy time"?

corn starch

Which is better: corn starch or talcum powder?

acute; 2-10 days

Which phase in treating protein malnutrition focuses on rehydrating the child, treating the diarrhea and intestinal parasites, as well as prevention of hypoglycemia and hypothermia? How long does it typically last?

Can those who are vomiting eat or drink?

Yes, when they are ready, **NO spicy foods

avulsed tooth & management

a tooth that has been knocked out replant and stabilize as soon as possible so that blood supply may be reestablished; If replanted w/in 15 min, has 98% survival rate.

20. The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary output

a. Abdominal swelling ANS: A The initial assessment finding with a Wilms (kidney) tumor is abdominal swelling. Weight loss, not weight gain, may be a finding. Hypertension occasionally occurs with a Wilms tumor. Urinary output is not increased, but hematuria may be noted. PTS: 1 DIF: Cognitive Level: Understand REF: 917 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

2. A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

a. Apples d. Carrot sticks e. Strawberries ANS: A, D, E Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted. PTS: 1 DIF: Cognitive Level: Apply REF: 916 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

1. The nurse is conducting a staff in-service on renal ultrasounds. Which statement describes this diagnostic test? a. Computed tomography uses external radiation to visualize the renal system. b. Visualization of the renal system is accomplished without exposure to radiation or radioactive isotopes. c. Contrast medium and x-rays allow for visualization of the renal system. d. External radiation for x-ray films is used to visualize the renal system, before, during, and after voiding.

a. Computed tomography uses external radiation to visualize the renal system.

9. Which is instituted for the therapeutic management of minimal change nephrotic syndrome? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis

a. Corticosteroids ANS: A Corticosteroids are the first line of therapy for minimal change nephrotic syndrome. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated. PTS: 1 DIF: Cognitive Level: Apply REF: 914 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

38. The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What nursing care should be included? a. Elevate the head but give nothing by mouth. b. Elevate the head for feedings. c. Feed glucose water only. d. Avoid suctioning unless infant is cyanotic.

a. Elevate the head but give nothing by mouth.

3. The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect? a. Fever with a positive blood culture b. Proteinuria and edema c. Oliguria and hypertension d. Anemia and thrombocytopenia

a. Fever with a positive blood culture ANS: A Symptoms of urosepsis include a febrile UTI coexisting with systemic signs of bacterial illness; blood culture reveals presence of urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome (MCNS). Oliguria and hypertension are symptoms of acute glomerulonephritis (AGN). Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome (HUS). PTS: 1 DIF: Cognitive Level: Analyze REF: 846 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

11. The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

a. Infection ANS: A Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with minimal change nephrotic syndrome. The child will most likely have neurologic signs and symptoms.

45. The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate? a. Notify practitioner b. Measure abdominal girth c. Auscultate for bowel sounds d. Take vital signs, including blood pressure

a. Notify practitioner ANS: A Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic-therapeutic care plan. The first action would be to report the normal stool to the practitioner. DIF: Cognitive Level: Apply REF: p. 728 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

22. The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

a. Oliguria and hypertension ANS: A The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical manifestation. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure. PTS: 1 DIF: Cognitive Level: Understand REF: 919 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

12. A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this? a. Prevent infection. b. Stimulate appetite. c. Detect evidence of edema. d. Ensure compliance with prophylactic antibiotic therapy.

a. Prevent infection. ANS: A High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis. pg 860

15. Which is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. Raisins b. Pancakes c. Muffins d. Ripe bananas

a. Raisins ANS: A Raisins are a high-fiber food. Pancakes and muffins do not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber. DIF: Cognitive Level: Apply REF: p. 703 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

46. Which is an important nursing consideration in the care of a child with celiac disease? a. Refer to a nutritionist for detailed dietary instructions and education. b. Help child and family understand that diet restrictions are usually only temporary. c. Teach proper hand washing and standard precautions to prevent disease transmission. d. Suggest ways to cope more effectively with stress to minimize symptoms.

a. Refer to a nutritionist for detailed dietary instructions and education. ANS: A The main consideration is helping the child adhere to dietary management. Considerable time is spent explaining to the child and parents about the disease process, the specific role of gluten in aggravating the condition, and foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related. DIF: Cognitive Level: Apply REF: p. 732 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

1. The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

a. Vomiting c. Failure to gain weight f. Persistent diaper rash ANS: A, C, F Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a UTI. PTS: 1 DIF: Cognitive Level: Understand REF: 909 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

5. Which should the nurse recommend to prevent urinary tract infections in young girls? a. Wear cotton underpants. b. Limit bathing as much as possible. c. Increase fluids; decrease salt intake. d. Cleanse perineum with water after voiding.

a. Wear cotton underpants. ANS: A Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids/decreasing salt intake, or cleansing the perineum with water after voiding decrease urinary tract infections in young girls. PTS: 1 DIF: Cognitive Level: Apply REF: 910 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

24. When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as: a. uremia. b. oliguria. c. proteinuria. d. pyelonephritis.

a. uremia. ANS: A Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urinary output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis. PTS: 1 DIF: Cognitive Level: Remember REF: 921 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

a state where immune bodies are actively formed against specific antigens either naturally (acquiring disease) or artificially (by introducing antigen to individual)

active immunity

the etiology and course of the infections are influened by

age of the child season living conditions preexisting medical problems

these precautions are used to isolate people with a known airborne (<5mm) infectious disease such as measles, vericella or tuberculosis

airborne precautions

conditions that weaken defenses of the respiratory tract

allergies preterm birth bronchopulmonary dysplasia asthma history of RSV cardiac anomalies

Diphtheria

an upper respiratory tract illness caused by a bacteria. It is characterized by sore throat, low fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity

Systematic clinical findings associated with bedbugs manifest as folliculitis. anaphylaxis. rash. wheal.

anaphylaxis. Anaphylaxis is an example of a systemic reaction. Folliculitis is an example of a secondary reaction whereas rash and wheal represent cutaneous symptoms.

A nurse is providing teaching about the dental care and teething to the parent of a 9-month-old infant. Which of the following statements by the parent indicates an understanding of the teaching? a. "I can give my baby a warm teething ring to relieve discomfort" b. "I should clean my baby's teeth with a cool, wet wash cloth" c. "I can give Advil for up to 5 days while my baby is teething." d. "I should place diluted juice in the bottle my baby drinks while falling asleep".

answer: B Ibuprofen (Advil) should not be used for more than 3 days. To prevent childhood caries, infants should not be given bottles while falling asleep.

A nurse is conducting a well baby visit with a 4 mo old infant. Which of the following immunizations should the nurse plan to administer to the infant? (Select all that apply). a. measles, mumps, rubella (MMR) b. Polio (IPV) c. Pneumococcal vaccine (PCV) d. Varicella e. rotavirus vaccine (RV)

answer: B, C, E MMR: 12-15 months varicella: minimum of 12 months

A nurse is performing a developmental screening on an 18 month old. Which of the following skills should the toddler be able to perform? (Select all that apply) A. Build a tower with 6 blocks B. Throw a ball overhand C. Walk up and down stairs D. Draw circles E. Use a spoon without rotation

answer: B, E Tower w/ 6 blocks = 2 year Walk up & down stairs = 2 yr Draw circles = 2.5 yr

A nurse is assessing a 2.5 year old toddler at a well-child visit. Which of the following findings should the nurse report to the provider? A. Height increase by 7.5 cm (3 in) in the past year B. Head circumference exceeds chest circumference C. Anterior & posterior fontanels are closed D. Current weight equals 4x the birth weight

answer: C The head and chest circumference should be equal by 1-2 years of age, with the chest circumference continuing to increase in size until it exceeds the head circumference. Therefore, the nurse should report this finding to the provider. Height should increase 7.5 cm (3 in) each year. Posterior fontanel closes by 6-8 months. Anterior fontanel closes by 12-18 months. Weight should be 4x birth weight.

a protein that is formed in response to exposure to an antigen

antibody

a variety of foreign substances that stimulate the formation of an antibody

antigen

how much output should a patient greater than 30kg produce per hour?

at least 30ml per hour

when do mycoplasmal infections occur?

autumn and early winter

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurse's rationale for this action is described primarily in which statement? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease the child's respiratory efforts. c. Separation from the mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

b

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

b

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

b, c, e

34. The nurse is conducting teaching for an adolescent being discharged to home after a renal transplant. The adolescent needs further teaching if which statement is made? a. "I will report any fever to my primary health care provider." b. "I am glad I only have to take the immunosuppressant medication for two weeks." c. "I will observe my incision for any redness or swelling." d. "I won't miss doing kidney dialysis every week."

b. "I am glad I only have to take the immunosuppressant medication for two weeks." ANS: B The immunosuppressant medications are taken indefinitely after a renal transplant, so they should not be discontinued after two weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplant. PTS: 1 DIF: Cognitive Level: Apply REF: 925 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potentia

27. One of the clinical manifestations of chronic renal failure is uremic frost. Which best describes this term? a. Deposits of urea crystals in urine b. Deposits of urea crystals on skin c. Overexcretion of blood urea nitrogen d. Inability of body to tolerate cold temperatures

b. Deposits of urea crystals on skin ANS: B Uremic frost is the deposition of urea crystals on the skin. The urea crystals are present on the skin, not in the urine. The kidneys are unable to excrete blood urea nitrogen, leading to elevated levels. There is no relation between cold temperatures and uremic frost. PTS: 1 DIF: Cognitive Level: Understand REF: 922 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

40. What is the best description of pyloric stenosis? a. Dilation of the pylorus b. Hypertrophy of the pyloric muscle c. Hypotonicity of the pyloric muscle d. Reduction of tone in the pyloric muscle

b. Hypertrophy of the pyloric muscle ANS: B Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of the pylorus, hypotonicity of the pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis. DIF: Cognitive Level: Understand REF: p. 728 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

32. Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is the preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

b. It is the preferred means of renal replacement therapy in children. ANS: B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. Renal transplantation can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis. PTS: 1 DIF: Cognitive Level: Understand REF: 925 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

17. Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. What enema solution should be used? a. Tap water b. Normal saline c. Oil retention d. Phosphate preparation

b. Normal saline 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. Phosphate enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the phosphate enema can result in diarrhea, which can lead to metabolic acidosis. DIF: Cognitive Level: Apply REF: p. 703 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

14. Which best describes acute glomerulonephritis? a. Occurs after a urinary tract infection b. Occurs after a streptococcal infection c. Associated with renal vascular disorders d. Associated with structural anomalies of genitourinary tract

b. Occurs after a streptococcal infection ANS: B Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies. PTS: 1 DIF: Cognitive Level: Understand REF: 860 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

7. 7. The nurse is conducting a staff in-service on newborn defects of the genitourinary system. Which describes the narrowing of the preputial opening of the foreskin? a. Chordee b. Phimosis c. Epispadias d. Hypospadias

b. Phimosis ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. PTS: 1 DIF: Cognitive Level: Remember REF: 912 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

8. Which is an objective of care for a 10-year-old child with minimal change nephrotic syndrome? a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.

b. Reduce excretion of urinary protein. ANS: B The objectives of therapy for the child with minimal change nephrotic syndrome include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimization of complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Excretion of urinary protein and fluid retention are part of the disease process and must be reversed. PTS: 1 DIF: Cognitive Level: Apply REF: 858 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

13. Which is included in the diet of a child with minimal change nephrotic syndrome? a. High protein b. Salt restriction c. Low fat d. High carbohydrate

b. Salt restriction ANS: B Salt is usually restricted (but not eliminated) during the edema phase. The child has little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals. PTS: 1 DIF: Cognitive Level: Understand REF: 914 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

4. The nurse is teaching parents about prevention of urinary tract infections in children. Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

b. Short urethra in young girls ANS: B The short urethra in females provides a ready pathway for invasion of organisms. Increased fluid intake and frequent emptying of the bladder offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria. PTS: 1 DIF: Cognitive Level: Understand REF: 908 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

36. A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer? a. Spironolactone (Aldactone) b. Sodium polystyrene sulfonate (Kayexalate) c. Lactulose (Cephulac) d. Calcium carbonate (Calcitab)

b. Sodium polystyrene sulfonate (Kayexalate) ANS: B Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels. PTS: 1 DIF: Cognitive Level: Apply REF: 920 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

20. A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

b. Thicken formula with rice cereal. ANS: B Small, frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula have been recommended. Milk-thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GER disease. Placing the child in a Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. DIF: Cognitive Level: Apply REF: p. 726 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

15. A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a. bacteriuria, hematuria. b. hematuria, proteinuria. c. bacteriuria, increased specific gravity. d. proteinuria, decreased specific gravity.

b. hematuria, proteinuria ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase. PTS: 1 DIF: Cognitive Level: Understand REF: 860 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation.

dental changes in middle years

begin with the shedding of the first deciduous teeth ends at puberty with the acquisition of the final permanent teeth (except wisdom teeth)

The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues to cover in the sessions include bicycle helmets need to be worn only if the child is planning to ride in traffic. reflectors should be installed only on bicycles that are to be ridden at night. bicycles should be ridden against the traffic so that the rider can see the cars. bicycles should be walked through busy intersections.

bicycles should be walked through busy intersections. Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries. Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.

when is the hep B vaccine normally given?

birth

If the mother of a child is hepatitis B surface antigen (HBsAg) negative, the nurse knows that the child should receive his or her first dose of the hepatitis B virus (HBV) vaccine at

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

it is recommended that children should start their vaccination requirements at what age?

birth or within 2 weeks of birth

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

bowel control is accomplished before bladder control, so the parent should focus on bowel training first. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. There is no universal right age to begin toilet training or an absolute deadline to complete training. One of the nurse's most important responsibilities is to help parents identify the readiness signs in their child.

general age of onset of puberty for boys and girls

boys: 12 years girls: 10 years

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 should be based on knowledge that bullying at this age is considered normal. children who bully others usually join gangs. bullying is a short-term problem that is generally outgrown by the end of the school-age years. bullying often manifests itself in children who are different or have poor academic or social skills.

bullying often manifests itself in children who are different or have poor academic or social skills. Poor relationships with peers and a lack of group identification, such as looking different or having poor academic or social skills, contribute to bullying behavior. Bullying is a maladaptive response to poor relationships with peers and lack of group identification; therefore, it is not considered normal behavior. Children who chronically bully tend to be impulsive, easily frustrated, and at increased risk for dropping out of school, but there is no direct correlation between bullies and joining gangs. Children who bully may be at risk for long-term psychological disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood.

35. The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching? a. "These injections will help with the hypertension." b. "We're glad the injections only need to be given once a month." c. "The red blood cell count should begin to improve with these injections." d. "Urine output should begin to improve with these injections."

c. "The red blood cell count should begin to improve with these injections." ANS: C Anemia in children with CRF is related to decreased production of erythropoietin. Recombinant human erythropoietin (rHuEPO) is being offered to these children as thrice-weekly or weekly subcutaneous injections and is replacing the need for frequent blood transfusions. The parents understand the teaching if they say that the red blood cell count will begin to improve with these injections. PTS: 1 DIF: Cognitive Level: Apply REF: 916 | 923 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

18. The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. "You will need to decrease the number of calories in your child's diet." b. "Your child's diet will need an increased amount of protein." c. "You will need to avoid adding salt to your child's food." d. "Your child's diet will consist of low-fat, low-carbohydrate foods."

c. "You will need to avoid adding salt to your child's food." ANS: C For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated. PTS: 1 DIF: Cognitive Level: Apply REF: 860 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

2. The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? a. pH b. Osmolality c. Creatinine d. Protein level

c. Creatinine ANS: C The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate. PTS: 1 DIF: Cognitive Level: Understand REF: 904 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

19. Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment b. Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

c. Fluid Volume Excess related to decreased plasma filtration Glomerulonephritis has a decreased filtration of plasma, which results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration. PTS: 1 DIF: Cognitive Level: Analyze REF: 915 TOP: Integrated Process: Nursing Process: Nursing Diagnosis MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

29. Which should the nurse recommend for the diet of a child with chronic renal failure? a. High in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

c. Low in phosphorus ANS: C Dietary phosphorus is controlled by the reduction of protein and milk intake to prevent or control the calcium-phosphorus imbalance. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease. PTS: 1 DIF: Cognitive Level: Apply REF: 922 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

10. Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration? a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

c. Oral rehydration solution (ORS) ANS: C ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens. DIF: Cognitive Level: Apply REF: p. 700 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

41. Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen

c. Palpable olive-like mass ANS: C The diagnosis of pyloric stenosis is often made after the history and physical examination. The olive-like mass is easily palpated when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed. Abdominal rigidity and substernal retraction are usually not present. The upper abdomen, not lower abdomen, is distended. DIF: Cognitive Level: Understand REF: p. 728 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

21. A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of this medication? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production

c. Reduce gastric acid production ANS: C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and perhaps prevent esophagitis. Preventing reflux or hematemesis and increasing gastric acid production are not the modes of action of histamine-receptor antagonists. DIF: Cognitive Level: Understand REF: p. 707 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

42. The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation

c. Visible peristalsis and weight loss pg 728 ANS: C Visible gastric peristaltic waves that move from left to right across the epigastrium and weight loss are observed in pyloric stenosis. Abdominal rigidity and pain on palpation or a rounded abdomen and hypoactive bowel sounds are usually not present. The upper abdomen, not lower abdomen, is distended.

25. Which is a major complication in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

c. Water and sodium retention ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure. PTS: 1 DIF: Cognitive Level: Understand REF: 921 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

18. A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. not necessary because of child's age. b. not necessary because colostomy is temporary. c. necessary because it will be an adjustment. d. necessary because the child must deal with a negative body image.

c. necessary because it will be an adjustment. ANS: C The child's age dictates the type and extent of psychological preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms, with the use of visual aids. It is necessary to prepare a 3-year-old child for procedures. The preschooler is not yet concerned with body image. DIF: Cognitive Level: Understand REF: p. 705 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Psychosocial Integrity: Coping and Adaptation

17. The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a. poor appetite. b. increased potassium intake. c. reduction of edema. d. restriction to bed rest.

c. reduction of edema. ANS: C This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized. PTS: 1 DIF: Cognitive Level: Understand REF: 860 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

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

c. Transforming: allowing the child to come to the conclusion on his or her own

What does family systems theory include? a. direct causality, meaning each change effects the whole family b. Family systems react to change as they take place, not initiate it c. a balance between morphogenesis & morphostasis is necessary d. Theory is used primarily for family dysfunction and pathology

c. a balance between morphogenesis & morphostasis is necessary

Shivering

causes the muscles and muscle fibers to contract, generating metabolic heat, which is distributed throughout the body (Newborns don't shiver. They use brown fat. Brown fat is limited and you need to keep newborn warm with clothes and blanket and hat)

who can use topical vapor rubs?

children older than 2 years.

The primary reason for universal screening of young children for lead poisoning is that children with lead poisoning rarely have symptoms. water and food in the United States are usually contaminated with lead. most children are exposed to lead through herbal products. most children in the United States are exposed to toxic amounts of lead.

children with lead poisoning rarely have symptoms. In the early stages of lead poisoning, children are asymptomatic. Water and food in the United States are not highly contaminated. Risks are homes painted before 1978, when painting products still had high lead levels. Universal screening will identify children who may receive lead via herbal supplements, if applicable. Universal screening will identify children who may receive lead via environmental exposure, if applicable.

The parents of 9-year-old twins tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is characteristic of giftedness. typical "twin" behavior. cognitive development at this age. psychosocial development at this age.

cognitive development at this age. Classification skills are developed during the school-age years. This age-group enjoys sorting objects according to shared characteristics. Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age-group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination. The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins. Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.

when does infectionrelated asthma occur?

cold weather

diaper dermatitis

common in infants due to prolonged and repetitive contact with an irritant such as urine, feces, cloth materials, detergents

___precautions are designed to prevent the spread of diseases by direct or indirect contact. (animate or inanimate object) {conjunctivitis, hepatitis, GI infections, herpes}

contact precautions

A mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. She plays "house" in it with her toddler brother. Based on the nurse's knowledge of growth and development, the nurse recognizes that this is unsafe play that should be discouraged. creative play that should be encouraged. suggestive of limited family resources. suggestive of limited adult supervision.

creative play that should be encouraged. This type of play should be encouraged. After children create something new, they can then transfer it to other situations. There should be some supervision to prevent injury or accidents. As long as the play is supervised, it should be encouraged. This is not considered unsafe play. There is no indication of limited resources. There is no indication of limited adult supervision.

23. The nurse is caring for a child with acute renal failure. Which clinical manifestation should the nurse recognize as a sign of hyperkalemia? a. Dyspnea b. Seizure c. Oliguria d. Cardiac arrhythmia

d. Cardiac arrhythmia ANS: D Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiograph anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia. PTS: 1 DIF: Cognitive Level: Apply REF: 920 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

10. Which is a common side effect of short-term corticosteroid therapy? a. Fever b. Hypertension c. Weight loss d. Increased appetite

d. Increased appetite ANS: D Side effects of short-term corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy. PTS: 1 DIF: Cognitive Level: Understand REF: 860 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

31. Which is an advantage of peritoneal dialysis? a. Treatments are done in hospitals. b. Protein loss is less extensive. c. Dietary limitations are not necessary. d. Parents and older children can perform treatments.

d. Parents and older children can perform treatments. ANS: D Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Treatments can be done at home. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis. PTS: 1 DIF: Cognitive Level: Analyze REF: 923 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

21. Which is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

d. Severe dehydration

16. Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

d. Surgical removal of affected section of bowel ANS: D Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary. DIF: Cognitive Level: Understand REF: p. 703 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

6. The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn? a. Absence of a urethral opening is noted. b. Penis appears shorter than usual for age. c. The urethral opening is along the dorsal surface of the penis. d. The urethral opening is along the ventral surface of the penis.

d. The urethral opening is along the ventral surface of the penis. ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Urethral opening along ventral surface of penis is known as epispadias.

26. Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant "uremic" breath odor

d. Unpleasant "uremic" breath odor ANS: D Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urinary output occurs. Hyperkalemia is a concern in chronic renal failure. PTS: 1 DIF: Cognitive Level: Understand REF: 922 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

33. A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions? a. WBC <1; specific gravity 1.008 b. WBC <2; specific gravity 1.025 c. WBC >2; specific gravity 1.016 d. WBC >2; specific gravity 1.030

d. WBC >2; specific gravity 1.030 ANS: D WBC count in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion. PTS: 1 DIF: Cognitive Level: Analyze REF: 907 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

30. The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to: a. neurologic manifestations that occur with dialysis. b. physiologic manifestations of renal disease. c. adolescents having few coping mechanisms. d. adolescents often resenting the control and enforced dependence imposed by dialysis.

d. adolescents often resenting the control and enforced dependence imposed by dialysis. ANS: D Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors. These are a function of the child's age, not neurologic or physiologic manifestations of the dialysis. Feelings of anger, hostility, and depression are functions of the child's age, not neurologic or physiologic manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management. PTS: 1 DIF: Cognitive Level: Analyze REF: 923 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance

16. A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a. blood pressure will stabilize. b. the child will have more energy. c. urine will be free of protein. d. urinary output will increase.

d. urinary output will increase. ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output. PTS: 1 DIF: Cognitive Level: Apply REF: 860 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

SIDS

death of child <12 months that remains unexplained after complete postmortem examination, including investigation of the death scene and review of case history

During the rehabilitative phase of care, pressure dressings are primarily applied to burned areas to relieve pain. decrease blood supply to scar. limit motion during the healing process. encourage healing through scar formation.

decrease blood supply to scar. Uniform pressure to the scar decreases the blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. The goal of the pressure dressing is to improve the appearance of scars by decreasing the blood supply to the area. Motion is encouraged because it prevents contractures. Movement should take place to the point of pain, but no further. The goal of the pressure dressing is to minimize the development of scar tissue.

pain can be minimized in vaccinations by...

deep IM administration

what can place a child as risk for infection?

deficiencies of the immune system. malnutrition anemia fatique

According to Erikson, major task during middle school years

developing a sense of industry or accomplishment

this disease results in respiratory manifestations; nasopharingitis, upper airway obstruction. the vaccine is often given as a combination, usually in 5 total doses

diptheria

marasmus

disease process resulting from lack of protein AND carbohydrates (more common in developing countries)

kwashiorkor

disease process resulting from lack of protein in diet

_____precautions (>5mm) involves reduction of large particle droplets usually spread by coughing, sneezing or talking. The spread is usually limited to a 3 ft radius. {meningitis, pneumonia, scarlet fever}

droplet precautions

assessing respiratory system

ears nose mouth and throat chest lungs

Nursing interventions to promote health during middle childhood should include stressing the need for increased calorie intake to meet the increased demands on the body. instructing parents to defer questions about sex until the child reaches adolescence. educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. advising parents that the child will need decreasing amounts of rest toward the end of this period.

educating the child and parents about the need for effective 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. Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex education with a life span approach and answer questions appropriate to the child's age. School-age children often need to be reminded to go to sleep.

A 2-year-old child has recently started having temper tantrums where breath holding occurs and occasionally fainting. The most appropriate action by the nurse is to refer the child for a respiratory evaluation. refer the child for a psychological evaluation. explain to the parent that this is not harmful. explain to the parent that the child is spoiled.

explain to the parent that this is not harmful. The rising carbon dioxide levels restart the breathing process when a child holds his or her breath; therefore, the process is self-limiting and not harmful. A respiratory evaluation is not indicated for this toddler. Temper tantrums are part of this developmental stage as the toddler asserts his or her independence. A psychological evaluation is not warranted. Temper tantrums are part of this developmental stage as the toddler asserts independence. There are no data to indicate that the child is spoiled.

The preschooler's body image has developed to include a well-defined body boundary. knowledge about his or her internal anatomy. fear of intrusive procedures. fear of looking different from his or her friends.

fear of intrusive procedures. Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. The fear of looking different is a concept that occurs in later school-aged children and adolescents.

signs and symptoms associated with respiratory tract infections

fever poor feeding and anorexia vomiting diarrhea abdominal pain nasal blockage nasal discharge cough respiratory sounds sore throat meningismus

The two rules used to provide sensitive information to a preschooler focus on describing the information in a succinct way and answering any questions. ask the child if he/she understands what you have told them and then clarify any additional questions. find out what they know and think and then be honest. use the opportunity to provide minimal information and keep the level of interaction simple.

find out what they know and think and then be honest. It is important to find out what they know and think before providing any information and then equally important is to be honest in your communication. The method of providing information may vary based on the type of information being provided and the level of understanding of the child.

When does Hirschsprung Disease occur?

first few months

IgE

food sensitivities are an immunological response consisting to ____-mediated immune response (ex. cow's milk allergy)

The most appropriate comfort intervention for a child with itching related to chickenpox is encourage frequent warm baths. give aspirin or acetaminophen (Tylenol). apply thick coat of pramoxine (Caladryl) lotion over open lesions. give an antipruritic medication such as diphenhydramine (Benadryl). apply thick coat of pramoxine (Caladryl) lotion over open lesions.

give an antipruritic medication such as diphenhydramine (Benadryl). Antipruritic medicines such as diphenhydramine are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Cool baths, not warm ones, are recommended for relief of itching secondary to chickenpox. Neither drug provides antipruritic effects, nor should aspirin ever be given to children with chickenpox, because there is an increased risk of developing Reye syndrome. Caladryl lotion, which contains diphenhydramine, should be applied sparingly, not in thick coats, over open lesions to minimize absorption.

The most important prevention method for the spread of any communicable disease is

hand washing. Hand washing is the single most important prevention method for the spread of any communicable disease. Immunizations are considered to be a form of primary prevention. Use of appropriate broad spectrum antibiotics are not considered effective against all communicable diseases. Isolation from infectious agents may not be a realistic option.

The parents of a 4½-year-old girl are worried because she has an imaginary playmate. Based on the nurse's knowledge of the preschooler, the most appropriate response is a psychosocial evaluation is indicated. an evaluation of possible parent-child conflict is indicated. having imaginary playmates is normal and useful at this age. having imaginary playmates is abnormal after age 2 years.

having imaginary playmates is normal and useful at this age. Imaginary playmates are a part of normal development at this age and serve many purposes, including being a friend in times of loneliness, accomplishing what the preschooler is still attempting, and experiencing what the preschooler wants to forget or remember. Because an imaginary playmate is part of normal development, a psychosocial evaluation is not warranted. Because an imaginary playmate is part of normal development, an evaluation of the parent-child relationship is not warranted. Imaginary playmates are commonly present during the preschool years; therefore, they are not abnormal after the age of 2 years.

at what age are infants presumed to have a lower infection rate because of the protective function of the maternal antibodies

healthy full term infants younger than 3 months old however, they may be susceptible to specific respiratory infections, namely pertussis during this time period.

full-term and pre-term infants who are born to hepB positive moms should be given

hepB vaccine and hepB immune globulin within 12 hours of birth

this vaccine is a conjugate vaccine that protects against a number of diseases such as bacterial meningitis, epiglottis, bac pneumonia. How many doses?

hib usually given in 4 doses

Pertussis

highly communicable, vaccine-preventable disease due to Bordetella pertussis, a bacteria, lasting for many weeks and typically afflicts children with severe coughing, whooping, and posttussive vomiting

reduce body temperature

if temp is high, important to control fever for comfort - nurse should verify that parent knows how to take childs temperature appropriately. make sure parent knows how to administer antipyretic if prescribed - make sure give the correct amount because medication can accumulate in childrens body and have an adverse effect on the child -incourage cool liquids

what is a cardinal sign a child is feeling better?

increase in activity

what are signs of clinical deterioration?

increasing respiratory distress increased respiratory rate increased heart rate worsening hypoxia poor perfusion reduced LOC lethargy

what age grous reacts more severely to acute respiratory infections?

infants and young children 6 months and 3 years old

recommended needle length infants: toddlers: adolescents:

infants: 1" toddlers: 1-1 1/4" adolescents: 1 1/2 -2 "

What is the most common way that hepatitis occurs?

infection

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of identity. intimacy. initiative. industry.

initiative. Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity versus role confusion is associated with adolescence. Intimacy versus isolation is associated with young adulthood. Industry versus inferiority is associated with the school-aged child.

An important nursing intervention in the care of a child with bacterial conjunctivitis is -intermittent warm, moist compresses to remove crusts on the eye area. -oral antihistamines to minimize itching. -continuous warm compresses to relieve discomfort. -application of optic corticosteroids to reduce inflammation.

intermittent warm, moist compresses to remove crusts on the eye area. The eye should be kept clean. Intermittent warm, moist compresses can soften the crusting for easier removal, maintaining the cleanliness of the eye. Antihistamines are not usually necessary for bacterial conjunctivitis. Continuous warm compresses would promote bacterial growth. Antibiotics are the treatment of choice for bacterial infections; optic corticosteroids are not warranted.

Auditory acuity

is at adult levels during infancy

How long is the requirement for diarrhea to be classified as acute?

less that 14 days

what is a characteristic of a child with acute infection?

loss of appetite.

lower respiratory tract

lower trachea bronchi bronchioles alveoli

what are the principles of management of a patient with respiratory failure?

maintain ventilation and maximize oxygen delivery correct hypoxemia and hypercapnia treat underlying cause minimize extrapulmonary organ failure apply specific and nonspecific therapy to control oxygen demands anticipate complications.

A parent is concerned because her 18-month-old daughter who was previously a "good eater" by her accounts is now being very picky during meal times. Meal time patterns of intake vary from one day to the next with eating large amounts then hardly eating at all. Based on this information, the nurse would suspect that the toddler probably has an ear infection so the parent should not be concerned. refer the parent to the pediatrician for a diagnostic work up. tell the mother that this type of behavior is associated with regression. may be exhibiting physiological anorexia which is a common finding during this time period.

may be exhibiting physiological anorexia which is a common finding during this time period. These findings are indicative of physiological anorexia as during this time period, many toddlers demonstrate variation in food intake, strong food preferences and picky eating behaviors. There is no correlation with ear infections causing this type of eating behavior. A diagnostic work up is not warranted and this behavior does not demonstrate regression.

radioallergosorbent test (RAST)

method used to diagnose cow's milk allergy by measuring the IgE antibodies aginast specific antigens (isolates antibodies)

challenge test

method used to diagnose cow's milk allergy by waiting for child to have all S/S subside and then introducing a little bit of the suspected allergen to see what occurs

An important consideration in preventing injuries during middle childhood is that peer pressure is not strong enough to affect risk-taking behavior. most injuries occur in or near school or home. injuries from burns are the highest at this age because of fascination with fire. lack of muscular coordination and control results in an increased incidence of injuries.

most injuries occur in or near school or home. Most children in the middle years spend the majority of their time in and around school or home; therefore, the risk for injuries is increased in and around these areas. Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence. Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, either as a pedestrian or passenger, account for the majority of severe accidents in the middle years. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscular coordination and control leading to injuries occurs in younger children.

The nurse is assessing a child with herpetic gingivostomatitis. The nurse wears gloves when examining the lesions. This nursing action is A. unnecessary because the virus is sexually transmitted. B. unnecessary because the virus is not easily spread. C. necessary only if the nurse touches his or her own mouth after touching the child's mouth. D. necessary because virus can easily enter breaks in the skin.

necessary because virus can easily enter breaks in the skin. HSV easily enters breaks in the skin and can cause herpetic whitlow on the fingers. Herpetic gingivostomatitis is usually caused by herpes simplex virus (HSV) HSV 2 is usually transmitted through sexual activity. Gloves are always necessary because the virus is easily spread.

In reviewing information about a school-age child, the nurse notes that the child goes to after school activities each day as the parents do not get home until considerably later in the day. Based on this description, the nurse would document concern for the growth and development due to lack of parental influence. no further action is needed. referral to a social worker for evaluation of the family unit. notation of being a latchkey child.

no further action is needed. Many children have working parents and do not exhibit any adverse outcomes if they attend after school activities each day following release from school. There is no need for referral to a social worker. A latchkey child by definition is one that has no parental or supervision contact following the school day and are responsible for their own care until the parent comes home.

is breastfeeding contraindicated for vaccination

no. you can safely vaccinate anything while breastfeeding.

refeeding syndrome

occurs when caregiver picks up child and feeds large amounts of carbhoydrates so the body has to process large amounts of glucose which subsequently requires large amounts of phosphates to be used up; possibly fatal situation

how do achieve adequate fluid intake?

offer small amounts of favorite fluids at frequent intervals. -oral rehydration solutions are a good source (pedialyte) for infants. -water or low carb flavored drink for older children. -clear liquids if child is vomiting dont give fluids with caffeine because they can act as a diuretic. -if infants are breast feeding, they should continue to breast feed - do not force fluids. gentle persuasion with preferred beverages or Popsicle is usually successful.

how to promote comfort

older children can manage nasal secretions with little difficulty young infants breathe through ther nose and made need help to clear secretions by using a bulb syringe to remove secretions use of saline nose drops to help clear secretions is another option 2-12 year olds can take a decongestant if they are able to tolerate them every 4 hours.

upper respiratory tract

oronasopharynx pharynx larynx upper part of the trachea

what is the decongestant prescribed to 2-12 year olds?

oxymetazoline 0.05% (children >6) or phenylephrine 0.25%

Enteral feedings are ordered for a young child with burns covering 40% of the total body surface area. The nurse should know that oral feedings are contraindicated. enteral feedings must be stopped during painful procedures. paralytic ileus precludes use of enteral feedings. the feedings will be high in carbohydrate and low in protein.

paralytic ileus precludes use of enteral feedings. Enteral feedings can begin when the paralytic ileus resolves. Oral feedings are not contraindicated. Oral feedings are encouraged. Most children with burns are unable to consume sufficient calories by mouth, but every possible effort is made to encourage oral feeding. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended to compensate for the increased basal metabolic rate that occurs after a burn injury.

temporary immunity obtained by transferring immunoglobulins against an antigen. Can be artificial or natural ( mom to baby via placenta)

passive immunity

preadolescence

period of approximately 2 years that begins at the end of middle childhood and ends at 13th bday.

follow-up; refeeding

phase of protein malnutrition treatment that ensures the child does not go back to state of malnutrition; what syndrome should we be aware of?

rehabilitation; 2-6 weeks

phase of protein malnutrition treatment where the child is refocused on increasing dietary intake, focus on weight gain; how long does it typically last?

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include wearing safety belts snugly over the toddler's abdomen. placing the car seat in the front passenger seat if there is an air bag. using lap and shoulder belts when child is over 3 years of age. placing the car seat in the back seat of the car facing forward.

placing the car seat in the back seat of the car facing forward. Car seats are required for toddlers to prevent injury in case of a motor vehicle accident. The car seat should be placed in the back seat, forward facing. Safety belts can cause injuries if they are placed over a toddler's abdomen. Car seats should be in rear of the car because air bags can injure the toddler. Three-year-olds should be restrained in car seats.

The best approach for effective communication with a preschooler is through speech. play. drawing. actions.

play. Preschoolers' most effective means of communication is through play. Play allows preschoolers to understand, adjust to, and work out life's experiences through their imagination and ability to invent and imitate. Speech is not effective, because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meaning of words and often take statements literally. Drawing is still being developed as a fine motor skill; therefore, it is not the most effective means of communication. Actions are not an appropriate means of communication for a preschooler.

what may be prescribed as a decongestant for a child older than 4 years old?

pseudophedrine

why are infants prone to fluid and electrolyte deficits when they have respiratory illness?

rapid respiratory rate precludes adequate oral fluid intake presence of fever increases the total fluid turnover in infants.

A toddler is exploring the environment but returns to his mother within a few minutes of exploration. This finding would be noted as an example of separation anxiety. separation. rapprochement. individuation.

rapprochement. Rapprochement occurs when the child returns to the mother for reassurance following exploration of the environment. Separation anxiety is when the child experiences anxiety based on separation from the parent or significant figure. Separation refers to the emergence of the child as a separate figure from the mother or parent. Individuation refers to the emergence of the child by expressing their own individual characteristic.

what are the primary objectives if respiratory arrest occurs?

recognize the situation immediately initiate resuscitative measures opening the airway positioning administering supplemental oxygen positive pressure ventilation cardiopulmonary resuscitation

A 4½-year-old boy has been having increasingly frequent angry outbursts in preschool for approximately 8 to 10 weeks. In addition, he is aggressive toward the other children and teachers. His parents ask the nurse for advice. The most appropriate nursing intervention is to explain that this is normal in preschoolers, especially boys. refer the child for counseling. talk to the preschool teacher to obtain validation for the behavior the parent reports. encourage the parent to try more consistent and firm discipline.

refer the child for counseling. This is not expected behavior. The child should be referred to a competent professional to deal with his aggression so that an accurate assessment can be made and a care plan determined. Outward aggression to others is not normal behavior and should be evaluated. The validation will be helpful for the referral, but the referral is the priority action. This may be recommended by the professional once an accurate assessment is made.

During a well-child visit, the father of a 4-year-old child tells the nurse that he is not certain if his child is ready for kindergarten. The child's birthday is close to the cutoff date, and the child has not attended preschool. The most appropriate recommendation by the nurse is to encourage the father to have the child start kindergarten. recommend to the father that he postpone kindergarten and send the child to preschool. refer the child for developmental screening and make a recommendation based on the results. have the father observe a kindergarten class and then decide if his child would enjoy the experience.

refer the child for developmental screening and make a recommendation based on the results. A developmental screening will provide the necessary information to help the family determine readiness. Encouraging the father to have the child start kindergarten does not address the father's concern about readiness and suggests that his concerns are not warranted. Recommending to the father that he postpone kindergarten and send the child to preschool assumes that the child is not ready for kindergarten, but the recommendation is not based on any data or facts. Recommending to the father that he simply place his child in preschool may lead to the child's boredom with school. Having the father observe a kindergarten class and then decide if the child would enjoy the experience will provide information about kindergarten but not about whether his child is ready to begin and thrive there.

apnea of infancy

refers to pathologic apnea in those more than 37 weeks gestation

catch-up growth

refers to when rate of growth is greater than expected rate for that age b/c the child is delayed; calories density feedings have to be increased, dietary supplements, high-calories formulas, vitamin supplements

assessment should include

respiratory rate depth and rhythm heart rate oxygenation hydration status body temp LOC activity level level of comfort

what accounts for the majority of acute illnesses in children?

respiratory tract infections

what are the cardinal signs of respiratory failure?

restlessness tachypnea tachycardia diaphoresis

Signs and symptoms that are associated with stress in a school-age child that require intervention are Select all that apply. child not wanted to go to sleep occasionally at the usual bedtime. reverting to a previous behavioral pattern exhibited several years ago. bedwetting. doesn't want to eat a certain food although the child has ate it before. doesn't want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable.

reverting to a previous behavioral pattern exhibited several years ago. bedwetting. doesn't want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable. Reverting to a previous behavior indicative of regression, evidence of bedwetting and change in socialization pattern as signs and symptoms of stress should be investigated as they are signal areas of concern. Occasional reluctance to go to sleep at the regularly scheduled bedtime may be an isolated event which is self-limiting. Refusal to eat a food even if the child ate the food before is not by itself indicative of a significant stress event.

The school nurse is seeing a child who brought poison ivy to school in a leaf collection. The child says that only hands touched it. The most appropriate nursing action is to apply Burow solution compresses immediately. soak hands in warm water. rinse hands in cold, running water. scrub hands thoroughly with antibacterial soap.

rinse hands in cold, running water. Washing the child's hands in cold running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold running water within 15 minutes of exposure to neutralize the effect. Applying Burrow solution is effective for soothing the skin lesions once the dermatitis has begun. Antibacterial soap is not recommended as it removes protective skin oils, and may allow spread of contact.

this disease is mild for kids but dangerous to developing fetus in pregnant women

rubella

why can organisms move more rapidly in younger children?

shorter respiratory tract which causes more extensive involvement

Kimberly, age 4 years, sometimes wakes her parents up at night, screaming, thrashing, sweating, and apparently frightened. Yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This most likely scenario is nightmares. sleep terrors. seizure activity. sleep apnea.

sleep terrors. In sleep terrors, the child is only partially aroused; therefore, she does not remember her parents' presence. A nightmare is a frightening dream followed by full awakening; therefore, the child would realize that her parents are present. The description of the child's experience does not indicate the presence of seizure activity. Sleep apnea is a cessation of breathing during sleep.

why is a child at increased risk for choking?

smaller airways

Characteristics of physical development of a 30-month-old child are Select all that apply. anterior fontanel is open. birth weight has doubled. genital fondling is noted. sphincter control is achieved. primary dentition is complete.

sphincter control is achieved. primary dentition is complete. Sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age. Primary dentition is usually completed by 30 months of age. Anterior fontanel closes between 12 and 18 months of age. Birth weight should double at 5-6 months of age and quadruple by 2½ years of age. Genital fondling is not a characteristic of physical development of this age group. This is part of the development of gender identity.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. Based on the nurse's knowledge of this age-group, the most appropriate recommendation is organized sports, such as soccer, are not appropriate at this age. competition is detrimental to the establishment of a positive self-image. sports participation is encouraged if the sport is appropriate to the child's abilities. girls should compete only against girls because at this age boys are larger and have more muscle mass.

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. Team sports contribute to the school-age child's social, intellectual, and skill growth. Organized sports for school-age children can provide safe, appropriate activities with supportive parents and coaches. The desire to participate in competitive team sports develops out of a need for peer interaction for the school-age child. A sport should be selected that meets the child's capabilities and interests. The physical changes in boys described take place during puberty, later in the school-age years; therefore, there is no reason for boys and girls to compete separately at age 8 years.

___ precautions synthesize the major features of universal precautions, designed to reduce the risk of BBP.

standard precautions

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to consistently use safety caps. store poisonous substances in a locked cabinet. keep ipecac in the home. store poisonous substances out of reach.

store poisonous substances in a locked cabinet. This is an appropriate action to prevent the curious toddler from getting into poisonous substances and products. Not all poisonous substances have safety caps, and safety caps are not always foolproof. Ipecac does not prevent poisoning and is not recommended as a treatment for poisoning. Toddlers can climb and are curious; therefore, storing substances out of reach only does not eliminate the potential for poisoning.

what type of injection is vericella? usually how many doses?

sub q 2 doses

talcum powder

substance that forms cakes on skin; dangerous if inhaled by infant

food sensitivity

term for the immunological response (allergic rxn) to a substance

apparent life threatening event (ALTE); <37

term for when parents report that a child "nearly died," especially if they were born a _____ weeks gestation

Chest circumference equals head circumference by

the end of the first year

A child is being treated for burns in the emergency room. The parents have provided information relative to the origin of the burn event but the patterns of injury are not consistent with their description. The nurse would suspect that the parents are too upset to provide information at this time, so additional questions can be answered later. the child may have not told the parents the truth about the event. there may be a potential for abuse and as such requires follow up. there is no real concern as the burn injuries are minimal and non life threatenning.

there may be a potential for abuse and as such requires follow up. Anytime burn pattern injuries do not correlate with the provided information of the event, there is a potential for suspecting abuse. As such the nurse should be cognizant of this fact and follow up accordingly. Being upset would be a reasonable parent response but the physical evidence should coincide with the provided description. Suspecting that the child (victim) is not telling the truth would not be a concern unless additional evidence would be presented that would support that conclusion. Even if the burn injuries are not considered to be life-threatenning, health care providers take the issue of suspected abuse very seriously and it must be reported and followed through as part of professional practice guidelines.

A parent is concerned as her 6-year-old child "cheats" when playing games with other children. The parent is concerned that this behavior will affect future behaviors as the child gets older. The nurse understands the parent's anxiety about the described behavior and provides the following assurance this type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose. this is a prompted behavior that occurs intermittently at this age. you are right to be concerned about this type of behavior. it is best to ignore the behavior as it will stop eventually.

this type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose. Cheating as a behavior occurs primarily between the ages of 5 and 6. It is almost at times displayed as an automatic behavior as the child does not understand about winning and losing. The behavior typically goes away as the child matures. Ignoring the behavior without some direction is not advised as it is best to address the situation and help the child to begin understanding of the concept.

the viral infection rate remains high during

toddler and preschool years.

____precautions are designed for patients documented or suspected infection with a highly transmissible pathogen which required additional precautions above standard precautions

transmission-based precautions

For a toddler with sleep problems, the nurse should suggest that the parents use a transitional object at bedtime. vary the bedtime ritual. restrict stimulating activities throughout the day. explain away their fears.

use a transitional object at bedtime. Transitional objects may help ease the toddler's anxiety and facilitate sleep. A consistent set of bedtime rituals will facilitate a toddler's sleep. Toddlers should have stimulating physical activity during the daytime in order for them to sleep at night. Toddlers do not understand verbal explanations, so parents cannot explain away their fears.

An example of indirect bullying would be if telling an individual that you don't like them because you were hurt by their actions. raising one's hand to prevent another person from hitting you. taking a toy away from someone because you want it to see it. using social media to make offensive comments about an individual.

using social media to make offensive comments about an individual. Indirect bullying are actions that are taken that are meant to cause harm to an individual or group. The use of social media to make offensive comments about an individual is not the place for professing feelings. One must take into account that offensive comments by definition are offensive. Telling an individual that you don't like them as a result of their exhibited behavior is an example of direct communication. Taking a toy away from someone because you want to see it may not be the best approach but it does involve direct action.

Which method should the student nurse use to apply the principles of cough etiquette in the clinical setting to prevent the potential spread of infection? Wearing a surgical mask for all patient contacts even if the student nurse has not overt clinical symptoms of having a cold. Maintaining a perimeter of 10 feet from patient and visitors when coughing. Using tissues when coughing to catch secretions. covering the nose when coughing.

using tissues when coughing to catch secretions. Using a tissue when coughing to catch secretions is recommended. One does not have to wear a surgical mask if they do not have any cold type symptoms in the clinical environment unless the patient is neutropenic. Maintaining a space of 3 feet or more is recommended whereas 10 feet would be excessive. Covering one's mouth is recommended when coughing whereas the nose should be covered during sneezing

A finding that is consistent with prepubescence is variation in physical appearance between boys and girls. age of onset of physical signs is the same for both boys and girls. does not occur during the preadolescence period. appearance of secondary sex characteristics is the same for both boys and girls.

variation in physical appearance between boys and girls. During the period of prepubescence there is a variation in physical appearance between boys and girls. The age of onset of these appearances also varies with girls exhibiting changes earlier than their male counterparts. The changes occur during the preadolescence period. Secondary sex characteristics also present at different times for boys and girls.

The school nurse is concerned about an outbreak of chickenpox because two children at the school have cancer and are immunodeficient from chemotherapy. The most appropriate recommendation by the school nurse is that A. no precautions necessary. B. Acyclovir (Zovirax) should be taken to minimize the symptoms of chickenpox. C. Varicella-zoster immune globulin (VZIG) to prevent chickenpox. D. temporarily stopping chemotherapy will allow the immune system to recover.

varicella-zoster immune globulin (VZIG) to prevent chickenpox. VZIG is an antibody to the virus that causes chickenpox. Administration of VZIG can prevent development of the disease in immunocompromised children secondary to chemotherapy. Chickenpox can be a life-threatening event for a child who is immunocompromised and must be addressed. Acyclovir is effective in reducing the number of lesions from chickenpox, but in immunodeficient children the disease itself should be prevented. The administration of VZIG does not place the child at any greater risk; therefore, there is no need to stop chemotherapy.

to avoid rebound nasal congestion

vasoconstrictive nose drops or sprays should not be administered for more than 3 days.

infants <12 mo should receive vaccine in what site?

vastus lateralis

examples of live viruses

vericella and MMR

what are most infections caused by?

viruses particularly RSV- respiratory syncytial virus rhinovirus nonpolio enterovirus adenovirus parainfluenza virus influenza virus human metapneumovirus group A beta-hemolytic streptococci (GABHS) staphylococci

how to ease respiratory efforts

warm or cool mist moisture soothes inflammed membranes and helps with hoarseness or laryngeal involvement steam from a hot shower or humidifier mist tents in hospital

when is RSV season?

winter and early spring

when do the most common respiratory pathogens appear in epidemics?

winter and spring months

diameter of the airway is smaller in

younger children and subject to considerable narrowing from edematous mucous membranes and increased production of secretions.

How old are children usually affected by appendicitis?

~10 years, very common emergency in children