Peds Test 1

The nurse is providing anticipatory guidance to the mother of a 6 month old infant. What is the best instruction by the nurse in relation to the infant's oral health?

"Clean your baby's gums, then new teeth with a washcloth." The infant's mouth should be cleansed with a damp washcloth as should the baby's new teeth. It is important to clean the mouth and the teeth in order to prevent dental caries. Toothpaste is unnecessary in infancy. Rinsing the infant's mouth would present a safety hazard.

The father of a 2 month old girl is expressing concern that his infant may be getting spoiled. The nurse's best response is:

"Consistently meeting the infant's needs helps promote a sense of trust." Infants need to have both their physical needs and their emotional needs met consistently so that they can develop a sense of trust, which is the basis for the later development of self-esteem.

As the school nurse conducting screening for vision in a 6 year old child, you would refer the child to a specialist if the visual acuity in both eyes is:

20/50 Visual acuity of 20/20 is not expected until 7 years of age.

In an effort to control health care costs, what is the best recommendation by the nurse?

"Stress primary prevention, using the health care system for check-ups." Primary prevention continues to be the most cost-effective approach to health care, allowing for health education and early detection of health problems.

During the health interview, the mother of a 4 month old says, "I'm not sure my baby is doing what he should be." What is the nurse's best response?

"Tell me more about your concerns."

The nurse is assessing the vital signs of a child who is being evaluated in an urgent care center. The child is to be seen by the pediatric nurse practitioner (PNP). The mother asks, "Why is my child seeing the PNP and not the doctor?" What is the best response by the nurse?

"The PNP is an experienced RN with advanced education in the diagnosis and treatment of children."

The nurse is teaching a group of students about the possible effects of immigration on the health status of children. Which response by the group would indicate the need for additional teaching?

"The children of immigrants have better access to preventative care." Children of immigrants may have a compromised health status due to a lack of preventive care, immunizations, and dental care. The language barrier can interfere with the child becoming involved in school activities and can also stop families from obtaining health insurance. Separation form support systems and relocation can add to the stress experienced by immigrants.

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse?

"The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods." As the tongue extrusion reflex disappears, the infant is better able to accept the spoon and learn to take solid foods.

The nurse is caring for a 2 year old in the hospital, and the mother expresses concern that the toddler will be scared. Which response by the nurse would be most appropriate?

"We will do our best to minimize the stress that your child experiences." Pediatric nurses practice the concept of atraumatic care, intervening to minimize physical and psychological distress for children and their families by identifying stressors, minimizing separation of the child from the family and providing nursing care that decreases stressful situations and minimizes pain and bodily injury. It is impossible to eliminate all pain and stress for a child. Telling the mother not to worry and recommending that she stay home are inappropriate and isolating the mother from involvement in the child's care.

The nurse is caring for a hospitalized 30 month old who is resistant to care, is angry, and yells "no" all the time. The nurse identifies this toddler's behavior as

Normal for this stage of growth and development. Negativism is characteristic of the stage, no matter what the situation (hospital or home)

Which facility fulfills the characteristics of a medical home?

A primary care pediatric practice A primary care pediatric practice is most likely to fulfill the characteristics of a medical home (see box 9.1)

A sleeping 5 month old girl is being held by the mother when the nurse comes in to do a physical examination. What assessment should be done initially?

Counting the heart rate. To assess heart rate accurately, the infant should be calm and not crying. Assess areas where listening is critical, such as the breath and heart sounds, while the child is asleep. The other assessments can be done even if the infant is fussing.

The school nurse is planning a screening program. What items should be included to address issues related to the "new morbidity?"

Academic difficulties, violence, and other mental health issues. The "new morbidity" for children includes academic difficulties, complex psychiatric disorders, self-harm and harm to others, use of firearms, hostility at school, substance abuse, HIV/AIDS, and adverse media influence.

When giving parents guidance for the adolescent years, the nurse would advise the parents to: (choose all that apply).

Accept the adolescent as a unique individual, listen and try to be open to the adolescent's views, respect the adolescent's privacy, provide unconditional love. Adolescents need to be accepted as unique individuals. Parents should provide unconditional love, respect their privacy, and listen to them. Screening all of their friends and providing strict, inflexible rules would only lead to poor interactions between the parents and the adolescent.

A 4 year old child is having a vision screenign performed. Which screening chart would be best for determining the child's visual acuity?

Allen figures The Allen figures chart is reliable for assessing visual acuity in a preschooler. Although the Snellen chart can be used if the child has a good knowledge of the alphabet, that is not an expectation for a 4-year-old child. The Ishihara and CVTME charts are designed to assess color vision discrimination and not visual acuity ( see table 9.4)

The nurse is preparing a 5 year old boy for surgery on his lower leg. His mother is helping him into the hospital gown and the boy fights removal of his underwear. What is the most appropriate nursing action?

Allow the boy to keep his underwear on. There is no need to remove the underwear, and keeping it on gives the boy a sense of control and privacy.

When providing atraumatic care to a child, which action would be most appropriate?

Allowing parents and children an informed choice about being together. Atraumatic care involves strategies and interventions to minimize distress. Allowing parents and children an informed choice helps to promote family-centered care and minimizes parent and child spearation. Restraints should be used only as a last resort. Keeping the lights on in the child's room throughout the day and night interferes with the child's ability to sleep, leading to physical distress. Topical anesthetics are appropriate for use any time a procedure would be a source of pain or distress.

A 10 year old child on a regular diet refuses to eat the food on her meal tray. She requests chicken nuggets, french fries, and ice cream. What is the best nursing action?

Ask that the child's desired foods be sent up from the kitchen. Within reason, the child on an unrestricted diet should be allowed to choose the foods that she likes. This increases the likelihood that she will get enough nutrition to support the healing process.

A 5 year old child is not gaining weight appropriately. Organic problems have been ruled out. What is the priority action by the nurse?

Assess the child's usual intake pattern at home. The nurse must first assess the child's current intake to determine if there is a deficiency.

When working with children and families, which is a critical strategy for promoting therapeutic communication?

Attentive listening Attentive or active listening conveys interest, allows the nurse to discover information, and establishes trust. Eye contact and reflection of the child's and parents' statements are also critical parts of therapeutic communication.

The successful resolution of developmental tasks for the school-age child, according to Erickson, would be identified by:

Developing a sense of worth and competence. School-age children develop a sense of worth and competence. Toddlers learn from repeating tasks. Preschoolers use fantasy and magical thinking. It is in infancy that the child develops a sense of trust.

A 15 month old girl is having her first health supervision visit at your facility. Her mother has not brought a copy of the child's immunization record but believes she is fully immunized: "She had immunizations 3 months ago at the local health department." which would be the best action by the nurse?

Call the local health department and verify the child's immunization status. Contacting the agency provides several benefits. It allows the nurse's facility to have a copy of the child's immunization record for the permanent records. It also avoids repeating vaccinations unnecessarily.

The nurse providing home care to a 2 year old listens to the child's parents talk about how the child and family are adjusting to the child's current illness. Which of the following roles is the nurse participating in?

Direct nursing care. Direct nursing care includes providing support, which often involves listening to the concerns of children and parents and simply being present during stressful or emotional experiences.

When should the child's first examination by a dentist occur?

By the first birthday The American Academy of Pediatric Dentistry recommends that a dentist examines the infant by the first birthday. At the initial visit, the focus is on anticipatory guidance for oral health care issues and establishment of the dental home. Besides accessing routine oral health care, establishing a dental home by the first birthday provides a resource for emergency dental care if it is needed.

Which would the nurse identify as a protective factor for youth violence?

Commitment to academic performance Protective factors include a strong commitment to school and academic performance, involvement in social activities, and consistent parental presence. Exposure to violence in the home is a risk factor for youth violence.

A 9 month old infant's mother is questioning why cow's milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response?

Cow's milk is iron poor and does not provide the proper balance of nutrients for the infant. Although whole milk contains a sufficient quantity of fat, cow's milk is inappropriate for use in infancy as it does not provide the appropriate balance of nutrients (especially iron) and may overload the infant's renal system with inappropriate amounts of sodium, protein, and minerals. Cow's milk use should be delayed until 1 year of age. Infant formula should always be reconstituted according to the manufacturer's recommendations.

A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location?

Need to be transferred if overnight stay is required. Advantages to outpatient surgery centers include decreased risk for infection, decreased cost, decreased separation from family, and decreased disruption of family functioning. The major disadvantage associated with this site is the inability to accommodate overnight stays if necessary due to complications. The child would usually have to be transferred to a hospital for continued care.

When planning education for a child and parents, what is the first step the nurse should take?

Determine the child's and family's learning needs and styles. Always assess the child's and family's learning needs and preferred style of learning first.

What has the most influence in determining an adolescent from beginning to drink alcohol?

Drinking habits of peers. The teenager's peer group has the greatest influence on his or her behavior. If peers are drinking, the teenager will be at greater risk of drinking.

In developing a weight-loss plan for an adolescent, which would the nurse include? (choose all that apply)

Eat slowly and place the fork down between each bite, have the family exercise together, refer to an adolescent weight-loss program, keep a food and exercise diary. These are steps that promote weight loss in adolescents. Adolescents want to be involved in the process, so having parents make all of the meal plans would not promote acceptance by the adolescent.

What is the best advice about nutrition for the toddler?

Encourage cup drinking and give water between meals and snacks. The toddler should wean the cup by age 12 to 15 months. Limit real fruit juice to 4 to 6 ounces per day and milk to 16 to 24 ounces per day, and give it with meals and snacks. Offer water between meals and snacks.

The mother of a 4 year old asks for advice on using time-out for discipline with her child. What advie shoudl the nurse give the mother?

Place the child in time-out for 4 minutes. The generally accepted guidelines recommend keeping the child in time-out for 1 minute per year of age.

What approach by the nurse would most likely encourage a child to cooperate with an assessment of physical and developmental health?

Explain what is going to happen in words the child can understand. Explain briefly what is going to happen.

The nurse is caring for a hospitalized 4 year old who insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler's behavior as:

Normal for this stage of growth and development. Imaginary friends help the preschooler cope with stress in his or her life.

The mother of a 3 year old is concerned about her child's speech. She describes her preschooler as hesitating at the beginning of sentences and repeatin consonant sounds. What is the nurses's best response?

Hesitancy and dysfluency are normal during this period of development. Preschoolers often have a period of dysfluency and hesitancy in their language development, but it usually resolves by about age 4 years.

Which statement indicates the best sequence for the nurse to conduct an assessment in a non emergency situation?

Introduce yourself, ask about any problems, take a history, and do the physical examination. The nurse will have the information to do a better physical examination if he or she first determines any significant history or problems.

To gain cooperation from a toddler, what is the best approach by the nurse?

Kneel in front of the toddler while he or she is on the mother's lap. Being at the toddler's level and allowing the toddler to stay with his mother allows him to feel more secure. If the toddler perceives the nurse to be non-threatening, the nurse is more likely to gain cooperation. Toddlers ordinarily answer "no," so asking the toddler's permission is not helpful. Simply jumping in and starting the task without allowing the toddler to warm up will threaten the child.

A 6 month old infant requires restraint to prevent removal of his nasogastric tube. What is the priority nursing intervention?

Leave the baby unrestrained when directly observed. Infants should be restrained only when necessary. Remove the restraints and provide direct observation as often as possible. Provide appropriate developmental stimulation while the restraints are on as well as off.

What is the leading cause of death in children?

Motor Vehicle accidents, a preventable cause of death

The mother of two sons, ages 6 & 9, states they want to play on th esame baseball team. As the school nurse, what advice would you give their mother?

Levels of coordination and concentration differ, so the boys need to be on different teams. With age, concentration and coordination increase, so the 9-year-old would be operating at a higher level of maturity.

The mother of a 15 month old is concerned about a speech delay. She describes her toddler as being able to understand what she says, sometimes following commands, but using only one or two words with any consistency. What is the nUrse's best response to this information?

Receptive language normally develops earlier than expressive language. Young toddlers understand far more language than they can actually express themselves.

Which activities will promote weight loss in an obese school-age child? ( Choose all that apply)

Role modeling by family, becoming active in sports, involving child in meal planning and grocery shopping. Inactivity while watching TV and playing computer games leads to weight gain. Sports facilitate the expenditure of calories while the child is participating in age-appropriate activities; unstructured mealtimes lead to increased consumption of fast foods and decreased role modeling by parents. The family needs to eat refular meals. Involving the child in meal preparation and grocery shopping facilitates interest in the weight-loss project. Intake of water increases metabolism and creates a feeling of fullness.

An infant boy is at your facility for his initial health supervision visit. He is 2 weeks old and responds to a bell during his examination. You review all his birth records and find no documentation that a newborn hearing screening was performed. What is the best action by the nurse?

Schedule the infant immediately for newborn hearing screening. Guidelines for infant hearing screening recommend universal screening with ABR or EOAE by one month of age (see table 9.3). All the other answers rely o n behavioral observation. Studies have shown that behavioral observation is not a reliable method of screening for hearing loss.

Parents of an 8 month old girl express concern tha tshe cries when left with the babysitter. How does the nurse best explain this behavior.

Separation anxiety is normal at this age; the infant recognizes parents as separate beings. As the infant realizes she is separate from her parents, it may distress her when the parents leave, as she understands they are no longer with her.

Which assessment finding is considered normal in children?

Split S2 and sinus arrhythmia. Infants and young children often display a split S2 heart sound, and it is very common for children to have sinus arrhythmia (increase in the heart rate in relation to respirations).

Which is associated with early adolescence? (choose all that apply)

Still at times wants to be dependent upon parents, is influenced by peers and values memberships in cliques. During early adolescence (11 to 14) adolescents are in conflict over becoming independent from their parents. They still at times want the role of the parents to be as it was during the school-age years. They are influenced by peers and value membership in cliques. Adolescents develop scientific reasoning and incorporate their own set of morals and values in middle and late adolescence.

The parents of two school-age children state that they expect their children to adhere to their rules without question and that they make all the decisions. Which type of parenting style does this reflect?

The authoritarian Parenting expects obedience from the children without questioning the rules of the family. The rules and standards set forth by the parents are strictly enforced and firm, and children have little or no say in decision making. The democratic or authoritative style of parenting shows some respect for the opinions of children and allows children to be different, respecting each child as an individual. The permissive style of parenting involves little parental control over the behavior of the children.

A 2 year old is having a temper tantrum. What advice should the nurse give the mother?

The tantrum should be ignored as long as the toddler is safe. Ignoring tantrums is the best method for discouraging them. Any additional attention received because of the outburst may only contribute to another occurrence in the future.

A single mother asks the nurse for suggestions on disciplining her 2-year-old-son. Which suggestion would be most appropriate?

Time-out is an effective discipline method, especially with toddlers, preschoolers, and early school-age children. 1 minute for each year of age. Emphasizing the child's appropriate behavior rather than the inappropriate behavior acts as a positive reinforcement for the appropriate behavior.

Which of the following are reasons that stealing occurs in school-age children? (Choose all that apply)

To escape punishment, lack of sense of propriety, strong desire to own something. Stealing in the school-age years occurs for multiple reasons: to escape punishment, because of a lack of sense of propriety or ownership, and because of a strong desire to own somehting they do not have because of lack of money or refusal by parents. Stealing also occurs when a school-age child has low self-esteem and high expectations from his family or peers that the child cannot meet.

When caring for an adolescent, in which case must the nurse share information with the parents no matter which state the care is provided in?

Tuberulosis Care for communicable diseases such as tuberculosis would require parental consent and notification.

When caring for children, how does the nurse best incorporate the concept of family-centered care?

Uses the concepts of respect, family strengths, diversity, and collaboration with the family. When applying patient- and family-centered care, the nurse recognizes the family as central to the child's life, respecting the family's strengths and diversity and empowering the family through honesty, support, flexibility, and collaboration.

A 5 year old boy visits the physician's office with an upper respiratory infection. Which approach would give the nurse the most information about the child's developmental level?

Using a screening tool during a follow up office visit. Assessment of development should not be done when a child is ill. It is more accurate when the child is alert and able to participate fully.