Peds Test 2 Book questions and 2 evolve chapters

A 14-year-old male with a spinal cord injury (SCI) is placed on a standing table and suddenly begins to sweat profusely and complain of a headache. The nurse takes a set of vital signs and notes a significant increase in systolic blood pressure and a heart rate of 50 bpm. The most helpful intervention in this situation would be for the nurse to: 1004 a. Place the adolescent back in his wheelchair and take him to his room b. Palpate the bladder for distention c. Administer a routine analgesic for his headache and discontinue the therapy d. Place the standing table in a horizontal position and allow the adolescent to rest for a few minutes

B

A 5-month-old infant is seen in the well-child clinic for a complaint of vomiting and failure to grow. His birth weight was 7 pounds, and he now weighs 8 pounds, 10 ounces. The infant's mother reports that he is taking 4 to 7 ounces of formula every 4 to 5 hours, but he "spits up a lot after eating and then is hungry again." The child is noted to be alert but appears malnourished. The mother reports his stools are 736 brown in color, and he has one to two bowel movements every day. Based on these findings, the nurse anticipates the infant has: a. Meckel diverticulum b. Hypertrophic pyloric stenosis (HPS) c. Intussusception d. Hirschsprung disease

B

A father calls the pediatrician's office concerned about his 5-year-old type 1 diabetic child who has been ill. He reports that upon checking the child's urine, it was positive for ketones. What is the nurse's best response to this father? a. "Come to the office immediately." b. "Encourage the child to drink calorie-free liquids." c. "Hold the next dose of insulin." d. "Administer an extra dose of insulin now."

B

The nurse caring for a 4-month-old infant with biliary atresia (BA) and significant urticaria can anticipate administering: a. Diphenhydramine b. Ursodiol (ursodeoxycholic acid) c. Loratadine d. Ranitidine (Zantac)

B

The typical play activity in which toddlers engage is called: a. Solitary b. Parallel c. Associative d. Cooperative

B

Urinary system distress (neurogenic bladder) in children with spina bifida (SB) is managed by: a. DDAVP (1-deamino-8-D-arginine vasopressin) b. Clean intermittent catheterization (CIC) c. Continuous urinary catheterization d. Mitrofanoff procedure

B

You are working in the emergency department, and a 10-year-old child with type 1 diabetes mellitus (DM) has just been admitted. He has been diagnosed with diabetic ketoacidosis (DKA). Which assessment data will you expect to note in this child? a. Shallow or normal respirations, hypertension, and tachycardia b. Fruity breath odor and decreasing level of consciousness c. Headache, hunger, and excessive irritability d. Normal urine output with specific gravity less than 1.020 and a trace of ketones

B

You are working with a nurse who is new to your endocrine unit and has never worked with an infant born with congenital adrenal hyperplasia (CAH). You want to make sure he has a full understanding of this diagnosis. Which statement by the nurse indicates a need for further teaching? a. "Definitive diagnosis is confirmed by evidence of increased 17-ketosteroid levels in most types of CAH." b. "Blood studies to identify elevated calcium and decreased phosphorus levels are routinely performed." c. "Another test that can be used to visualize the presence of pelvic structures, such as female reproductive organs is ultrasonography." d. "This deficiency is an autosomal recessive disorder that results in improper steroid hormone synthesis."

B

You are working with a pediatric nurse who has just transferred to the pediatric clinic. You are role-playing phone triage related to a child with a head injury. You ascertain that the nurse needs more teaching based on what response? a. "After initial physical exam, if there was no loss of consciousness with the head injury, the child can be observed at home." b. "If there is a language barrier, written instructions can be given, followed by discharge." c. "Another physical exam should take place in 1 or 2 days." d. "Parents should call the doctor if their child has any of these signs: blurred vision, walking unsteadily, or is hard to awaken."

B

Hepatitis A virus (HAV) is transmitted by which of the following? Select all that apply. a. Breast milk from mother with HAV b. Ingestion of contaminated food c. Fecal-oral route d. Casual contact with infected person e. Blood transfusion

B, C

Discharge teaching for parents of a school-age patient with diabetes insipidus (DI) should include which of the following? Select all that apply. a. Education and support regarding the rationale for fluid restrictions b. Information for school personnel regarding the diagnosis so that they can grant children unrestricted use of the lavatory c. A thorough explanation regarding the condition with specific clarification that DI is a different condition from diabetes mellitus (DM) d. Understanding that treatment will only be needed until the child reaches puberty e. Knowing that school-age children may assume full responsibility for their care

B, C, E

You are discharging a patient with hemophilia. Which of the following responses by the parents indicate an understanding of this disorder? Select all that apply. a. "My child should remain active to decrease joint problems, and most children with hemophilia can participate in the same activities as peers." b. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." c. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." d. "If there is bleeding in a joint, elevation, ice, and rest should help and may prevent the need for factor VIII replacement." e. "All of my son's teachers need to be aware of what to do if he gets a bloody nose."

B, C, E

A child with sickle cell anemia (SCA) is admitted in a vasoocclusive crisis (VOC). Which of the following interventions should the nurse expect to see ordered? Select all that apply. a. Cold compresses to painful joints b. IV fluids started, and oral fluids encouraged c. Meperidine ordered every 4 hours for pain d. High-calorie, high-protein diet e. Antibiotics ordered for any existing infection

B, D, E

A 16-month-old has a history of diarrhea for 3 days with poor oral intake. He received intravenous (IV) fluids, has tolerated some oral fluids in the emergency department (ED), and is being discharged home. Instructions for diet for this child should include: a. BRAT (bananas, rice, applesauce, and toast) diet for 24 hours, then a soft diet as tolerated b. Chicken or beef broth for 24 hours, then resume a soft diet c. Offer a regular diet as child's appetite warrants d. Keep on clear liquids and toast for 24 hours

C

A 2-day-old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip (DDH), and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include: a. Return to the orthopedist's office in 2 weeks to remove the hip spica cast. b. The infant's bilateral foot casts should be elevated on pillows as much as possible. c. Remove the Pavlik harness once a day for no more than 2 hours and inspect skin. d. Remove the Pavlik harness while the infant is awake to allow "tummy time."

C

A child is admitted to the pediatric unit. The mother reports that the doctor says her son is anemic. What laboratory findings/manifestations would the nurse expect to see to confirm iron deficiency anemia? a. Cyanosis, due to inadequate oxygen saturation of existing hemoglobin b. A decreased reticulocyte count c. A total iron-binding capacity (TIBC) that is elevated above the normal range d. Decreased blood pressure changes, which are an early sign because of the compensatory mechanisms

C

A formerly preterm infant who had surgery for necrotizing enterocolitis is now 6 months old and has short bowel syndrome. He is unable to absorb most nutrients taken by mouth and is totally dependent on parenteral nutrition (PN), which he receives via a Broviac catheter. The clinic nurse following this infant is aware that this infant should be closely observed for the development of: a. Gastroesophageal reflux (GER) b. Chronic diarrhea c. Cholestasis d. Failure to thrive

C

A mother brings her 3-year-old daughter to the well-child clinic and expresses concern that the child's behavior is worrisome and possibly requires therapy or medication at minimum. The mother further explains that the child constantly responds to the mother's simple requests with a "no" answer even though the activity has been a favorite in the recent past. Furthermore, the child has had an increase in the number of temper tantrums at bedtime and refuses to go to bed. The mother is afraid her daughter will hurt herself during a temper tantrum because she holds her breath until the mother picks her up and gives in to her request. The nurse's best response to the mother is that: a. The child probably would benefit from some counseling with a trained therapist. b. The mother and father should evaluate their childrearing practices. c. The child's behavior is normal for a toddler and may represent frustration with control of her emotions; further exploration of events surrounding temper tantrums and possible interventions should be explored. d. The child's behavior is typical of toddlers, and the parents should just wait for the child to finish this phase because this will end soon as well.

C

A nurse working on a pediatric unit is assigned to an infant with hypothyroidism. She knows that the assessment may include: a. Thyroid function tests that are usually normal, although thyroid-stimulating hormone (TSH) levels may be slightly or moderately elevated b. Increased secretion of pituitary TSH in response to decreased circulating levels of thyroid hormone (TH) or from infiltrative neoplastic or inflammatory processes c. Dry skin, puffiness around the eyes, sparse hair, constipation, sleepiness, lethargy, and mental decline d. Clinical features, including irritability, hyperactivity, short attention span, tremors, insomnia, and emotional lability

C

Following the sudden death of a 14-year-old seemingly healthy basketball player, his parents ask the school administration to install an automatic external defibrillator (AED) in a central area of the athletic center. The school nurse is asked to participate in a meeting with the parents in which the administrators insist such a device is not necessary. The 977 school nurse advocates by providing which information about AEDs and children? a. An AED should be used only by health care persons trained in its use. b. An AED provides too much of an energy shock dose for children younger than 12 years old. c. An AED can be effective in the resuscitation of a child or adolescent with a shockable rhythm. d. An AED is more commonly used in adults who have heart attacks than in children with undiagnosed heart conditions.

C

A 12-year-old who was in an all-terrain vehicle (ATV) accident has a long-leg fiberglass cast on his left leg for a tibia-fibula fracture. He requests pain medication at 2:00 AM for pain he rates at a 10/10 on the Numeric Scale. The nurse brings the pain medication and notes that he has removed the pillows that kept his leg elevated. He complains of pain in the left foot, and she notes that there is 3+ edema in the exposed leg and foot, and she is unable to slip a finger under the cast. The nurse's priority interventions in this situation should include: a. Administer the pain medication and elevate the child's leg on the pillows. b. Elevate the leg on the pillows and follow up within 2 to 3 hours to see if the edema has decreased. c. Let the child know that he cannot have any additional pain medication until 6:00 AM. d. Notify the surgeon of the findings immediately.

D

You are caring for a child with hydrocephalus who is postoperative from a shunt revision. Which assessment finding is your priority for increased intracranial pressure (ICP)? a. Nausea and refusal to eat postoperatively b. Complaint of a headache 909 c. Irritability and wanting to sleep d. Decrease in heart rate over the last hour

D

You are the nurse assigned to care for a child with a basilar skull fracture. Your most important nursing observation is change in level of consciousness (LOC). You will be highly alert for: a. Alterations in vital signs that often appear before alterations in consciousness or focal neurologic signs b. Bleeding from the ear, which is indicative of an anterior basal skull fracture c. Seizures, which are relatively uncommon in children at the time of head injury d. Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

D

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 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 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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

A common cause of accidental death in children 1 to 19 years old involves motor vehicle crashes. Evidence from test crashes indicates that the safest action to prevent accidental deaths in toddlers includes: a. Placing the child in a rear-facing weight-appropriate car restraint seat until 24 months old b. Allowing the child to ride in the front seat with a lap-shoulder seat restraint to avoid emotional outbursts c. Allowing the child to ride in a forward-facing booster restraint seat after 12 months old d. Placing the child in the regular seat using the lap-shoulder belt as long as the child weighs at least 45 pounds

A

One indication that the toddler is ready to begin toilet training is: a. Child recognizes urge to let go and hold on and is able to communicate this sensation to the parent b. Child is able to stay dry all night c. Child demonstrates mastery of dressing and undressing self d. Child asks parent to have wet or soiled diaper changed

A

The potential physiologic and psychological effects of prolonged immobilization on a 9-year-old child who has experienced significant trauma in a motor vehicle crash include which of the following? Select all that apply. a. Orthostatic intolerance b. Deep vein thrombosis (DVT) c. Pressure ulcer formation d. Pneumonia e. Diarrhea f. Kidney stones g. Sense of euphoria and elation h. Constipation

A, B, C, D, F, H

Because many children with celiac disease require parenteral nutrition therapy, they are at risk for which of the following nutritional deficiencies when the PN is discontinued? Select all that apply. a. Iron deficiency anemia b. Folic acid deficiency c. Zinc deficiency d. Vitamin A, D, E, and K deficiency e. Vitamin B12 deficiency

A, B, D

You are working with a family that brought their child into the pediatric clinic. The mother describes what may be a type of seizure. What subjective data will help you determine the type? Select all that apply. a. The presence or absence of an aura b. If the child appeared disoriented after the seizure c. Presence of vomiting after the seizure d. The duration of the seizure e. If the seizure was related to certain foods or occurred after a certain activity

A, B, D

You are working with a recent graduate on the pediatric unit. You are assigned to take care of an adolescent with β-thalassemia. The nurse needs more information about this disease if she states which of the following? Select all that apply. a. "We need to check the patient's iron level to make sure he is not anemic." b. "I believe this is most common in those of Hispanic descent, although this patient is Mediterranean." c. "The doctor will be prescribing deferasirox (Exjade) or deferoxamine (Desferal) for chelation therapy." d. "This patient looks much younger than I would expect. I guess he's just a late bloomer." e. "I think a transfusion will be ordered, because his hemoglobin level is 9.0."

A, B, D

Disordered eating patterns, which may be observed in the female athlete triad, may include which of the following? Select all that apply. a. Use of diet pills and laxatives b. Fasting c. Binge eating d. Restriction of certain foods e. Inadequate caloric intake f. Excessive vitamin consumption

A, B, D, E

Toddlers are often known to be finicky eaters and may exhibit abnormal eating patterns that may concern parents. Which of the following actions for feeding toddlers should be suggested so that adequate amounts of nutrients for growth and development are consumed? Select all that apply. a. Avoid placing large food portions on the toddler's plate. b. Allow the child to graze on nutritious (not "junk" food) snacks during the day. c. Insist that the child sit at the table until all persons have completed their meals. d. Allow the child to make certain food choices (within reasonable limits)—for example, would you like a half peanut butter or ham sandwich? e. Provide meals at the same time of day as much as possible so that the toddler has a sense of consistency. f. Make the child eat all of the food provided, and provide disciplinary actions, such as a "time-out" if the plate is not cleaned.

A, B, D, E

Which of these statements accurately describes Duchenne muscular dystrophy (DMD)? Select all that apply. a. The absence of dystrophin leads to muscle fiber degeneration. b. DMD is inherited as an X-linked recessive trait. c. Cognitive and intellectual impairment are rare in children with DMD. d. Affected children have a waddling gait and lordosis and fall frequently. e. Ambulation usually becomes impossible by 12 years old, and affected children are confined to a wheelchair. f. Affected children must be hospitalized when ambulation becomes impossible.

A, B, D, E

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.

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 Falls occur frequently in preschoolers. Closely monitor playground activities such as climbing jungle-gym. Closely supervise around any water and ensure swimming pools are securely fenced to prevent submersion injury. Place all medications and poisons out of reach and in locked cabinets. Administer medications as a drug, not as candy. Keep poison control phone number by telephone. When riding tricycles and bicycles, children often forget not to ride in the streets. Sports injuries occur in older children.

The primary risk factor for the development of cerebral palsy (CP) is: a. Maternal chorioamnionitis b. Premature birth c. Birth asphyxia d. Intraventricular hemorrhage

B

As the nurse assigned to a child diagnosed with bacterial meningitis, you know that: a. The child will not need to be placed in isolation because antibiotics have been started. b. Enteric precautions will remain in place for up to 48 hours. c. Respiratory isolation will remain in place for 24 hours after antibiotics are started. d. Due to headache, the child will want the head of the bed elevated with two pillows.

C

The most common complication that should be anticipated and observed for in an infant with myelomeningocele after surgical repair of the defect is: a. Urinary stress b. Chiari malformation c. Hydrocephalus d. Latex allergy

C

Which is the most accurate genetic explanation for a family with hemophilia? a. It is a Y-linked dominant disorder. b. It is equally distributed among males and females. c. It is an X-linked recessive disorder. d. It is an autosomal recessive disorder.

C

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.