Course Point TTR's chapters 23-29

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has has occurred when a participant makes what statement?

"Newborns who are appropriate for gestational age at birth have lower chance of complications than others." Birth weight variations include appropriate for gestational age (AGA), which describes a newborn with a weight that falls within the 10th to 90th percentile for that particular gestational age. This describes approximately 80% of all newborns. Infants who are appropriate for gestational age have lower morbidity and mortality than other groups.

The parents of a 3-year-old boy have asked the nurse for advice about a preschool for their child. Which suggestion is most important for the nurse to make? "Look for a preschool that is clean and has a loving staff." "Check to make sure your child can attend with the sniffles." "Make sure that you can easily get an appointment to visit." "The staff should be trained in early childhood development."

"The staff should be trained in early childhood development." The nurse would recommend a preschool where the staff is trained in early childhood development and cardiopulmonary resuscitation. Cleanliness and a loving staff are not enough without competence. Good hygiene procedures require that a sick child not be allowed to attend. It is also important that parents are allowed to visit any time without an appointment. pg.1004

What is the correct amount of wet diapers a mature infant should have each day?

An infant should have 6 to 8 wet diapers/day Urination occurs in the first 24 hours of life. A normal amount of urine is 200 to 300 mL/day as the infant matures. This amount is equal to 6 to 8 wet diapers/day. pg. 978

A common symptom that would alert the nurse that a preterm infant is developing respiratory distress syndrome is:

Expiratory Grunting Expiratory grunting is a physiologic measure to ensure alveoli do not fully close on expiration (so they require less energy expenditure to reopen).

The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation? Presence of 20 deciduous teeth Presence of 10 deciduous teeth Absence of dental caries Presence of 19 deciduous teeth

Presence of 10 deciduous teeth The presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present. The absence of dental caries or presence of 19 teeth does not warrant further investigation. pg. 1023

An 18-year-old reveals that she has a nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach her at this time? Complications are more likely when they are done on your own. Review the safety rules for those who do the tattooing. Tattooing carries risks such as infection, disease, and nerve damage. It is not recommended to get the tattoo from your friend in his garage.

Tattooing carries risks such as infection, disease, and nerve damage. The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if they tattoo themselves or have the tattoos done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done. There are developed safety rules for those who do piercing and tattoos. pg. 1094

The nurse is admitting a 15-year-old to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent? The adolescent's need for privacy should be respected. The adolescent should be encouraged to call friends often. The adolescent's need for parental support should be discussed. The adolescent should be given freedom to participate in unit activities as desired.

The adolescent's need for privacy should be respected. Adolescents must be given privacy, individualized attention, confidentiality, and the right to participate in decisions about their health care. pg. 1085

The nurse is assessing development of a 4-month-old boy during a well-child visit. Which observation needs further investigation? The infant responds to his mother when he sees her but not at other times when she is near. The infant turns his head in the direction of a squeak toy. The infant shows interest in looking at near or high-contrast objects. The infant makes babbling sounds, coos, and smiles.

The infant responds to his mother when he sees her but not at other times when she is near. If the infant does not respond to his mother's voice, it could indicate hearing loss. Infants recognize parents' voices from 1 month of age. It is normal for the infant to turn his head in the direction of a squeak toy, to focus visually on near or high-contrast objects, and to make babbling sounds but no words by this age. Infants develop a social smile at 2 months. pg. 970

A 20-year-old client gave birth to a baby boy during the 43rd week of gestation. What might the nurse observe in the newborn during routine assessment?

The newborn may look wrinkled and old at birth Postterm babies are those born past 42 weeks of gestation. These babies often appear wrinkled and old at birth. They often have long fingernails and hair, dry parched skin, and no vernix caseosa. Both the quantity of lanugo and the amount of vernix decrease with gestational age. Undescended testes are usually not seen in postterm newborns; however, they are highly prevalent in preterm infants.

A group of caregivers of toddlers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is most appropriate related to this form of discipline? "When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to time out." "She is 2 years old now and I put her in time out for 5 to 10 minutes when she misbehaves." "Our time-out chair is in the master bedroom so she can't see anyone else in the family." "We use the time-out chair when our son gets tired but doesn't want to take a nap."

When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to time out." A method for a child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary. pg. 1012

The nurse is caring for an infant diagnosed with a ventricular septal defect. Which assessment findings does the nurse anticipate?

a harsh murmur The infant diagnosed with a ventricular septal defect exhibits a characteristic loud, harsh murmur. Otherwise, the child may be asymptomatic. There is no cyanosis as blood does not shunt to the left due to pressure gradients. Normal activity and growth and development are anticipated.

A 4-year-old tells the nurse he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which nursing diagnosis is most applicable for his family? Compromised family coping related to abnormal behavior of child Deficient knowledge of normal preschool development Disturbed thought processes related to deep-set psychological need Social isolation related to unwillingness to relate except through imaginary friend

eficient knowledge of normal preschool development Because a preschooler's imagination is at a peak, imaginary friends are not uncommon. pg. 1024

A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings?

esophageal atresia Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be given until the newborn has been examined. pg.944

The newborn nursery nurse is admitting a large-for-gestational age infant with a fractured clavicle. What laboratory tests would the nurse expect to monitor:

hematocrit total bilirubin serum calcium Laboratory and diagnostic testing of an infant with signs of birth trauma include baseline serum calcium, magnesium, and bilirubin levels and monitoring frequently for changes. Hypocalcemia is typically manifested in the first 2 to 3 days of life as a result of birth injury. Red blood cell breakdown leads to increased hematocrit and polycythemia. Hyperbilirubinemia may be caused by the birth trauma forming an enclosed hemorrhage. pg. 923

In completing the newborn assessment checklist, the nurse documents a meconium stool. This documentation rules out which condition?

imperforate anus Clinical manifestations of an imperforate anus include not having a meconium stool within the first 24 hours of birth. A hiatal hernia can cause esophageal reflux. Spina bifida occulta is caused by a neural tube defect and is typically asymptomatic, causing no problems. Epispadias is when the opening of the urethra is on the dorsal aspect of the penis.

When caring for a neonate receiving phototherapy, the nurse should remember to:

reposition neonate frequently Phototherapy works by the chemical interaction between a light source and the bilirubin in the neonate's skin. Therefore, the larger the skin area exposed to light, the more effective the treatment. Changing the neonate's position frequently ensures maximum exposure. Because the neonate will lose water through the skin as a result of evaporation, the amount of formula or water may need to be increased. The neonate is typically undressed to ensure maximum skin exposure. The eyes are covered to protect them from light, and an abbreviated diaper is used to prevent soiling. The skin should be clean and patted dry. Use of lotions would interfere with phototherapy. pg. 939

The parents of a 10-year-old girl voice concern to the nurse because their daughter seems to "have a higher amount of body fat" than they expect based on the healthy eating habits and high activity level of the family. What is the best response by the nurse? "Do you think maybe your daughter eats in the evening or when you are monitoring her intake at home? You may want to ask her." "Girls are always heavier than boys it seems. I'm sure she just falls into that category." "Her metabolism may be slower than the rest of your family. Try increasing her activity to see if her body fat decreases." "Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys."

"Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys." Boys have more lean body mass per inch of height than girls during the late school-age years, in preparation for adolescence. pg. 1062

The parents of an 8-month-old boy voice concern to the nurse that their child is not developing motor skills as he should. What question would be appropriate for the nurse to ask in determining if their fears are warranted? "Does he move a toy back and forth from one hand to the other when you give it to him?" "Does he place toys into a box or container and take them out?" "Is he able to drink with a cup by himself?" "Is he able to hold a pencil and scribble on paper?"

"Does he move a toy back and forth from one hand to the other when you give it to him?" Transferring an object from one hand to the other is expected at 7 months of age, so this would be expected of an 8-month-old. The other options are not expected until later months, so questioning the parents about these skills would not help in determining if he was at the motor skill developmental level that should be expected. pg. 972

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? "I give my daughter juice at breakfast and when she is thirsty during the day." "She drinks three 6-ounce cups of whole milk each day." "When she doesn't eat well at meals we give her nutritious snacks." "New foods are offered along with ones she likes."

"I give my daughter juice at breakfast and when she is thirsty during the day." High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new. pg. 1008

A mother tells a nurse that her child has recently established some friendships for the first time. In which age group do you expect this child to be? Toddler Preschool School age Adolescence

Preschool The preschool child begins to develop friendships. pg. 1029

The nurse is assisting parents who have just experienced the death of their twin infants. What would be the most appropriate action for the nurse?

Allow the parents to be present at medical rounds and the resuscitation. In times of impending death and loss initiate spiritual comfort by calling the hospital clergy only if appropriate; offer to pray with the family only if appropriate. Have the parents participate in early and repeated care conferencing to reduce family stress. Allow the family to be present at both medical rounds and resuscitation; provide explanations of all procedures. Encourage the father to cry and grieve with his partner.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue? Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Eliminating caffeine sources beginning late afternoon Providing a nightlight Taking the TV set out of the child's room Planning for the child to get 12 hours of sleep daily

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers. pg. 1039

A 15-year-old is seen at a health care facility for facial acne. When counseling him, the nurse would teach him that the basic cause of his acne is: lack of showering adequately after gym class. activation of androgen hormones. vitamin deficiency from an inadequate diet. thyroid-gland secretions increasing with adolescence.

activation of androgen hormones. As androgen rises with puberty, sebaceous glands are activated to increase production of sebum, which leads to plugging of ducts (comedones). pg. 1079

The nurse is collecting data from a teen being seen for a well-child check. During the interview the teen reports he sleeps about 6 hours per night during the week but is able to sleep 8 to 9 hours on the weekend. What response by the nurse is most appropriate? "I am glad to see you are getting the amount of rest you need." "You would benefit by trying to sleep a little less on the weekends." "Let's talk about ways to increase the amount of rest you get during the week." "Sleeping during the weekend to catch up on missed rest is a good thing to do."

"Let's talk about ways to increase the amount of rest you get during the week." It is recommended that teens get 8 to 9.5 hours of sleep per night. Teens who do not get adequate rest during the week often sleep more hours on the weekend. The best practice would be to determine ways to improve daily rest patterns. pg. 1092

A 15-year-old client's mother comments on the fact that her daughter seems to always choose the opposite of what everyone else wants and that her mood swings are a common occurrence. What statement shows the nurse that the client's mom understands these changes? "I know that she is doing this because of all the hormones." "This is common for this age group and it will get better with time." "This is her temperament and we will have to learn how to deal with her." "She will never find anyone to live with her if she acts like this."

"This is common for this age group and it will get better with time." During middle adolescence, the teenager spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period. They tend to smooth out and the teen will become more introspective. By late adolescence emotions become more consistent. pg. 1081

The nurse is playing a game with a toddler in the hospital room. What is the most important benefit of this nurse-client interaction? Occupying the toddler's time while the parents are meeting with the physician Distracting the toddler from expending too much energy with active playing Developing a trusting relationship with the nurse Utilizing clinical time when the unit is not busy

Developing a trusting relationship with the nurse While all of these are benefits of playing a game with the child, the most important benefit is establishing a relationship with the client. This will help the child to be less fearful in an unfamiliar environment and foster a better treatment and recovery period while hospitalized. pg. 1000

The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify? Running a mild fever or vomiting Choosing soft foods over hard foods Increased biting and sucking Frequent loose stools

Increased biting and sucking The nurse would advise the mother to watch for increased biting and sucking. Mild fever, vomiting, and diarrhea are signs of infection. The child would more likely seek out hard foods or objects to bite on. pg. 985

A newborn is identifies as extremely low birth weight placing the newborn's weight at which level?

Less than 1,000 g An extremely low-birth-weight newborn weighs less than 1,000 g. A very-low-birthweight newborn weighs less than 1,500 g. A large-for-gestational-age newborn typically weighs more than 4,000 g. A small-for-gestational-age newborn or a low-birth-weight newborn typically weighs about 2,500 g.

The mother of a 3-month-old is concerned because her daughter does not yet sit by herself. Which statement best reflects average sitting ability? Most babies sit steadily at 3 months; she is slightly delayed. Most babies do not sit steadily until 8 months; she is normal. Sitting ability and the age of first tooth eruption are correlated. Most babies sit steadily at 4 months; she is normal.

Most babies do not sit steadily until 8 months; she is normal. Many infants sit steadily by 8 months of age. pg. 968

A 9-year-old child is feeling conflict from seeing other children in her class engaging in behaviors she senses are not appropriate. When making decisions about what actions are most appropriate, a child of this age will rely most heavily on which party of influence? Characters in media such as television Peers at school The teacher Parents

Parents All the above have an influence on the actions of the school-age child. The parents have the highest degree of influence on their ultimate actions. pg. 1056

A nurse is caring for a hospitalized 10-year-old. What would be an appropriate activity for this child to meet the developmental tasks of this age group? Participating in a craft project Playing with a jack-in-the-box Playing with blocks Writing letters to friends

Participating in a craft project During this stage, the child is interested in how things are made and run, and engaging in meaningful projects and seeing them through to completion. pg. 1052

The parents of a 30-month-old girl have brought her into the emergency department because she had a seizure. During the health history, the nurse suspects the child had a breath-holding spell. Which parental report suggests breath-holding? A tantrum preceded the event. The event took place during a nap. The child was lethargic afterward. The child became unconscious.

A tantrum preceded the event. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells. pg. 1014

What teaching points would a nurse provide for families of school-aged children to help prevent substance abuse? Select all that apply. Give the child "what if" examples to situations they may face. Set firm rules regarding alcohol and other drug usage and discuss consequences associated with breaking the rules. Explain that what you do has nothing to do with what your expectations are for them since you are an adult. Threaten the child if they get caught using alcohol or other drugs including tobacco. Encourage decision-making and discuss family values.

Give the child "what if" examples to situations they may face. Set firm rules regarding alcohol and other drug usage and discuss consequences associated with breaking the rules. Encourage decision-making and discuss family values. Children mimic what adults do so it is important to set good examples for behavior regarding substance abuse. Offering children opportunities to think through " what if" situations allows the child to have already thought about difficult situations they may find themselves in. Although threats are not productive, setting strict rules regarding substance abuse are very important. Also encourage decision-making by the child based upon previous good decisions.

A 4-year-old is hospitalized with a urinary tract infection. Based on what you know of her cognitive development, which approach would be best to prepare her for a radiograph? Explain that she must behave because the technician is busy. Tell her she must follow directions or she will be hurt. Tell her a radiograph is a picture of the dark inside her body. Help her pretend the x-ray machine is a camera.

Help her pretend the x-ray machine is a camera. Most preschoolers express fear of the dark and mutilation. Their active imaginations make it possible to turn almost any procedure into a game. pg. 1030

The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse? Ask the child if he really has had respiratory infections during these absences Speak with the parents about the unusual increased number of respiratory infections Continue to monitor the child's absences Discuss with the child's teacher to determine if the number of absences has effected academic performance

peak with the parents about the unusual increased number of respiratory infections In the school-age child the respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. Because the child is absent excessively for respiratory infections the nurse should speak with the parents to aid in determining if there is an underlying cause, or suggest the child visits the pediatrician to discuss the issue. pg. 1051