Exam #1 COMBO: Ch. 26-31, 38, 41

A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient? a. A 4-year-old boy who is first day post-appendectomy surgery b. A 6-year-old boy with pneumonia c. A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis d. A 12-year-old boy with cellulitis

C

A nurse is preparing to complete an admission assessment on a 2-year-old child. The child is sitting on the parent's lap. Which technique should the nurse implement to complete the physical exam? a. Ask the parent to place the child in the hospital crib. b. Take the child and parent to the exam room. c. Perform the exam while the child is on the parent's lap. d. Ask the child to stand by the parent while completing the exam.

C

Match the sequence of cephalocaudal development that the nurse expects to find in the normal infant with the appropriate step numbers. Begin with the first development expected, sequencing to the final. a. Crawl b. Sit unsupported c. Lift head when prone d. Gain complete head control e. Walk

STEP 1- C. Lift head when prone STEP 2- D. Gain complete head control STEP 3- B. Sit unsupported STEP 4- A. Crawl STEP 5- E. Walk

A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child? a. None, this is an emergency and the child should not participate in care. b. Allow the child to hold the digital thermometer while taking the child's blood pressure. c. Ask the child if it is OK to take a temperature in the ear. d. Have parents wait in the waiting room.

B

Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation c. Outpatient admission b. Emergency hospitalization d. Rehabilitation admission

B

An infant is brought to the emergency department with poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of: a. Overhydration. b. Dehydration. c. Sodium excess. d. Calcium excess.

B These clinical manifestations indicate dehydration. Symptoms of overhydration are edema and weight gain. Regardless of extracellular sodium levels, total body sodium is usually depleted in dehydration. Symptoms of hypocalcemia are a result of neuromuscular irritability and manifest as jitteriness, tetany, tremors, and muscle twitching.

Which vaccine is now recommended for the immunization of all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines

B Universal vaccination for hepatitis B is now recommended for all newborns. A vaccine is available for hepatitis A, but it is not yet universally recommended. No vaccine is currently available for hepatitis C. Only hepatitis B vaccine is recommended for newborns.

Which statement best describes the process of critical thinking? a. It is a simple developmental process. b. It is purposeful and goal directed. c. It is based on deliberate and irrational thought. d. It assists individuals in guessing what is most appropriate.

b. It is purposeful and goal directed.

A school-age child, admitted for intravenous antibiotic therapy for osteomyelitis, reports difficulty in going to sleep at night. Which intervention should the nurse implement to assist the child in going to sleep at bedtime? a. Request a prescription for a sleeping pill. b. Allow the child to stay up late and sleep late in the morning. c. Create a schedule similar to the one the child follows at home. d. Plan passive activities in the morning and interactive activities right before bedtime.

C

What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

C

Therapeutic management of the child with acute diarrhea and dehydration usually begins with: a. Clear liquids. b. Adsorbents such as kaolin and pectin. c. Oral rehydration solution (ORS). d. Antidiarrheal medications such as paregoric.

C ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended and neither are antidiarrheals because they do not get rid of pathogens.

A child is playing in the playroom. The nurse needs to take a blood pressure on the child. Which is the appropriate procedure for obtaining the blood pressure? a. Take the blood pressure in the playroom. b. Ask the child to come to the exam room to obtain the blood pressure. c. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom. d. Document that the blood pressure was not obtained because the child was in the playroom.

C The playroom is a safe haven for children, free from medical or nursing procedures. The child can be returned to his or her room for the blood pressure and then escorted back to the playroom. The exam room is reserved for painful procedures that should not be performed in the child's hospital bed. Documenting that the blood pressure was not obtained because the child was in the playroom is inappropriate.

Which statement regarding childhood morbidity is the most accurate? a. Morbidity does not vary with age. b. Morbidity is not distributed randomly. c. Little can be done to improve morbidity. d. Unintentional injuries do not have an effect on morbidity.

b. Morbidity is not distributed randomly.

The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. The nurse should recognize that: A. this assessment is normal. B. the child is probably cognitively impaired. C. developmental/neurologic evaluation is needed. D. the parent needs to work with the infant to stop head lag.

C. developmental/neurologic evaluation is needed.

The MOST appropriate recommendation for relief of teething pain is to instruct the parents to: A. rub gums with aspirin to relieve inflammation. B. apply hydrogen peroxide to gums to relieve irritation. C. give child a frozen teething ring to relieve inflammation. D. have child chew on a warm teething ring to encourage tooth eruption.

C. give child a frozen teething ring to relieve inflammation.

In addition to injuries, the leading causes of death in adolescents ages 15 to 19 years are: a. Suicide, cancer. b. Homicide, suicide c. Homicide, heart disease. d. Drowning, cancer.

b. Homicide, suicide

The nurse should expect the anterior fontanel to close at age: *a.* 2 months. *b.* 2 to 4 months. *c.* 6 to 8 months. *d.* 12 to 18 months.

*d.* 12 to 18 months. (Ages 2 through 8 months are too early. The expected closure of the anterior fontanel occurs between 12 and 18 months; if it closes at these earlier ages, the child should be referred for further evaluation.)

The school nurse understands that children are impacted by divorce. Which has the most impact on the positive outcome of a divorce? a. Age of the child b. Gender of the child c. Family characteristics d. Ongoing family conflict

ANS: C

Transdermal fentanyl (Duragesic) is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. The most appropriate nursing action is to: A. administer meperidine (Demerol) intramuscularly (IM). B. administer morphine sulfate immediate release (MSIR) intravenously (IV). C. use a nonpharmacologic strategy. D. place another fentanyl patch on the adolescent.

B. administer morphine sulfate immediate release (MSIR) intravenously (IV). A. Intramuscular injections should be avoided in cancer patients because of increased risk of bleeding and the fact that they do not act immediately. B. The nurse should administer an immediate-release opioid such as MSIR IV for the breakthrough pain. C. Nonpharmacologic strategies are not effective in severe pain. D. Transdermal fentanyl will take up to 24 hours to reach peak effect and thus is not effective for severe breakthrough pain.

During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. Now the nurse observes that Eric appears to be "settled in" and unconcerned about seeing his parents. The nurse should interpret this as which of the following? a. He has successfully adjusted to the hospital environment. b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is "at home" in the hospital now, seeing his mother frequently will only start the cycle again.

C

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of intravenous (IV) antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he stops crying. b. Tell the child big boys and girls "don't cry." c. Let the child decide which color arm board to use with the IV. d. Administer a narcotic analgesic for pain to quiet the child.

C

At what age would the nurse advise parents to expect their infant to be able to say "mama" and "dada" with meaning? A. 4 months B. 6 months C. 10 months D. 14 months

C. 10 months

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

C. reassure the mother that this is very normal at this age Sucking is an infant's chief pleasure, and she may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. Dental damage does not appear to occur unless the use of the pacifier or finger persists after age 4 to 6 years. The nurse should explore with the mother her feelings about pacifier vs. thumb. This is a normal behavior to meet nonnutritive sucking needs. No data support that Latasha has sensory deprivation.

The nurse is doing a prehospitalization orientation for Kayla, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that Kayla will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeon's responsibility. c. Too stressful for a young child. d. An appropriate part of the child's preparation.

D

Which is the most appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll head side to side. c. Hold by feet upside down with head supported. d. Gently stimulate trunk by patting or rubbing.

D. Gently stimulate trunk by patting or rubbing. If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. The infant should not be shaken vigorously, have the head rolled side to side, or be held by the feet upside down with the head supported. These actions can cause injury.

A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse's knowledge of breastfed infants, what type of stool is expected? A. Dark brown and small hard pebbles B. Loose with green mucus streaks C. Formed and with white mucus D. Semiformed, seedy, yellow

D. Semiformed, seedy, yellow

The most consistent indicator of pain in infants is: A. increased respirations. B. increased heart rate. C. clenching the teeth and lips. D. facial expression of discomfort.

D. facial expression of discomfort. A. Respiratory pattern may be markedly variable in an infant in pain and thus is not a consistent indicator of pain. B. Heart rate may initially decrease in some infants with pain and then increase; thus it is not a consistent indicator of pain. C. Clenching the teeth and lips are signs of pain often assessed in the toddler, not the infant. D. Facial expression of discomfort is the most consistent behavioral manifestation of pain in infants.

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

*a.* Birth history. (The birth history refers to information that relates to previous aspects of the child's health, not to the current problem. The mother's difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through it progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth. Sequelae such as pulmonary dysfunction would be included.)

A nurse is planning to use an interpreter during a health history interview of a non-English speaking patient and family. Which nursing care guidelines should the nurse include when using an interpreter? (Select all that apply) *a.* Elicit one answer at a time. *b.* Interrupt the interpreter if the response from the family is lengthy. *c.* Comments to the interpreter about the family should be made in English. *d.* Arrange for the family to speak with the same interpreter, if possible. *e.* Introduce the interpreter to the family.

*a.* Elicit one answer at a time. *d.* Arrange for the family to speak with the same interpreter, if possible. *e.* Introduce the interpreter to the family. (When using an interpreter, the nurse should pose questions to elicit only one answer at a time, such as: "Do you have pain?" rather than "Do you have any pain, tiredness, or loss of appetite?" Refrain from interrupting family members and the interpreter while they are conversing. Introduce the interpreter to family and allow some time before the interview for them to become acquainted. Refrain from interrupting family members and the interpreter while they are conversing. Avoid commenting to the interpreter about family members because they may understand some English.)

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

*a.* Initiate a game of peek-a-boo. (Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done while the child is on the father's lap. The nurse should have the father undress the child as needed for the examination.)

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? *a.* Introduce himself or herself. *b.* Make the family comfortable. *c.* Explain the purpose of the interview. *d.* Give an assurance of privacy.

*a.* Introduce himself or herself. (The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next, the purpose of the interview and the nurse's role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.)

Which data would be included in a health history? (Select all that apply) *a.* Review of systems. *b.* Physical assessment. *c.* Sexual history. *d.* Growth measurements. *e.* Nutritional assessment. *f.* Family medical history.

*a.* Review of systems. *c.* Sexual history. *e.* Nutritional assessment. *f.* Family medical history. (The review of systems, sexual history, nutritional assessment, and family medical history are part of the health history. Physical assessment and growth measurements are components of the physical examination.)

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

*a.* The child may think the equipment is alive. (Young children attribute human characteristics to inanimate objects. They often fear that the objects my jump, bite, cut , or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the child's fear. The preschooler will need repeated explanations as reassurance.)

Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? *a.* 1 month. *b.* 3 to 4 months. *c.* 6 to 8 months. *d.* 12 months.

*b.* 3 to 4 months. (Binocularity is usually achieved by ages 3 to 4 months. Age 1 month is too young for binocularity. If binocularity is not achieved by 6 months, the child must be observed for strabismus.)

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. This should be interpreted as: *a.* Inappropriate, because of child's age. *b.* A way to establish rapport. *c.* Too distracting, when cooperation is important. *d.* Acceptable, if there is adequate time.

*b.* A way to establish rapport. (A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic.)

When the nurse interviews an adolescent, it is especially important to: *a.* Focus the discussion on the peer group. *b.* Allow an opportunity to express feelings. *c.* Emphasize that confidentiality will always be maintained. *d.* Use the same type of language as the adolescent.

*b.* Allow an opportunity to express feelings. (Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.)

The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is sexually active is to: *a.* Ask her, "Are you sexually active?" *b.* Ask her, "Are you having sex with anyone?" *c.* Ask her, "Are you having sex with your boyfriend?" *d.* Ask both the girl and her parent if she is sexually active.

*b.* Ask her, "Are you having sex with anyone?" (Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase "sexually active" is broadly defined and may not provide specific information to the nurse to provide necessary care. The word "anyone" is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone.)

The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined? *a.* Ask for a detailed listing of symptoms. *b.* Ask the adolescent, "Why did you come here today?" *c.* Use what the adolescent says to determine, in correct medical terminology, what the problem is. *d.* Interview the parent away from the adolescent to determine the chief complaint.

*b.* Ask the adolescent, "Why did you come here today?" (The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A listing of symptoms will make it difficult to determine the chief complain. The adolescent should be prompted to tell which symptom caused him or her to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time.)

The nurse must check vital signs on a 2-year-old boy who is brought to the clinic for his 24-month checkup. Which criteria should the nurse use in determining the appropriate-size blood pressure cuff? (Select all that apply) *a.* The cuff is labeled "toddler." *b.* The cuff bladder width is approximately 40% of the circumference of the upper arm . *c.* The cuff bladder length covers 80% to 100% of the circumference of the upper arm. *d.* The cuff bladder covers 50% to 66% of the length of the upper arm.

*b.* The cuff bladder width is approximately 40% of the circumference of the upper arm. *c.* The cuff bladder length covers 80% to 100% of the circumference of the upper arm. (Research has demonstrated that cuff selection with a bladder width that is 40% of the arm circumference will usually have a bladder length that is 80% to 100% of the upper arm circumference. This size cuff is a representative size that may not be suitable for any individual child. Choosing a cuff by limb circumference more accurately reflects arterial pressure than choosing a cuff by length.)

What is an important consideration for the nurse who is communicating with a very young child? *a.* Speak loudly, clearly, and directly. *b.* Use transition objects such as a doll. *c.* Disguise own feelings, attitudes, and anxiety. *d.* Initiate contact with the child when the parent is not present.

*b.* Use transition objects such as a doll. (Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child. Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.)

By what age do the head and chest circumferences generally become equal? *a.* 1 month. *b.* 6 to 9 months. *c.* 1 to 2 years. *d.* 2.5 to 3 years.

*c.* 1 to 2 years. (Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference at ages 1 month and 6 to 9 months. Chest circumference is larger that head circumference at age 2.5 to 3 years.)

The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? *a.* 1 month. *b.* 1 to 2 months. *c.* 3 to 4 months. *d.* 6 months.

*c.* 3 to 4 months. (Visual fixation and following a target should b present by ages 3 to 4 months. Ages 1 to 2 months are too young for this developmental milestone. If the infant is not able to fix and follow by 6 months of age, further opthalmologic evaluation is needed.)

With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)-for-age percentile indicates a *risk* for being overweight? *a.* 10th percentile. *b.* 9th percentile. *c.* 85th percentile. *d.* 95th percentile.

*c.* 85th percentile. (Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight.)

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered because these milestones are: *a.* Unnecessary information because the child is age 3 years. *b.* An important part of the family history. *c.* An important part of the child's past growth and development. *d.* An important part of the child's review of systems.

*c.* An important part of the child's past growth and development. (Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. Developmental milestones provide important information about the child's physical, social, and neurologic health. The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones.)

An 8-year-old girls asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: *a.* Ask her why she wants to know. *b.* Determine why she is so anxious. *c.* Explain in simple terms how it works. *d.* Tell her she will see how it works as it is used.

*c.* Explain in simple terms how it works. (School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively to requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification or what will be occurring. The nurse must explain how the blood pressure cuff works so the child can observe during the procedure.)

Where in the health history should the nurse describe all details related to the chief complaint? *a.* Past history. *b.* Chief complaint. *c.* Present illness. *d.* Review of systems.

*c.* Present illness. (This history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the child's health, not to the current problem. The chief complaint is the specific reason for the child's visit to the clinic, office. or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system.)

During a routine health assessment, the nurse notes that an 8-month-old infant has significant head lag. Which is the nurse's most appropriate action? *a.* Teach the parents appropriate exercises. *b.* Recheck head control at the next visit. *c.* Refer the child for further evaluation. *d.* Refer the child for further evaluation if the anterior fontanel is still open.

*c.* Refer the child for further evaluation. (Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Reduction of head lag is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated.)

Which age group is most concerned with body integrity? *a.* Toddler. *b.* Preschooler. *c.* School-age child. *d.* Adolescent.

*c.* School-age children. (School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to children in the toddler, preschooler, and adolescent age groups.)

What is the single most important factor to consider when communicating with children? *a.* The child's physical condition. *b.* The presence of absence of the child's parent. *c.* The child's developmental level. *d.* The child's nonverbal behaviors.

*c.* The child's developmental level. (The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children, but it may be detrimental when speaking with adolescents. Nonverbal behaviors vary in importance based on the child's developmental level.)

An appropriate approach to performing a physical assessment on a toddler is to: *a.* Always proceed in a head-to-toe direction. *b.* Perform traumatic procedures first. *c.* Use minimal physical contact initially. *d.* Demonstrate use of equipment.

*c.* Use minimal physical contact initially. (Parents can remove the child's clothing, and the child can remain on the parent's lap. The nurse should use minimal physical contact initially to gain the child's cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group.)

Which action is most likely to encourage parents to talk about their feelings related to their child's illness? *a.* Be sympathetic. *b.* Use direct questions. *c.* Use open-ended questions. *d.* Avoid periods of silence.

*c.* Use open-ended questions. (Closed-ended questions should be avoided when attempting to elicit parent's feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique may be most helpful? *a.* Suggest that the child keep a diary. *b.* Suggest that the parent read fairy tales to the child. *c.* Ask the parent whether the child is always uncommunicative. *d.* Ask the child to draw a picture.

*d.* Ask the child to draw a picture. (Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the child's inner self. It would be difficult for a 6-year-old child to keep a diary because the child is most likely learning to read. Reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative.)

The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that: *a.* This growth chart should not be used. *b.* Growth patterns of African-American children are the same as for all other ethnic groups. *c.* A correction factor is necessary when the NCHS growth chart is used for non-Caucasian ethnic groups. *d.* The NCHS charts are accurate for U.S. African-American children.

*d.* The NCHS charts are accurate for U.S. African-American children. (The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African-American children were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists.)

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because: a. Regression is seen during hospitalization. b. Developmental delays occur because of the hospitalization. c. The child is experiencing urinary urgency because of hospitalization. d. The child was too young to be "potty-trained."

A

Nurses must be alert for increased fluid requirements when a child has: a. Fever. b. Congestive heart failure. c. Mechanical ventilation. d. Increased intracranial pressure (ICP).

A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. ICP does not lead to increased fluid requirements in children.

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child will begin with: a. Intravenous fluids. b. Oral rehydration solution (ORS). c. Clear liquids, 1 to 2 ounces at a time. d. Administration of antidiarrheal medication.

A Intravenous fluids are initiated in children with severe dehydration. ORS is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety c. Fear of bodily injury b. Loss of control d. Fear of pain

A The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do (select all that apply)? a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position.

A, B Rolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. Rolling from back to abdomen is developmentally appropriate for a 6-month-old infant. An 8-month-old infant should be able to sit erect without support. A 10-month-old infant can usually move from a prone to a sitting position.

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

A, B, C, D, E A. allow for catch-up growth. B. correct nutritional deficiencies. C. achieve ideal weight for height. D. restore optimum body composition. E. educate the parents or primary caregivers on child's nutritional requirements.

When preparing to administer Hepatitis B vaccine to a newborn, the nurse should: (Select all that apply.) A. initiate an immunization record. B. confirm the hepatitis B status of the newborn's mother. C. obtain a syringe with a 25-gauge, 5/8-inch needle. D. assess the dorsogluteal muscle as the preferred site for injection. E. confirm that the newborn's mother has signed the informed consent.

A, B, C, E A. initiate an immunization record. B. confirm the hepatitis B status of the newborn's mother. C. obtain a syringe with a 25-gauge, 5/8-inch needle. E. confirm that the newborn's mother has signed the informed consent.

The nursing process is a method of problem identification and problem solving that describes what the nurse actually does. The five steps include (Select all that apply): a. Assessment. b. Diagnosis. c. Planning. d. Documentation e. Implementation. f. Evaluation

A, B, C, E, F

Pacifiers can be extremely dangerous because of the frequency of use and the intensity of the infant's suck. In teaching parents about appropriate pacifier selection, the nurse should explain that a pacifier should have which characteristics (select all that apply)? a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material

A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. An attached ribbon or string and soft, pliable material are not characteristics of a good pacifier.

The nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8-week-old make which statement? (Select all that apply.) A. "I only smoke in the kitchen." B. "I put my baby to sleep on her back." C. "I have my baby sleep with me instead of alone in the crib." D. "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." E. "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night."

A, C, D, E A. "I only smoke in the kitchen." C. "I have my baby sleep with me instead of alone in the crib." D. "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." E. "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night."

Olivia, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

ANS: A Children in this age-group still fear that their insides may leak out at the injection site, even if the bleeding has stopped. Provide the Band-Aid. No explanation should be required.

Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident (select all that apply)? a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

A, C, E

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

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

What is an age-appropriate nursing intervention to facilitate psychologic adjustment for an adolescent expected to have a prolonged hospitalization (select all that apply)? a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. d. Follow home routines. e. Encourage parents to bring in favorite foods.

A,B,E

A nurse has completed a teaching session for parents about "baby-proofing" the home. Which statements made by the parents indicate an understanding of the teaching (select all that apply)? a. "We will put plastic fillers in all electrical plugs." b. "We will place poisonous substances in a high cupboard." c. "We will place a gate at the top and bottom of stairways." d. "We will keep our household hot water heater at 130 degrees." e. "We will remove front knobs from the stove."

A. "We will put a plastic fillers in all electrical plugs." C. "we will place a gate at the top and bottom of stairways." E. "we will remove front knobs from the stove." By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs from the stove can prevent burns. Poisonous substances should be stored in a locked cabinet, not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.

By what age does the posterior fontanel usually close? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months

A. 6 to 8 weeks The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks. Ten weeks or longer is too late.

The best play activity to provide tactile stimulation for a 6-month-old infant is to: a. Allow to splash in bath. b. Give various colored blocks. c. play music box, tapes, or CDs d. Use infant swing or stroller.

A. Allow to splash in bath The feel of the water while the infant is splashing provides tactile stimulation. Various colored blocks provide visual stimulation for a 4- to 6-month-old infant. A music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation

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

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

Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. When teaching the parents about the infant's care, what is the most important information the nurse should include in the discharge teaching plan? A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous (IV) fluids C. Reassurance that the infant cannot be electrocuted during monitoring D. Advice that the infant not be left with other caretakers such as baby-sitters

A. Cardiopulmonary resuscitation (CPR)

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

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

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

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

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

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

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

A. Never heating a bottle in a microwave oven. Neither infant formula nor breast milk should be warmed in a microwave oven as this may cause oral burns as a result of uneven heating in the container. The bottle may remain cool while hot spots develop in the milk. Warming expressed milk in a microwave decreases the availability of antiinfective properties and causes separation of the fat content. Milk should be warmed in a lukewarm water bath.

With the goal of preventing plagiocephaly, the nurse should teach new parents to: a. Place the infant prone for 30 to 60 minutes per day. b. Buy a soft mattress. c. Allow the infant to nap in the car safety seat. d. Have the infant sleep with the parents.

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

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

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

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as: a. A normal finding. b. A questionable finding—the infant should be rechecked in 1 month. c. An abnormal finding—indicates the need for immediate referral to a practitioner. d. An abnormal finding—indicates the need for developmental assessment.

A. a normal finding Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

The mother of a 3-month-old breastfed infant asks about giving her baby water since it is summer and very warm. The nurse should recommend that: A. fluids in addition to breast milk are not needed. B. water should be given if the infant seems to nurse longer than usual. C. water once or twice a day will make up for losses caused by environmental temperature. D. clear juices would be better than water to promote adequate fluid intake.

A. fluids in addition to breast milk are not needed.

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

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

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

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

Nonpharmacologic strategies for pain management: A. may reduce pain perception. B. make pharmacologic strategies unnecessary. C. usually take too long to implement. D. trick children into believing that they do not have pain.

A. may reduce pain perception. A. Nonpharmacologic techniques for pain management may help the child with associated fears and stress related to pain. The strategies may provide assistance with coping that may reduce the perception of pain, decrease anxiety, and increase effectiveness of medications. B. The child with moderate or severe pain will require pharmacologic intervention. C. The child should be taught nonpharmacologic pain management strategies before pain occurs, thus reducing the implementation time. D. The child will still have the pain, but the perception may be altered.

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands; however, she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.

A. normal development This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of developmental lag, delayed development, or neurologic dysfunction is present.

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

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

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. sit erect without support d. Move from prone to sitting position.

A. roll from abdomen to back Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

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

A. soft and flexible shoes are generally better The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may be helpful keeping the child's foot in the shoe. Inflexible shoes can delay walking, aggravate in-toeing and out-toeing, and impede development of the supportive foot muscles.

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests that they consider administering a placebo instead of the usual pain medication. This decision should be based on knowledge that: A. this practice is unjustified and unethical. B. this practice is effective in determining whether a child's pain is real. C. the absence of a response to a placebo means the child's pain has an organic basis. D. a positive response to a placebo will not occur if the child's pain has an organic basis.

A. this practice is unjustified and unethical. A. Placebos should never be given by any route in the assessment or management of pain. B. Placebos should never be given as a means to determine whether pain is real. Individuals respond differently to placebos; thus the patient's response may not be an accurate measure of pain. C. Response to a placebo is not a measure of the origin of pain and should never be used as a means of assessing pain. D. Response to a placebo is not a measure of the origin of pain and should never be used as a means of assessing pain.

In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in a crude pincer grasp. c. Hold a crayon and make a mark on paper. d. Release cubes into a cup.

A. transfer objects from one hand to the other By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The infant can scribble spontaneously at age 15 months. At age 12 months, the infant can release cubes into a cup.

The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: A. trust. B. industry. C. initiative. D. separation.

A. trust.

The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a large family. The nurse recognizes that the adolescent is likely to relate to which group? a. Peers b. Parents c. Siblings d. Teachers

ANS: A

The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal? a. Adapt, as necessary, ethnic practices to health needs. b. Attempt, in a nonjudgmental way, to change ethnic beliefs. c. Encourage continuation of ethnic practices in the hospital setting. d. Strive to keep ethnic background from influencing health needs.

ANS: A

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

ANS: A

When discussing discipline with the mother of a 4-year-old child, which should the nurse include? a. Parental control should be consistent. b. Withdrawal of love and approval is effective at this age. c. Children as young as 4 years rarely need to be disciplined. d. One should expect rules to be followed rigidly and unquestioningly.

ANS: A

The parents of a 5-year-old child ask the nurse how they can minimize misbehavior. Which responses should the nurse give? (Select all that apply.) a. Set clear and reasonable goals. b. Praise your child for desirable behavior. c. Don't call attention to unacceptable behavior. d. Teach desirable behavior through your own example. e. Don't provide an opportunity for your child to have any control.

ANS: A, B, D

Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.) a. Regressive behavior b. Fear of abandonment c. Fear regarding the future d. Blame themselves for the divorce e. Intense desire for reconciliation of parents

ANS: A, B, D

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is: a. Erikson. c. Kohlberg. b. Freud. d. Piaget.

ANS: A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's. Jean Piaget's cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment. c. An opportunity for regression. b. Threat to child's self-image. d. Loss of companionship with friends.

ANS: A If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control.

What is probably the single most important influence on growth at all stages of development? a. Nutrition c. Culture b. Heredity d. Environment

ANS: A Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment all contribute to the child's growth and development; however, good nutrition is essential throughout the life span for optimal health.

The nurse is reviewing the importance of role learning for children. The nurse understands that children's roles are primarily shaped by which members? a. Peers b. Parents c. Siblings d. Grandparents

ANS: B

The nurse is observing parents playing with their 10-month-old daughter. What should the nurse recognize as evidence that the child is developing object permanence? a. She looks for the toy the parents hide under the blanket. b. She returns the blocks to the same spot on the table. c. She recognizes that a ball of clay is the same when flattened out. d. She bangs two cubes held in her hands.

ANS: A Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning blocks to the same spot on a table is not an example of object permanence. Recognizing a ball of clay is the same when flat is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.

Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? a. Explain hospital schedules such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years, the child and parents should be oriented to the environment.

Which term refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period c. Terminal points b. Sequential period d. Differentiation points

ANS: A Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.

The head-to-tail direction of growth is referred to as: a. Cephalocaudal. c. Mass to specific. b. Proximodistal. d. Sequential.

ANS: A The first pattern of development is the head-to-tail, or cephalocaudal, direction. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near-to-far, is the second pattern of development. Limb buds develop before fingers and toes. Postnatally the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is punishing her. d. The child has successfully manipulated the nurse in the past.

ANS: A This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience.

The nurse is teaching parents about the effects of media on childhood obesity. The nurse realizes the parents understand the teaching if they make which statements? (Select all that apply.) a. "Advertising of unhealthy food can increase snacking." b. "Increased screen time may be related to unhealthy sleep." c. "There is a link between the amount of screen time and obesity." d. "Increased screen time can lead to better knowledge of nutrition." e. "Physical activity increases when children increase the amount of screen time."

ANS: A, B, C

Which describe the feelings and behaviors of adolescents related to divorce? (Select all that apply.) a. Disturbed concept of sexuality b. May withdraw from family and friends c. Worry about themselves, parents, or siblings d. Expression of anger, sadness, shame, or embarrassment e. Engage in fantasy to seek understanding of the divorce

ANS: A, B, C, D

What factors indicate that parents should seek genetic counseling for their child (Select all that apply)? a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder

ANS: A, B, E Factors indicating that parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease.

The nurse is presenting a staff development program about understanding culture in the health care encounter. Which components should the nurse include in the program? (Select all that apply.) a. Cultural humility b. Cultural research c. Cultural sensitivity d. Cultural competency

ANS: A, C, D

Play serves which of the following functions (Select all that apply): a. Intellectual development b. Physical development c. Self-awareness d. Creativity e. Temperament development

ANS: A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Self-awareness is the process of developing a self-identity. This process is facilitated through play. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors but not the child's temperament attributes may be modified through play.

A nurse is preparing to administer a Denver II. Which statement(s) about the Denver II test is (are) accurate (Select all that apply)? a. All items intersected by the age line should be administered. b. There is no correction for a child born prematurely. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time.

ANS: A, D, E To identify "cautions," all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age.

A foster parent is talking to the nurse about the health care needs for the child who has been placed in the parent's care. Which statement best describes the health care needs of foster children? a. Foster children always come from abusive households and are emotionally fragile. b. Foster children tend to have a higher than normal incidence of acute and chronic health problems. c. Foster children are usually born prematurely and require technologically advanced health care. d. Foster children will not stay in the home for an extended period, so health care needs are not as important as emotional fulfillment.

ANS: B

A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as what? a. Indicative of maladjustment b. A common reaction to divorce c. Suggestive of a lack of adequate parenting d. An unusual response that indicates a need for referral

ANS: B

After the family, which has the greatest influence on providing continuity between generations? a. Race b. School c. Social class d. Government

ANS: B

Children may believe that they are responsible for their parents' divorce and interpret the separation as punishment. At which age is this most likely to occur? a. 1 year b. 4 years c. 8 years d. 13 years

ANS: B

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child's mother says she has rubbed the edge of a coin on her child's oiled skin. The nurse should recognize this as what? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture

ANS: B

The nurse is aware that if patients' different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what? a. Acculturation b. Ethnocentrism c. Cultural shock d. Cultural sensitivity

ANS: B

The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed? a. "We will try to preserve the adopted child's racial heritage." b. "We are glad we will be getting full medical information when we adopt our child." c. "We will make sure to have everyone realize this is our child and a member of the family." d. "We understand strangers may make thoughtless comments about our child being different from us."

ANS: B

The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching? a. Lack of congruence among family members b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit

ANS: B

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Family stress theory c. Erikson's psychosocial theory d. Developmental systems theory

ANS: B

Which family theory is described as a series of tasks for the family throughout its life span? a. Exchange theory b. Developmental theory c. Structural-functional theory d. Symbolic interactional theory

ANS: B

Which type of family should the nurse recognize when a mother, her children, and a stepfather live together? a. Traditional nuclear b. Blended c. Extended d. Binuclear

ANS: B

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

ANS: B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.

Which statement is true about toy safety? a. Adults should be the only ones who select toys. b. Adults should be alert to notices of recalls by manufacturers. c. Government agencies inspect all toys on the market. d. Evaluation of toy safety is a joint effort between children and adults.

ANS: B Adults should be involved in the selection of toys for children to ensure that they are safe and age appropriate. Once the child is using a toy, the adult should be alert to manufacturer recalls. The child and adult should be involved in the joint process of toy selection. Government agencies do not inspect all toys for sale. The U.S. Consumer Products Safety Commission does keep track of potentially dangerous and recalled toys. Children do not have the ability to determine the safety of a toy. It is the adult's responsibility.

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap

ANS: B An example of parallel play is when both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play, such as Brian and Kristina playing with their own trucks side by side. Sharing clay is characteristic of associative play. A group of children playing a board game is characteristic of cooperative play. Playing alone on the mother's lap is an example of solitary play.

Which "expected outcome" would be developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times.

ANS: B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

By the time children reach their twelfth birthday, they should have learned to trust others and should have developed a sense of: a. Identity. c. Integrity. b. Industry. d. Intimacy.

ANS: B Industry is the developmental task of school-age children. By age 12 years, children engage in tasks that they can carry through to completion. They learn to compete and cooperate with others, and they learn rules. Identity versus role confusion is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.

What is characteristic of the preoperational stage of cognitive development? a. Thinking is logical. c. Reasoning is inductive. b. Thinking is concrete. d. Generalizations can be made.

ANS: B Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Increasingly logical thought, inductive reasoning, and the ability to make generalizations are characteristic of the concrete operations stage of development, ages 7 to 11 years.

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

ANS: B Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping or that the siblings lack understanding.

How does the onset of the pubertal growth spurt compare in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls it depends on their growth in infancy.

ANS: B Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.

A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? a. The parent is trying to feed the child only what the child likes most. b. Hispanics believe the "evil eye" enters when a person gets cold. c. The parent is trying to restore normal balance through appropriate "hot" remedies. d. Hispanics believe an innate energy called chi is strengthened by eating soup.

ANS: C

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." Which is the nurse's most appropriate answer? a. "I'm sure he'll be fine if you get a good babysitter." b. "You will need to stay home until Eric starts school." c. "Let's talk about the child care options that will be best for Eric." d. "You should go back to work so Eric will get used to being with others."

ANS: C

Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined? a. Ethnicity b. Racial variation c. Status d. Geographic boundaries

ANS: C

The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse is aware that the new stepparent understands the teaching when which statement is made? a. "I am glad there will be no disruption in my lifestyle." b. "I don't think children really want to live in a two-parent home." c. "I realize there may be power conflicts bringing two households together." d. "I understand contact between grandparents should be kept to a minimum."

ANS: C

The nurse is planning to counsel family members as a group to assess the family's group dynamics. Which theoretic family model is the nurse using as a framework? a. Feminist theory b. Family stress theory c. Family systems theory d. Developmental theory

ANS: C

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include? a. Send the child to his or her room if the child has one. b. A general rule for length of time is 1 hour per year of age. c. Select an area that is safe and nonstimulating, such as a hallway. d. If the child cries, refuses, or is more disruptive, try another approach.

ANS: C

Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society? a. Race b. Culture c. Ethnicity d. Superiority

ANS: C

Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Extended d. Binuclear

ANS: C

The intrauterine environment can have a profound and permanent effect on the developing fetus with or without chromosome or gene abnormalities. Most adverse intrauterine effects are the result of teratogens. The nurse is cognizant that this group of agents does not include: a. Accutane c. Amniotic bands b. Rubella d. Alcohol

ANS: C Amniotic bands are a congenital anomaly known as a "disruption" that occurs with the breakdown of previously normal tissue. Congenital amputations caused by amniotic bands are not the result of a teratogen. Other agents include Dilantin, warfarin, cytomegalovirus, radiation, and maternal PKU.

By what age does birth length usually double? a. 1 year c. 4 years b. 2 years d. 6 years

ANS: C Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average most children have doubled their birth length at age 4 years. One year and 2 years are too young for doubling of length.

Which strategy would be the least appropriate for a child to use to cope? a. Learning problem solving c. Having parents solve problems b. Listening to music d. Using relaxation techniques

ANS: C Children respond to everyday stress by trying to change the circumstances or adjust to the circumstances the way they are. Strategies that provide relaxation and other stress-reduction techniques should be used. An inappropriate response would be for the parents to solve the problems. Some children develop socially unacceptable strategies such as lying, stealing, or cheating. Learning problem solving, listening to music, and using relaxation techniques are positive approaches for coping in children.

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

ANS: C During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child's ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another's place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.

In what type of play are children engaged in similar or identical activity without organization, division of labor, or mutual goal? a. Solitary c. Associative b. Parallel d. Cooperative

ANS: C In associative play no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play activities for a common goal.

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

ANS: C Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting is an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.

Emma, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

ANS: C Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

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

ANS: D

How is family systems theory best described? a. The family is viewed as the sum of individual members. b. A change in one family member cannot create a change in other members. c. Individual family members are readily identified as the source of a problem. d. When the family system is disrupted, change can occur at any point in the system.

ANS: D

Parents of a preschool child ask the nurse, "Should we set rules for our child as part of a discipline plan?" Which is an accurate response by the nurse? a. "It is best to delay the punishment if a rule is broken." b. "The child is too young for rules. At this age, unrestricted freedom is best." c. "It is best to set the rules and reason with the child when the rules are broken." d. "Set clear and reasonable rules and expect the same behavior regardless of the circumstances."

ANS: D

Which is a consequence of the physical punishment of children, such as spanking? a. The psychologic impact is usually minimal. b. The child's development of reasoning increases. c. Children rarely become accustomed to spanking. d. Misbehavior is likely to occur when parents are not present.

ANS: D

Which is an accurate description of homosexual (or gay-lesbian) families? a. A nurturing environment is lacking. b. The children become homosexual like their parents. c. The stability needed to raise healthy children is lacking. d. The quality of parenting is equivalent to that of nongay parents.

ANS: D

The predominant characteristic of the intellectual development of the child ages 2 to 7 years is egocentricity. What best describes this concept? a. Selfishness c. Preferring to play alone b. Self-centeredness d. Inability to put self in another's place

ANS: D According to Piaget, this age child is in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another's place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.

An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 c. 18 b. 16 d. 21

ANS: D In general birth, weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday. Weights of 14, 16, and 18 pounds are less what would be expected for an infant with a birth weight of 7 pounds.

Which function of play is a major component of play at all ages? a. Creativity c. Intellectual development b. Socialization d. Sensorimotor activity

ANS: D Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.

Three children playing a board game would be an example of: a. Solitary play c. Associative play b. Parallel play d. Cooperative play

ANS: D Using a board game requires cooperative play. The children must be able to play in a group and carry out the formal game. In solitary, parallel, and associative play, children do not play in a group with a common goal.

Because of their striving for independence and productivity, which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants c. Preschoolers b. Toddlers d. School-age children

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children.

Infants most at risk for sudden infant death syndrome (SIDS) are those: (Select all that apply.) A. who sleep supine B. who sleep prone C. who were premature D. with prenatal drug exposure E. with a cousin that died of SIDS

B, C, D B. who sleep prone C. who were premature D. with prenatal drug exposure

Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.) a. Spending off-duty time with children and families b. Asking questions if families are not participating in the care c. Clarifying information for families d. Buying toys for a hospitalized child e. Learning about the family's religious preferences

B, C, E

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a SIDS incident (select all that apply)? a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness

B, C, E Certain groups of infants are at increased risk for SIDS: those with low birth weight, low Apgar scores, or recent viral illness, and those of male sex. Breastfed infants and infants of average or above-average weight are not at higher risk for SIDS.

A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices (select all that apply)? a. Use of acetaminophen (Tylenol) for fever b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches e. Cool mist vaporizer at the bedside for "stuffiness"

B,C,D

A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play (select all that apply)? a. Serves as method to assist disturbed children b. Allows the child to express feelings c. The nurse can gain insight into the child's feelings d. The child can deal with concerns and feelings e. Gives the child a structured play environment

B,C,D

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

B. 15 pounds Birth weight doubles at about age 5 to 6 months. At 6 months, an infant who weighed 7 pounds at birth would weigh approximately 15 pounds. Ten pounds is too little; the infant would have gone from the 50th percentile at birth to below the 5th percentile. Twenty pounds or more is too much; the infant would have tripled the birth weight at 6 months.

When is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. when birth weight has tripled d. When tooth eruption has started

B. 4 to 6 months Physiologically and developmentally, the 4- to 6-month-old is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding. Two to 3 months is too young. The extrusion reflex is strong, and the infant will push food out with the tongue. No research base indicates that the addition of solid food to bottle-feeding has any benefit. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

A 6-year-old is hospitalized with a fractured femur. Based on the nurse's knowledge of opioid side effects, the nurse should include which actions in the patient's plan of care to prevent constipation? (Select all that apply.) A. Instruct the child to remain supine while in bed. B. Administer docusate sodium (Colace). C. Encourage fluid intake. D. Encourage the child to eat fruit. E. Administer diphenhydramine (Benadryl).

B. Administer docusate sodium (Colace). C. Encourage fluid intake. D. Encourage the child to eat fruit. Administration of Colace, a stool softener, can help prevent constipation. Increased fluid and fruit intake (high fiber content) can help prevent constipation. Increased activity helps stimulate peristalsis. Diphenhydramine would not increase peristalsis or prevent constipation.

The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem? A. Putting her in parents' bed to cuddle B. Beginning to put her to bed while still awake C. Letting her cry herself back to sleep D. Giving her a bottle of formula instead of breastfeeding her so often at night

B. Beginning to put her to bed while still awake

A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan? a. Avoid use of pacifiers. b. Eliminate all secondhand smoke contact. c. Lay infant flat after feeding. d. Avoid swaddling the infant.

B. Eliminate all secondhand smoke contact. To prevent and treat colic, teach parents that if household members smoke, they should avoid smoking near the infant; smoking activity should preferably be confined to outside of the home. A pacifier can be introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy blanket and placed in an upright seat after feedings.

The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: a. Front facing in back seat. b. Rear facing in back seat. c. Front facing in front seat if an air bag is on the passenger side. d. Rear facing in front seat if an air bag is on the passenger side.

B. Rear facing in back seat The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. Infants should face the rear from birth to 20 pounds and as close to 1 year of age as possible. The middle of the back seat provides the safest position. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

A nurse is preparing to administer routine immunizations to a 4-month-old infant. The infant is currently up to date on all previously recommended immunizations. Which immunizations will the nurse prepare to administer (select all that apply)? a. Measles, mumps, and rubella (MMR) b. Rotavirus (RV) c. Diphtheria, tetanus, and acellular pertussis (DTaP) d. Varicella e. Haemophilus influenzae type b (HIB) f. Inactivated poliovirus (IPV)

B. Rotavirus (RV) C. Diptheria, tetanus, and acellular pertussis (DTaP) E. Haemophilus influenzae type b (HIB) F. Inactivated poliovirus (IPV) The recommended immunization schedule for a 4-month-old, up to date on immunizations, would be to administer the RV, DTaP, HIB, and IPV vaccinations. The MMR and varicella vaccinations would not be administered until the child is at least 1 year of age.

A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that, to achieve equianalgesia (equal analgesic effect), the oral dose will be: A. the same as the intravenous (IV) dose. B. greater than the IV dose. C. one half of the IV dose. D. one fourth of the IV dose.

B. greater than the IV dose. A. Oral morphine is not as effective at the same dose as IV morphine. B. When the route of morphine administration is changed from IV to PO (by mouth), it is essential that the dosage be increased to achieve an equianalgesic effect. C. The dosage of morphine is increased, not decreased, when the administration route changes from IV to PO. D. The dosage of morphine is increased, not decreased, when the administration route changes from IV to PO.

The exhausted parents of a 2-month-old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse's initial action is to: A. advise the mother to follow a milk-free diet for 3 to 5 days. B. take a thorough, detailed history of usual daily events. C. administer simethicone drops to provide relief from gas pains. D. explain that the parents need to stay calm so the infant will remain calm.

B. take a thorough, detailed history of usual daily events.

An important consideration when using the FACES pain rating scale with children is: A. that children color the face with the color they choose to best describe their pain. B. the scale can be used with most children, including those as young as 3 years old. C. the scale is not appropriate for use with adolescents. D. the scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

B. the scale can be used with most children, including those as young as 3 years old. A. The child points at the face that best describes the pain being experienced. B. The FACES scale has been validated for children as young as 3 years old to rate pain. C. The scale is useful for all ages above 3 years, including adults. D. The scale does not have a means of assessing physiologic data.

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that: A. the infant is most likely spoiled. B. this is a normal reaction for this age. C. this is an abnormal reaction for this age. D. grandparents are not responsive to that infant.

B. this is a normal reaction for this age.

By what age should the nurse expect that an infant will be able to pull to a standing position? a. 6 months b. 8 months c. 9 moths d. 11 to 12 months

C. 9 months Most infants can pull themselves to a standing position at age 9 months. Any infant who cannot pull to a standing position by age 11 to 12 months should be referred for further evaluation for developmental dysplasia of the hip. At 6 months, the infant has just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs.

The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride supplements because she is exclusively breastfed. The nurse's best response is: a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 6 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

C. "She may need to begin taking them at age 6 months." Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. The recommendation is to begin supplementation at 6 months, not at 2 weeks. The amount of water that is ingested and the amount of fluoride in the water are evaluated when supplementation is being considered.

An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents? a. "Did you hear the infant cry out?" b. "Why didn't you check on the infant earlier?" c. "What time did you find the infant?" d. "Was the head buried in a blanket?"

C. "What time did you find the infant?" During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as "Why didn't you go in earlier?" "Didn't you hear the infant cry out?" or "Was the head buried in a blanket?"

A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention? A. "Never shake baby powder directly on your infant because it can be aspirated into his lungs." B. "Do not permit your child to chew paint from window ledges because he might absorb too much lead." C. "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall." D. "Keep doors of appliances closed at all times."

C. "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall."

An infant experienced an apparent life-threatening event and is being placed on home apnea monitoring. The parents have understood the instructions for use of a home apnea monitor when they state: a. "We can adjust the monitor to eliminate false alarms." b. "We should sleep in the same bed as our monitored infant." c. "We will check the monitor several times a day to be sure the alarm is working." d. "We will place the monitor in the crib with our infant."

C. "we will check the monitor several times a day to be sure the alarm is working." The parents should check the monitor several times a day to be sure the alarm is working and that it can be heard from room to room. The parents should not adjust the monitor to eliminate false alarms. Adjustments could compromise the monitor's effectiveness. The monitor should be placed on a firm surface away from the crib and drapes. The parents should not sleep in the same bed as the monitored infant.

The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

C. 12 months The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

A parent asks the nurse "At what age do most babies begin to fear strangers?" The nurse responds that most infants begin to fear strangers at age: a. 2 months. b. 4 months. c. 6 months d. 12 months.

C. 6 months Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months, the infant is just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the infant does not fear strangers at this age.

At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months

C. 8 months Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake? A. Using developmental stimulation by a specialist during feedings B. Avoiding solids until after the bottle is well accepted C. Being persistent through 10 to 15 minutes of food refusal D. Varying schedule of routine activities on a daily basis

C. Being persistent through 10 to 15 minutes of food refusal

Parent guidelines for relieving colic in an infant include: a. Avoiding touching the abdomen. b. Avoiding using a pacifier. c. Changing the infant's position frequently. d. Placing the infant where the family cannot hear the crying.

C. Changing the infant's position frequently. Changing the infant's position frequently may be beneficial. The parent can walk holding the infant face down and with the infant's chest across the parent's arm. The parent's hand can support the infant's abdomen, applying gentle pressure. Gently massaging the abdomen is effective in some infants. Pacifiers can be used for meeting additional sucking needs. The infant should not be placed where monitoring cannot be done. The infant can be placed in the crib and allowed to cry. Periodically, the infant should be picked up and comforted.

When changing a dressing on the leg of a 16-year-old patient who suffered second degree burn injuries, the nurse expects to observe which characteristics of pain expression? (Select all that apply.) A. Stomping feet on the ground and screaming, "No" B. Attempting to move leg out of reach of the nurse. C. Repeatedly stating, "You're hurting me." D. Clinching fists and tensing arms in anticipation. E. Scooting away and asking parents to stop the nurse.

C. Repeatedly stating, "You're hurting me." D. Clinching fists and tensing arms in anticipation. Developmental characteristics of the adolescent's response to pain include: less vocal protest; less motor activity; more verbal expressions, such as "It hurts" or "You're hurting me"; and increased muscle tension and body control. Stating "You're hurting me" and muscle tension are expected responses to pain for the adolescent.

Which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face such as the mother b. Recognizes familiar object such as a bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

C. actively searches for a hidden object During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows that an object exists even when it is not visible. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. They cry, smile, vocalize, and show distinct preference for their mothers. This preference is one of the stages that influence the attachment process, but it is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect, such as pulling on a string to secure an object, is part of secondary schema development.

Which statement best describes the infant's physical development? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

C. birth weight doubles by age 5 months and triples by age 1 year Growth is very rapid during the first year of life. The birth weight approximately doubles by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given: a. Skim milk. b. Whole cow's milk. c. Commercial iron-fortified formula d. Commercial formula without iron.

C. commercial iron-fortified formula For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron deficiency anemia.

The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. An important consideration in managing the child's pain is to: A. give only an opioid analgesic at this time. B. increase the dosage of analgesic until the child is adequately sedated. C. plan a preventive schedule of pain medication around the clock. D. give the child a clock and explain when he or she can have pain medications.

C. plan a preventive schedule of pain medication around the clock. A. This is appropriate for the immediate pain but will not facilitate the more long-term plan of pain management. B. The dosage of analgesic is increased until pain is controlled, not until sedation is adequate. C. An around-the-clock administration strategy should be used for a child recovering from trauma and surgery. This schedule will help prevent low plasma levels of the drug, leading to breakthrough pain. D. The child should be frequently assessed for pain, and medication doses titrated accordingly. It is inappropriate to give a child a clock with instructions as to when pain medication can be given, especially a child who has experienced a traumatic event.

The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain: A. cannot occur if a child is comatose. B. may occur if a child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with the child.

C. requires astute nursing assessment and management. Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. Pain can occur in the comatose child. The child can be in pain while comatose. The family can provide insight into the child's different responses, but the nurse should be monitoring physiologic and behavioral manifestations.

Which type of dehydration results from water loss in excess of electrolyte loss? a. Isotonic dehydration b. Hypotonic dehydration c. Isosmotic dehydration d. Hypertonic dehydration

D Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion. Isosmotic dehydration is another term for isotonic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic.

A parent asks the nurse whether her infant is susceptible to pertussis. The nurse's response should be based on which statement concerning susceptibility to pertussis? a. Neonates will be immune the first few months. b. If the mother has had the disease, the infant will receive passive immunity. c. Children younger than 1 year seldom contract this disease. d. Most children are highly susceptible from birth.

D The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age-group.

The nurse expects which characteristic of fine motor skills in a 5-month-old infant? A. Strong grasp reflex B. Neat pincer grasp C. Able to build a tower of two cubes D. Able to grasp object voluntarily

D) Able to grasp object voluntarily

The parent of a 12-month-old infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much of a mess." The nurse's BEST response is: A. "It's important not to give in to this kind of temper tantrum at this age. Simply ignore the behavior and the mess." B. "You need to try different types of utensils, bowls, and plates. Some are specifically designed for young children." C. "It's important to let him make a mess. Just try not to worry about it so much." D. "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."

D. "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."

A mother tells the nurse that she doesn't want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given.

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

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is: a. Unacceptable because of the risk of sudden infant death syndrome (SIDS). b. Unacceptable because it does not encourage achievement of developmental milestones. c. Unacceptable to encourage fine motor development. d. Acceptable to encourage head control and turning over.

D. Acceptable to encourage head control and turning over. These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and positioning on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development.

Austin, age 6 months, has six teeth. The nurse should recognize that this is: a. Normal tooth eruption. b. Delayed tooth eruption. c. Unusual and dangerous d. Earlier-than-normal tooth eruption.

D. Earlier-than-normal tooth eruption This is earlier than expected. Most infants at age 6 months have two teeth. Six teeth at 6 months is not delayed; it is early tooth eruption. Although unusual, it is not dangerous.

The parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurse's reply should be based on knowing that: a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

D. Hot dogs must be cut into small, irregular pieces to prevent aspiration. Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut into irregularly shaped pieces.

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

D. Make a follow-up home visit to parents as soon as possible after the infant's death. A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their infant.

A 9-month-old infant is seen in the emergency department after developing a urticaric rash with cough and wheezing. When collecting the history of events before the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant? A. Potatoes B. Green beans C. Spinach D. Peanut butter

D. Peanut butter

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. What is the nurse's BEST reply? A. A pacifier should be substituted for the thumb. B. Thumb-sucking should be discouraged by age 12 months. C. Thumb-sucking should be discouraged when the teeth begin to erupt. D. There is no need to restrain nonnutritive sucking during infancy.

D. There is no need to restrain nonnutritive sucking during infancy.

Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on the knowledge that: a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.

D. This is a common and accepted practice, especially in some cultural groups. Co-sleeping or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently underway; no evidence at this time supports or abandons the practice for safety reasons. This is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon.

A 3-month-old bottle-fed infant is allergic to cow's milk. The nurse's BEST option for a substitute is: A. goat's milk. B. soy-based formula. C. skim milk diluted with water. D. casein hydrolysate milk formula.

D. casein hydrolysate milk formula.

The nurse is starting an intravenous (IV) line on a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that: A. children tolerate pain better than adults. B. children become accustomed to painful procedures. C. children often lie about experiencing pain. D. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

D. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures. A. There are no data to support the theory that children tolerate pain better than adults. B. The child has increasing difficulty with numerous and repeated painful procedures rather than becoming accustomed to them. C. Pain is whatever the experiencing person defines it to be. D. Children with chronic illnesses are more likely to identify invasive procedures as stressful compared with children with acute illnesses.

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on knowledge that: A. children tend to be overmedicated for pain. B. giving large doses of opioids causes euthanasia. C. narcotic addiction is common in terminally ill children. D. large doses of opioids are justified when there are no other treatment options.

D. large doses of opioids are justified when there are no other treatment options. A. Continuing studies report that children are consistently undermedicated for pain. B. The dosage of opioids is titrated to relieve pain, not cause death. C. Addiction refers to a psychologic dependence on the narcotic medication, which does not occur in terminal care. D. Large doses of opioids may be needed because the child has become physiologically tolerant to the drug, requiring higher doses to achieve the same degree of pain control. Pain is considered the fifth vital sign, and management of pain is critical to treatment of a child with bone cancer.

A child is being seen in the emergency department with multiple facial abrasions and lacerations. The combination agent lidocaine, adrenaline, and tetracaine (LAT) is applied topically to the wounds. The purpose of this combination therapy is to: A. cleanse the wound. B. promote scab formation. C. prevent infection of the wound. D. provide anesthesia to the wound.

D. provide anesthesia to the wound. The combination of lidocaine, adrenaline, and tetracaine provides anesthesia within 10 to 15 minutes of application. LAT does not have a cleansing effect. LAT has no effect on scab formation. LAT has no antibacterial effect.

The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib already asleep. The nurse should suspect his death was caused by: A. suffocation. B. child abuse. C. infantile apnea. D. sudden infant death syndrome (SIDS).

D. sudden infant death syndrome (SIDS).

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stool. The nurse bases her explanation on knowing that: a. Children should not be given fibrous foods until the digestive tract matures at age 4 years. b. The infant should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

D. this is normal because of the immaturity of digestive processes at this age. The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is a normal part of the maturational process, and no further investigation is necessary.

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

a. Appropriate use of car seat restraints

From a worldwide perspective, infant mortality in the United States: a. Is the highest of the other developed nations. b. Lags behind five other developed nations. c. Is the lowest infant death rate of developed nations. d. Lags behind most other developed nations.

a. Is the highest of the other developed nations.

Which of the following is descriptive of deaths caused by unintentional injuries? a. More deaths occur in males. b. More deaths occur in females. c. The pattern of deaths varies widely in Western societies. d. The pattern of deaths does not vary according to age and sex.

a. More deaths occur in males.

The type of injury a child is especially susceptible to at a specific age is most closely related to: a. Physical health of the child. b. Developmental level of the child. c. Educational level of the child. d. Number of responsible adults in the home.

b. Developmental level of the child.

The nurse is preparing staff in-service education about a traumatic care for pediatric patients. Which intervention should the nurse include? a. Prepare the child for separation from parents during hospitalization by reviewing a video. b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control associated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure.

b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal.

Which statement is most descriptive of pediatric family-centered care? a. It reduces the effect of cultural diversity on the family. b. It encourages family dependence on the health care system. c. It recognizes that the family is the constant in a child's life. d. It avoids expecting families to be part of the decision-making process.

c. It recognizes that the family is the constant in a child's life.

The leading cause of death from unintentional injuries in children is: a. Poisoning. . b. Drowning. c. Motor vehicle-related fatalities. d. Fire- and burn-related fatalities.

c. Motor vehicle-related fatalities.

Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patient's status c. Questioning the use of daily central line dressing changes d. Clarifying a physician's prescription for morphine

c. Questioning the use of daily central line dressing changes

The major cause of death for children older than 1 year is: a. Cancer. b. Infection. c. Unintentional injuries. d. Congenital abnormalities.

c. Unintentional injuries.

Which is now referred to as the "new morbidity"? a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problems that alter health

d. Behavioral, social, and educational problems that alter health

A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes b. Respiratory disease c. Celiac disease d. Type II diabetes

d. Type II diabetes