EXAM 1 module 1

The nurse is talking to the parent of a 13-month-old child. The mother states, "My child does not make noises like 'da' or 'na' like my sister's baby, who is only 9 months old." Which statement by the nurse would be most appropriate to make? a. "I am going to request a referral to a hearing specialist." b. "You should not compare your child to your sister's child." c. "You should ask other parents what noises their children made at this age." d. "I think your child is fine, but we will check again in 3 months."

a. "I am going to request a referral to a hearing specialist." Rationale : By 11 months of age a child should be making well-formed syllables such as "da" or "na" and should be referred to a specialist if not. The remaining statements/responses are not appropriate statements to make to the parent.

Which describes avoidance behaviors parents may exhibit when learning that their child has a chronic condition? (Select all that apply.) a. Shares burden of disorder with others b. Punishes self because of guilt and shame c. Withdraws from outside world d. Refuses to agree to treatment e. Verbalizes possible loss of child

b)Punishes self because of guilt and shame c) Withdraws from outside world d)Refuses to agree to the treatment Rationale: A parent who refuses to agree to treatment, withdraws from the outside world, and punishes self because of guilt and shame is exhibiting avoidance coping behaviors. A parent who shares the burden of disorder with others and verbalizes possible loss of child is exhibiting approach coping behaviors.

A nurse is counseling an adolescent, in her second month of pregnancy, about the risk of teratogens. The adolescent has understood the teaching if she makes which statement? a. "I can continue to clean my cat's litter box." b. "I should avoid any alcoholic beverages." c. "I will ask my physician to adjust my phenytoin (Dilantin) dosage." d. "I will be able to continue taking isotretinoin (Accutane) for my acne."

b. "I should avoid any alcoholic beverages." Rationale: Teratogens are agents that cause birth defects when present in the prenatal period. Avoidance of alcoholic beverages is recommended to prevent fetal alcohol syndrome. Isotretinoin (accutane) and phenytoid (Dilantin) have been shown to have teratogenic effects and shouuld not be taken during pregnancy. Cytomegalovirus, an infectious agent and a teratogen, can be transmitted through cat feces, and cleaning the litter box during pregnancy should be avoided.

Mark, a 9-year-old with Down syndrome, is mainstreamed into a regular third-grade class for part of the school day. His mother asks the school nurse about programs, such as Cub Scouts, that he might join. The nurse's recommendation should be based on which statement? a. Parents of children with Down syndrome encourage programs, such as scouting, because they deny that their children have disabilities. b. Children with Down syndrome have the same need for socialization as other children. c. Children with Down syndrome socialize better with children who have similar disabilities. d. Programs like Cub Scouts are inappropriate for children who are cognitively impaired.

b. Children with Down syndrome have the same need for socialization as other children. RaTIONALE: Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics. Programs, such as Cub Scouts can help children with cognitive impairment develop socialization skills. Although all children should have an opportunity to form a close relationship with someone of the same developmental level, it is appropriate for children with disabilities to develop relationships with children who do not have disabilities. The parents are acting as advocates for their children.

A nurse is caring for four patients; three are toddlers and one is a preschooler. Which represents the major stressor of hospitalization for these four patients? a. Loss of control b. Separation anxiety c. Fear of pain d. Fear of bodily injury

b. Separation anxiety Rationale: The major stressor 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.

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 this as which description? a. The child has successfully manipulated the nurse in the past. b. This is normal behavior for a school-age child. c. The child thinks the nurse is punishing her. d. The behavior is not seen past the preschool years.

b. This is normal behavior for a school-age child. Rationale: The 10-year-old girl is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. Telling the nurse "Wait a minute" and "I'm not ready" can be characteristic behavior when an individual needs to maintain some control over a situation.

A nurse is assessing a patient admitted for an asthma exacerbation. Which breath sounds does the nurse expect to assess? a. Rattles b. Wheezes c. Crackles d. Rubs

b. Wheezes Rationale: Asthma causes bronchoconstriction and narrowed passageways. Wheezes are produced as air passes through narrowed passageways. Rubs are the sound created by the friction of one surface rubbing over another. Pleural friction rub is caused by inflammation of the pleural space. Rattles is the term formerly used for cracklers. Crackles are the sounds made when air passes through fluid or moisture.

A parent reports to the nurse that her child has inflamed conjunctivae of both eyes with purulent drainage and crusting of the eyelids, especially on awakening. These manifestations suggest: a. conjunctivitis caused by foreign body b. bacterial conjunctivitis. c. viral conjunctivitis. d. allergic co njunctivitis.

b. bacterial conjunctivitis. Rationale: Bacterial conjunctivitis has these symptoms. Viral or allergic conjunctivitis has watery drainage. The foreign body causes tearing and pain and usually only one eye are affected.

The screening test for PKU is most reliable if the blood sample is: a. taken 14 days after birth b. fresh blood from the heel. c. from cord blood. d. taken before oral feedings are initiated.

b. fresh blood from the heel. Rationale: Fresh heel-stick is the preferred source for the test. Fresh heel-stick blood, not cord blood, must be used. The test must be performed soon after birth so that a low-phenylalanine diet can be instituted if required. The newborn should ingest breast milk or formula before the test is performed.

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. How should this action be interpreted? a. Acceptable, if there is adequate time b. Inappropriate, because of child's age c. A way to establish rapport d. Too distracting, when cooperation is important

c. A way to establish rapport Rationale: 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.

Which is an important nursing consideration in preventing the complications of congenital hypothyroidism (CH)? a. Be certain appropriate screening is done prenatally. b.Assess the mother for signs of hypothyroidism c. Be certain appropriate screening is done on newborn d. Assess for family history of CH

c. Be certain appropriate screening is done on newborn RATIONALE: Early diagnosis and treatment are essential to prevent the complications of CH. Neonatal screening is mandatory in all 50 United States and its territories and is usually obtained in the first 24 to 48 hours of birth. A number of different etiologies exist for CH; family history will identify a small percentage only. The screening can be done postnatally on blood obtained via heel stick

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. What is most likely the cause of the diaper rash? a.Impetigo b. Infrequent diapering c. Candida albicans d. Urine and feces

c. Candida albicans Rationale: C. albicans infection produces perianal inflammation and a muculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper, but sparing the folds, are likely to be caused by chemical irritation, especially urine and feces.

A common parental reaction to a child with special needs is parental overprotection. What parental behavior is suggestive of this behavior? a. Encouraging social and educational activities not appropriate to child's level of capability b. Providing consistent, strict discipline c. Giving inconsistent discipline d. Forcing child to help self, even when not capable

c. Giving inconsistent discipline rationale: Parental overprotection is manifested by the parents' fear of letting the child achieve any new skill; they allow the child to avoid all discipline and cater to every desire to prevent frustration. Overprotective parents do not set limits and/or institute discipline; prefer to remain in the role of the total caregiver; do not allow the child to perform self-care, and do not encourage the child to participate in social and educational activities.

Which is an important nursing consideration in the care of the newborn with PKU? a. Give reassurance that dietary restrictions are a temporary inconvenience. b. Encourage the breastfeeding mother to adhere to a low-phenylalanine diet. c. Suggest ways to make the formula more palatable. d. Teach proper administration of phenylalanine hydroxylase.

c. Suggest ways to make formula more palatable. Rationale: To achieve optimal metabolic control, a restricted phenylalanine diet will probably be required for virtually all individuals with classic PKU throughout life. The nurse and nutritionalist should work with families to make the formula more palatable for the newborn. Phenylalanine hydroxylase is not effective because it cannot act within the cell where phenylalanine is metabolized. Partial breastfeeding may be possible, but only with extremely careful monitoring of the newborn's blood levels. According to the latest research, lifelong dietary restriction may be necessary.

Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. What is the best interpretation of this situation? a. The parents are used to having expectations that are too high. b. This is a sign parents are in denial. c. This is a normal anticipated time of parental stress. d. The parents need to learn more about cerebral palsy.

c. This is a normal anticipated time of parental stress. Rationale: Parenting a child with a chronic illness can be stressful for parents. There are anticipated times that parental stress increases. One of these identified times is when the chld begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; they are responding to the child's placement in school. The parents are not exhibiting signs of a knowledge deficit; this is their first interaction with the school system with this child.

A visitor arrives at a daycare center during lunchtime. The preschool children think that every time they have lunch a visitor will arrive. Which preoperational characteristic is being displayed? a. Egocentrism b. Intuitive reasoning c. Transductive reasoning d. Conservation

c. Transductive reasoning Rationale : Transductive reasoning is when two events occur together, they cause each other. The expectation that every time lunch is served a visitor will arrive is descriptive of transductive reasoning. Egocentrism is the inability to see things from any perspective than their own. Intuitive reasoning (e.g., the stars have to go to bed just as they do) is premoninantly egocentric thought. Conservation (able to reasize that physical facors such as volume, weight, and number remain the same even though outward appearances are changed) does not occur until school age.

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which areas with onset before age 3 years? (Select all that apply.) a. Parallel play b. Growth below the 5th percentile for height and weight c. Gross motor development d. Social interaction e. Symbolic or imaginative play f. Language as used in social communication

d)Social interaction e)Symbolic or imaginative play f)Language as used in social communication Rationale: There are three of the areas in which autistic children may show delayed or abnormal functioning; language as used in social communication, symbolic or imaginative play, and social interaction. Parallel play is a typical to play of toddlers and is usually not affected. Gross motor development and growth below the 5th percentile for height and weight are usually not characteristic of autism.

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 should be expected about separation anxiety? a. "I think I would like for my siblings to visit me, but not my friends." b. "I will be embarrassed if my friends come to the hospital to visit." c. "I wish my parents could spend the night with me while I am in the hospital." d. "I hope my friends don't forget about visiting me."

d. "I hope my friends don't forget about visiting me." Rationale : Loss of peer-group contact may post a severe emotional threat to an adolescent because of loss of group status, so friends visiting are an important aspect of hospitalization for an adolescent. Most adolescents do not need a parent to spend the night during hospitalization and sometimes view the hospitalization as a welcome event. Adolescents would be more concerned about friends visiting than siblings. Adolescents want visitors to keep control and maintain social status among their group of peers.

Which is most important to document about immunizations in the child's health history? a. The exact date the immunizations were received b. The practitioner who administered the immunizations c. Dosage of immunizations received d. Occurrence of any reaction after an immunization

d. Occurrence of any reaction after an immunization Rationale: The occurrence of any reaction after an immunization was given is the most important to document in a history because of possible future reactions, especially allergic reactions. Exact dosage of the immmunication received may not be recorded on the immunization record. Exact dates are important to obtain but not as important as a history of reaction to an immunization. The practitioner who administered the immunization does not need to be recorded in the health history. A potentially severe physiologic response is the most threatening and most important information to document for safety reasons.

A 9-year-old boy has several physical disabilities. His father explains to the nurse that his son concentrates on what he can, rather than cannot, do and is as independent as possible. What is the nurse's best interpretation of this statement? a. The father is experiencing denial b. The child is using a maladaptive coping style c. The father is expressing his own views d. The child is using an adaptive coping style

d. The child is using an adaptive coping style Rationale: The father is describing a well-adapted child who has learned to accept physical limitations. These children function well at home, at school, and with peers. They have an understanding of their disorder that allows them to accept their limitations, assume responsibililty for care, and assist in treatment and rehabilitation. The father is describing his child's behavior. He is not denying the child's limitations. The father is exhibiting an adaptive coping style.