Health Promotion/Children

3 (some areas may specify a min. age for treatment usually 12-14 years old, generally teens have the right to seek treatment for STD without their parents permission. These medical records are not shared with parents, without the clients permission. However teens must be made aware that certain infections, including gonorrhea, must be reported by law to public health agencies. Partner notification will also take place but methods vary)

A 17 year old high school senior calls the clinic because she thinks she may have gonorrhea. She wants to be seen but wants assurances no one will know. Which is the most appropriate response by the nurse? 1. because you are underage, we will need your parents consent to treat you 2. we can treat you without your parents consent, but they have the right to review your medical record 3. we can see you without your parents consent but have to report any positive results to the public health dept. 4. We can see you and will not share your results with anyone

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

ANS: A Feedback A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. B The crude pincer grasp is apparent at approximately age 9 months. C The child can scribble spontaneously at age 15 months. D At age 12 months, the child can release cubes into a cup.

Which is appropriate play for a 6-month-old infant? a. Pat-a-cake, peek-a-boo b. Ball rolling, hide-and-seek game c. Bright rattles and tactile toys d. Push and pull toys

ANS: A Feedback A Six-month-old children enjoy playing pat-a-cake and peek-a-boo. B Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games. C Four-month-old infants enjoy bright rattles and tactile toys. D Twelve-month-old infants enjoy playing with push and pull toys.

You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunizations cannot be given? Select all that apply. a. DTaP b. HepA c. IPV d. Varicella e. MMR

ANS: D, E Feedback Correct: Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children. Incorrect: DTaP, HepA, and IPV can be given safely.

3,6 (typical abilities demonstrated by 8 month old infants include playing peek a boo and transferring objects from one hand to another. the ability to say dada and mama is more typical of 10 months infants. Infants usually are at least 12 months old when they achieve the ability to walk independently. Infants who are 15 months old commonly can feed themselves with a spoon and stack two blocks.)

An 8 month old infant is seen in the well child clinic for a routine checkup. The nurse should expect the infant to be able to do which tasks? select all that apply 1. say mama and dada with specific meaning 2. feed self with a spoon 3 play peekaboo 4. walk independently 5. stack two blocks 6. transfer object from hand to hand

A mother asks which developmental milestones she can expect when her baby is 6 months old. Which response by the nurse is the most appropriate? 1. Lifts head momentarily when prone 2. Has well-developed pincer grasp 3. Transfers objects from one hand to the other 4. Rolls from front to back

Correct Answer: 3 Rationale 1: Lifting head when prone is a milestone at 1 month. A well-developed pincer grasp is a milestone at 12 months. Transferring objects from one hand to the other is a milestone at 6 months. Rolling from front to back is a milestone at 4 months.

3 (The MMR is a live vaccine. Neither the American Academy of Pediatrics nor the Public Health Agency of Canada recommends routine vaccination with the MMR (either alone or in combination with the varicella vaccine) to children younger than 12 months. The DTaP, Hib, and influenza are all indicated)

The parents of a 9 month old bring the infant to the clinic for a regular check up. The infant has recieved no immunizations. Which vaccine if prescribed would the nurse question? 1. DTaP 2. Hib 3. MMR 4. Infulenza (inactivated)

4 (school age children are concerned about justice and fair play. They become upset when they think someone is not playing fair. Physical affection makes them embarrassed and uncomfortable They are concerned about others and are cooperative in play and school)

A nurse assessing the growth and development of a 10 year old child. What is the expected behavior of this child? 1. enjoys physical demonstrations of affection 2. is selfish and insensitive to the welfare of others 3. is uncooperative in play and school 4. has a strong sense of justice and fair play

The nurse is teaching a new mother developmental expectations. Which activity should the nurse expect a newborn to do within the first month of life? 1. Bring hands to eyes and mouth. 2. Push up with hands, moving chest up. 3. Keep hands in a relaxed position. 4. Roll over from back to abdomen.

Correct Answer: 1 Rationale 1: Newborns at one month of age can bring hands to their eyes and mouths, move their heads from side to side when lying on their abdomens, and attempt to lift their heads only when prone. Newborn hands are kept in tight fist position, and the newborn cannot roll over until 4 months of age.

2

Parents of a 15 year old state their child is moody and rude. The nurse advises the parents to : 1. restrict their childs activities 2. discuss their feelings with their child 3. obtain family counseling 4. talk to other parents of teens

The most fatal type of burn in the toddler age-group is a. Flame burn from playing with matches b. Scald burn from high-temperature tap water c. Hot object burn from cigarettes or irons d. Electric burn from electrical outlets

ANS: A Feedback A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group. B These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. C These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. D These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use.

The environment, both physical and psychosocial, is a significant determinate of growth and development outcomes before and after birth. Nurses can assist parents in preventing environmental injury for their 2-year-old toddler by teaching them to avoid the most common sources of exposure. This anticipatory guidance includes teaching related to a. Avoiding sun exposure, secondhand smoke, and lead b. Socioeconomic status, primarily poverty c. Maternal smoking and alcohol intake during pregnancy d. The passing of environmental toxins through breast milk

ANS: A Feedback A Lead can be present in the home and in toys made overseas. Environmental injury can also be the result of mercury, pesticides (flea and tick collars), radon, and exposure to the sun and secondhand smoke. It is important for the nurse to provide health teaching related to these factors. B The nurse is unable to influence socioeconomic status. C It is too late for the nurse to instruct the mother regarding smoking or alcohol intake during pregnancy. This should have been included in prenatal teaching. D It is unlikely that a 2-year-old child will still be breastfeeding.

Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer

ANS: A Feedback A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. B Nesting blocks are more appropriate for a 12- to 15-month-old child. C A bicycle with training wheels is appropriate for a preschool or young school-age child. D A computer can be appropriate as early as the preschool years.

The parent of 16-month-old Chris asks, "What is the best way to keep Chris from getting into our medicines at home?" The nurse should advise that a. "All medicines should be locked away securely." b. "The medicines should be placed in high cabinets." c. "Chris just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A Feedback A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. B Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. C Toddlers are not able to generalize as dangerous all of the different forms of medications that may be available in the home. D This is not feasible. Many parents require medications for chronic illnesses. Parents must be taught safe storage for their home and when they visit other homes

Which play patterns does a 3-year-old child typically display? Select all that apply. a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play

ANS: A, B, C, E Feedback Correct Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years. Incorrect Structured play is typical of school-age children.

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach? Select all that apply. a. Secure in a rear-facing, upright car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

ANS: A, C, E Feedback Correct Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. Incorrect The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an airbag.

The nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.

ANS: B Feedback A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). C By 2 years of age, 60% to 70% of the toddler's speech is understandable. D The toddler's vocabulary contains approximately 300 or more words.

A preschool aged child will be receiving immunizations. Which statement identifies an appropriate level of language development for a 4-year-old child? a. The child has a vocabulary of 300 words and uses simple sentences. b. The child uses correct grammar in sentences. c. The child is able to pronounce consonants clearly. d. The child uses language to express abstract thought.

ANS: B Feedback A Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. B The 4-year-old child is able to use correct grammar in sentence structure. C The 4-year-old child typically has difficulty in pronouncing consonants. D The use of language to express abstract thought is developmentally appropriate for the adolescent

Which developmental assessment instrument is appropriate to assess a 5-year-old child? a. Brazelton Behavioral Scale b. Denver Developmental Screening Test II (DDST-II) c. Dubowitz Scale d. New Ballard Scale

ANS: B Feedback A The Brazelton Behavioral Scale is used for newborn assessment. B The DDST-II is used for infants and children between birth and 6 years of age. C The Dubowitz Scale is used for estimation of gestational age. D The New Ballard Scale is used for newborn screening.

Which is the preferred site for administration of the Hib vaccine to an infant? a. Deltoid b. Anterolateral thigh c. Upper, outer aspect of the arm d. Dorsal gluteal region

ANS: B Feedback A The deltoid muscle is not used for infants. B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants. C Subcutaneous injections can be given in the upper arm. The HIB vaccine is given by the intramuscular route. D The dorsal gluteal site is never used for vaccines.

Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence.

ANS: B Feedback A The peer group validates acceptable behavior during adolescence. B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being "self-centered or lazy." C Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. D Conformity becomes less important in late adolescence.

Which milestone is developmentally appropriate for a 2-month-old infant? a. Pulled to a sitting position, head lag is absent. b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted. c. The infant can lift his or her head from the prone position and briefly hold the head erect. d. In the prone position, the infant is fully able to support and hold the head in a straight line.

ANS: C Feedback A A 2-month-old infant's neck muscles are stronger than those of a newborn; however, head lag is present when pulled to a sitting position. B A 2-month-old infant continues to have some head lag when pulled to a sitting position. C A 2-month-old infant is able to briefly hold the head erect when in a prone position. If a parent were holding the infant against the parent's shoulder, the infant would be able to lift his or her head briefly. D It is not until 4 months of age that the infant can easily lift his or her head and hold it steadily erect when in the prone position.

Which children are at greater risk for not receiving immunizations? a. Children who attend licensed daycare programs b. Children entering school c. Children who are home schooled d. Young adults entering college

ANS: C Feedback A All states require immunizations for children in daycare programs. B All states require immunizations for children entering school. C Home-schooled children are at risk for being underimmunized and need to be monitored. D Most colleges require a record of immunizations as part of a health history.

Why do peer relationships become more important during adolescence? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C Feedback A During adolescence, the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. B Parents continue to play an important role in the personal and health-related decisions. C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. D The peer group forms the transitional world between dependence and autonomy.

When counseling parents and children about the importance of increased physical activity, the nurse can emphasize a. Anaerobic exercise should comprise a major component of the child's daily exercise. b. All children should be physically active for at least 2 hours per day. c. It is not necessary to participate in physical education classes at school if a student is taking part in other activities. d. Making exercise fun and a habitual activity.

ANS: D Feedback A Aerobic exercise should comprise a major component of children's daily exercise; however, physical activity should also include muscle and bone strengthening activities. B Children and adolescents should be physically active for at least 1 hour daily. C Encourage all student to participate fully in any physical education classes. D It is important to make exercise a fun and a habitual activity. Encourage parents to investigate their community's different activity programs. This includes recreation centers, parks, and the YMCA.

A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "My mother has told us that if we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will have to go back in for my cat Fluffy because she will be scared."

ANS: D Feedback A All children should know two different escape routes from the house, in case one is blocked. B It is important for children to be taught how to call 911 in an emergency. C All families should have a predetermined meeting place away from the house. D Children should be taught never to return to a burning house, not even for a pet.

The nurse in the newborn nursery is admitting a neonate. To determine the health and development of the newborn, what will the nurse include in the assessment? 1. Head circumference 2. Body length 3. Weight 4. Length of pregnancy 5. Hearing screens

Correct Answer: 1,2,3,4 Rationale 1: The nurse should assess almost all of these parameters to determine the health of the newborn. However, hearing screens are typically done after the first 12 hours after birth and are not part of newborn assessment.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that a. Children in 5th grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development.

ANS: D Feedback A Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. B They should be encouraged to ask questions. C Preadolescents need precise and concrete information. D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development.

3 (understanding object permanence means the child is aware of the existence of objects that are covered or displaced. although at 10 months, neuromuscular development, curiosity has increased; neither are related to the thought process involved in object permanence)

A 10 month old looks for objects that should have been removed from his view. The nurse should instruct the parents that: 1. Neuromuscular development enables the child to reach out and grasp objects 2. The child's curiosity has increased 3. The child understands the permanence of objects even though the child cannot see them 4. The child is now able to transfer objects from hand to hand

3 (Teen boys lag about 2 years behind teen girls in growth. Most girls are 1-2 inches taller than boys beginning teen years, but tend to stop growing approx 2-3 years after menarche with the closure of epiphyseal lines of the long bones.)

A nurse is assessing the growth and development of a 14 year old boy. He reports that his 13 year old sister is 2 inches taller than he is. The nurse should advise the boy that the growth spurt in teen boys compared with the growth spurt of teen girls: 1. occurs at about the same time 2. occurs 2 years earlier 3. occurs 2 years later 4. occurs 1 year earlier

Which immunizations should be used with caution in children with an allergy to eggs? a. HepB b. DTaP c. Hib d. MMR

ANS: D Feedback A HepB is safe for children with an egg allergy. B DTaP is safe for children with an egg allergy. C Hib is safe for children with an egg allergy. D Live measles vaccine is produced by using chick embryo cell culture, so there is a remote possibility of anaphylactic hypersensitivity in children with egg allergies. Most reactions are actually the result of other components in the vaccine.

3 (info about why teens choose alcohol or other drugs can be used to determine whether they are becoming responsible users or problem users. The senior students probably know the legal implications of drinking, and the nurse will establish a more therapeutic relationship with the students by understanding their motivations for use. The type of alchohol and when and with whom they use are not the first data to obtain when assessing the situation)

Several high school seniors are referred t the nurse because of suspected alcohol misuse. When the nurse assesses the situation, what would be most important to determine? 1. what they know about the legal implications of drinking 2. the type of alcohol they usually drink 3. the reasons they chose alcohol 4. when and with whom they use alcohol

A nursery nurse is planning care for the newborns currently in the newborn nursery. Which activities does the nurse plan for the first 48 hours of life? Standard Text: Select all that apply. 1. Monitor feeding behaviors. 2. Perform a hearing screening. 3. Perform a heel stick to obtain blood for the newborn screen. 4. Monitor the mother as she performs the first newborn bath to remove blood and amniotic fluids. 5. Administer folic-acid injection to the infant to prevent bleeding.

Correct Answer: 1,2,3 Rationale 1: The nurse should assess feeding behaviors of the infant whether the infant is breast-fed or bottle-fed. A hearing screening is performed on all newborn infants prior to discharge. The newborn screen is performed prior to infant discharge from the newborn unit. The nurse, not the mother, performs the first bath to remove blood and amniotic fluids. Vitamin K is administered, not folic acid.

Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious? a. "You need to be stricter so that your teen stops trying to test the limits." b. "You need to collaborate with your daughter and set limits that are perceived as being reasonable." c. "Increasing your teen's involvement with her peers will improve her self-esteem." d. "Allow your teenager to choose the type of discipline that is used in your home."

ANS: B Feedback A Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process. C Increasing peer involvement does not typically increase self-esteem. D Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

A follow-up visit for a newborn client is scheduled with the pediatric nurse practitioner 3 days after discharge. What will the nurse include in the assessment during the scheduled visit for this newborn? 1. Feeding pattern 2. Jaundice 3. Length 4. Vision screen 5. Sleep pattern

Correct Answer: 1,2,5 Rationale 1: Feeding pattern, sleep pattern, and jaundice assessment would be appropriate 3 days after discharge. It would not be necessary to do a length or vision screen at this age.

The nurse working with a family has observed that the older children have a large number of dental caries and plans to provide the mother with information to prevent the development of dental caries in her new infant. Which interventions will prevent the development of dental caries in the infant? 1. Avoiding nursing or giving the infant a bottle at bedtime 2. Giving foods high in sugar only at breakfast time 3. Using a soft moist gauze for cleaning 4. Using a topical anesthetic daily beginning as soon as the first tooth begins to erupt

Correct Answer: 1,3 Rationale 1: The only interventions that will assist in the prevention of dental caries listed in this question are wiping the gums with a soft, moist gauze and avoiding putting the infant to bed with a bottle. Foods high in sugar should be avoided in the infant period. Topical anesthetic should not be applied daily.

The mother of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the mother is a. "It is important for your toddler to eat three meals a day and nothing in between." b. "It is not unusual for toddlers to eat less." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Giving your child a multivitamin supplement daily will increase your toddler's appetite."

ANS: B Feedback A Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. B Physiologically, growth slows and appetite decreases during the toddler period. C Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. D Supplemental vitamins are important for all children, but they do not increase appetite.

At what age is an infant first expected to locate an object hidden from view? a. 4 months of age b. 6 months of age c. 9 months of age d. 20 months of age

ANS: C Feedback A Four-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. B Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. C By 9 months of age, an infant will actively search for an object that is out of sight. D Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around age 9 months.

Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

ANS: C Feedback A Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. B Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier those delays in development are discovered and intervention initiated, the less dramatic their effect will be. D Normal growth and development is orderly and proceeds in a predictable pattern based on each individual's abilities and potentials.

A nurse assesses the height and weight measurements on an infant and documents these measurements at the 75th percentile. The nurse notes that the previous measurements two months ago were at the 25th percentile. Which interpretation by the nurse is the most accurate? 1. The infant is not gaining enough weight. 2. The infant has gained a significant amount of weight. 3. The previous measurements were most likely inaccurate. 4. These measurements are most likely inaccurate.

Correct Answer: 2 Rationale 1: A comparison of these two sets of measurements shows that the infant has crossed two percentiles going from the 25th to the 75th percentile and therefore has gained a significant amount of weight. There is neither indication that the previous measurements are inaccurate nor that the current measurement is inaccurate.

3 (It is normal behavior for teens to assert independence and begin to separete from their parents; the behavior is not changed by disability, nor unique to a girl. The nurse offers reassurance to the parents and then opens the conversation for additional discussion)

A 16 year old client and who has been confined to a wheelchair since early childhood has lately been acting rebellious and rude. Her parents asks the nurse, are all teens like this? The nurse should respond with which statement? 1. Yes although your daughters behaviors are more like those of an adolescent boy. 2. No, your daughter must need some help in dealing with her feelings 3. your daughters behavior seems typical teen behavior. Let us talk more about it. 4. your daughters behavior results from feelings about her disability; ignore them.

A mother asks the nurse, "When should I begin to clean my baby's teeth?" What is the best response for the nurse to make? a. "You can begin when all her baby teeth are in." b. "You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth." c. "I don't think you have to worry about that until she can handle a toothbrush." d. "You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary."

ANS: D Feedback A An infant's teeth need to be cleaned as soon as they erupt. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. B Because toothpaste contains fluoride and infants will swallow the toothpaste, parents should avoid its use. C The infant's teeth need to be cleaned by the parent as soon as they erupt. Even when a child has the ability to hold a toothbrush, the parent should continue cleaning the child's teeth. D An infant's teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate.

3 (by the end of 3 months the infant should babble. Lack of babbling suggests a language delay and warrants further investigation. Infants typically begin peek a boo at around 7 months. The ability to roll front to back typically occurs at 5 months. Sitting unsupported is expected at 6 months)

A parent brings a 4 month old to the clinic for a regular visit and expressess concern that the infant is not developing appropriately. Which finding in the infant would indicate the need for further developmental screening? 1. has no interest in peek a boo games 2. does not turn front to back 3. does not babble 4. sits unsupported

2 (National advisory committees on immunization practices review vaccination evidence and update recommendations yearly. Current vaccination catch up schedules are readily available on their websites. The lack of vaccinations is a strong indicator the child probably does not have a HCP. Even if the child has a provider, however they may be hard to reach on a weekend. If consulted the pharmacist would most likely have to review the latest guidelines that are equally available to the nurse. Reading each of the manufacturers inserts for multiple vaccines would be time consuming and synthesis of the info could possibly lead to errors.)

A parent brings a 5 year old child to a weekend vaccination clinic to prepare for school entry. The nurse notes that the child has not had any vaccinations since 4 months of age. What is the best way for the nurse to determine how to catch up the childs vaccinations? 1. ask the childs HCP 2. check the nationally published immunization guidlines 3. read each vaccines manufacturers insert 4. contact the pharmacist

3 (craving to eat non food items is known as pica. Toddlers use oral gratification to cope with anxiety. )

A parent brings an 18 month old to the clinic because the child eats ashes, crayons, and paper. Which information should the nurse assess first? 1. evidence of eruption of large teeth 2. amount of attention from the parent 3. any changes in the home environment 4. intake of a soft, low roughage diet

3 ( A child will regress behavior used in an earlier stage of development to cope with perceived threatening situations. Children are afraid of hospitalization, but bed wetting is compensatory mechanism done to regress to a previous stage of development that is more comfortable and secure for the child. )

A parent of a toilet trained 3 year old expresses concern over her childs bed wetting while hospitalized. The nurse should tell the parent: 1. your child was too immature to be toilet trained. In a few months your child should be old enough 2. Children are afraid in the hospital and frequently wet their bed 3. It is very common for children to regress when they are in the hospital 4. This is normal, your child probably received too much fluid the night before

3 (The nurse should provide her with info on toxic shock because of the identified relationship between tampon use and the syndromes development. Additionally 95% of cases of toxic shock occur during menses. Most teens can use tampons safely if they change them freq. Using tampons is not related to menstrual flow or sexual activity. There is no need to refer the girl to a gynocologist. A nurse can provide teaching about tampon use. )

A teen female tells the nurse that she would like to use tampons during her period. The nurse should first: 1. assess her usual menstrual flow pattern 2. determine whether she is sexually active 3. provide info on preventing toxic shock syndrome 4. refer her to a specialist in adolescent gynecology

A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.

ANS: A Feedback A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls. B Puberty occurs 1 1/2 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls). C Puberty occurs approximately 1 year earlier in African-American girls than in white girls. D Physical growth is slow and steady during the school-age years.

A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The best explanation for this is that a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs

ANS: A Feedback A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. B This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. C This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. D This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern.

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."

ANS: A, C, E Feedback Correct 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 form the stove can prevent burns. Incorrect 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.

The most common cause of death in the adolescent age-group involves a. Drownings b. Firearms c. Drug overdoses d. Motor vehicles

ANS: D Feedback A Drownings are major concerns in adolescence but do not cause the majority of deaths. B Firearms are major concerns in adolescence but do not cause the majority of deaths. C Drug overdoses are major concerns in adolescence but do not cause the majority of deaths. D Risk taking behaviors play a major role in the high incidence of motor vehicle injuries and death among teenagers i.e. alcohol use, failure to wear a seatbelt, and inexperience.

Which interventions are appropriate for preventing childhood obesity? Select all that apply. a. Establish consistent times for meals and snacks. b. Eliminate all snacks. Eat three nutritious meals a day. c. Teach the family and child how to select foods and prepare foods. d. Encourage schools to provide snack machines with popcorn, cookies, and diet soda. e. Limit computer and television time.

ANS: A, C, E Feedback Correct Preventing obesity includes encouraging families to establish consistent times for meals and snacks and discouraging between-meal eating. Parents and children also need to be taught how to select and prepare healthful foods. Because snacks are an important aspect in childhood nutrition, nutritious snacks should be identified. School-age children usually require a healthful snack after school and in the evening. A child who spends time with social media has less interest in physical activity and going outdoors. Incorrect Snacks are an important aspect in childhood nutrition. Nutritious snacks should be identified, not eliminated. Healthy snack options include fruit, popcorn, nuts, and yogurt, not cookies and diet soda. In schools with snack machines, children may use their lunch money to purchase high-calorie snacks versus a nutritious lunch.

The mother of a 10-month-old infant tells the nurse that her infant "really likes cow's milk." What is the nurse's best response to this mother? a. "Milk is good for him." b. "It is best to wait until he is a year old before giving him cow's milk." c. "Limit cow's milk to his bedtime bottle." d. "Mix his cereal with cow's milk and give him formula in a bottle."

ANS: B Feedback A Although milk is a good source of calcium and protein for children after the first year of life, it is not the best source of nutrients for children younger than 1 year old. B It is best to wait until the infant is at least 1 year old before giving him cow's milk because of the risk of allergies and intestinal problems. Cow's milk protein intolerance is the most common food allergy during infancy. C Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. D Cereal can be mixed with formula.

An important consideration for the school nurse who is planning a class on bicycle safety is a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear bicycle helmets if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra-large seat.

ANS: B Feedback A Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. C The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. D Children should not ride double.

Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year of age? a. 14 3/4 lb b. 22 1/8 lb c. 29 1/2 lb d. Unable to estimate weigh at 1 year

ANS: B Feedback A An infant doubles birth weight by 6 months of age. B An infant triples birth weight by 1 year of age. C An infant quadruples birth weight by 2 years of age. D Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight.

Which statement made by a mother is consistent with a developmental delay? a. "I have noticed that my 9-month-old infant responds consistently to the sound of his name." b. "I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand." c. "I am so happy when my 1 1/2-month-old infant smiles at me." d. "My 5-month-old infant is not rolling over in both directions yet."

ANS: B Feedback A An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. B Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay. C A social smile is present by 2 months of age. D Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.

Which statement, made by a 4-year-old child's father, is true about the care of the preschooler's teeth? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth." c. "My son's 'permanent teeth' will begin to come in at 4 to 5 years of age." d. "Fluoride supplements can be discontinued when my son's 'permanent teeth' erupt."

ANS: B Feedback A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. C Secondary teeth erupt at approximately 6 years of age. D If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

Which expected outcome is 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 Feedback A Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. 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 demonstrates developmental appropriateness. C 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. D 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.

What predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age-group

ANS: B Feedback A Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue. B During growth spurts, the need for sleep is increased. C Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue. D Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue.

Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide? a. "Tell your friend to come to the clinic immediately." b. "You need to gather details about your friend's suicide plan." c. "Your friend's threat needs to be taken seriously, and immediate help for your friend is important." d. "If your friend mentions suicide a second time, you will want to get your friend some help."

ANS: C Feedback A Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. B It is important to determine whether a person threatening suicide has a plan of action; however, the best information for the 15-year-old to have is that all threats of suicide should be taken seriously and immediate help is important. C Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. D It is imperative that help is provided immediately for a teenager who is talking about suicide. Waiting until the teen discusses it a second time may be too late.

The parents of a newborn infant state, "We will probably not have our baby immunized because we are concerned about the risk of our child being injured." What is the nurse's best response? a. "It is your decision." b. "Have you talked with your parents about this? They can probably help you think about this decision." c. "The risks of not immunizing your baby are greater than the risks from the immunizations." d. "You are making a mistake."

ANS: C Feedback A It is the parents' decision not to immunize the child; however, the nurse has a responsibility to inform parents about the risks to infants who are not immunized. B Grandparents can be supportive but are not the primary decision makers for the infant. C Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines. D Telling parents that they are making a mistake is an inappropriate response.

A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? a. DTaP, Hib, HepB, MCV, varicella b. DTaP, Hib, HepB, HPV, IPV, Rota c. DTaP, Hib, HepB, PCV, Rota d. DTaP, Hib, HepB, PCV, HepA

ANS: C Feedback A Meningococcal vaccine should be administered to children at 11 to 12 years of age. B Human papillomavirus vaccine is administered to adolescent girls only. C DTaP, Hib, HepB, PCV, IPV, and Rota are appropriate immunizations for an unimmunized 2-month-old child. D HepA is recommended for all children at 1 year of age.

The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. "Your teenager needs clearer and stricter limits about her behavior." b. "Your teenager needs more responsibility at home." c. "During adolescence this behavior is not unusual." d. "The behavior is abnormal and needs further investigation."

ANS: C Feedback A Stricter limits are not an appropriate response for a behavior that is part of normal development. B More responsibility at home is not an appropriate response for this situation. C Egocentric and narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity. D The behavior is normal and needs no further investigation.

Which is a priority in counseling parents of a 6-month-old infant? a. Increased appetite from secondary growth spurt b. Encouraging the infant to smile c. Securing a developmentally safe environment for the infant d. Strategies to teach infants to sit up

ANS: C Feedback A The infant's appetite and growth velocity decrease in the second half of infancy. B Although a social smile should be present by 6 months of age, encouraging this is not of higher priority than ensuring environmental safety. C Safety is a primary concern as an infant becomes increasingly mobile. D Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary.

Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."

ANS: C Feedback A Toddlers need fluoride supplements when they use a water supply that is not fluorinated. B Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. D A small nylon bristle brush works best for cleaning toddlers' teeth.

Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment

ANS: D Feedback A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age. C Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment. D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment.

The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown shopper at the grocery store. What is the best response for the nurse to make to the mother? a. "You could consider leaving the infant more often with other people so he can adjust." b. "You might consider taking him to the doctor because he may be ill." c. "Have you noticed whether the baby is teething?" d. "This is a sign of stranger anxiety and demonstrates healthy attachment."

ANS: D Feedback A An infant who manifests stranger anxiety is showing a normal sign of healthy attachment. This behavior peaks at 7 to 9 months and is developmentally appropriate. The mother leaving the child more often will not change this developmental response to new strangers. B Assessing developmental needs is appropriate before taking an infant to a physician. C Pain from teething expressed by the infant's cries would not occur only when the mother left the room. D The nurse can reassure parents that healthy attachment is manifested by stranger anxiety in late infancy.

When planning care for adolescents, the nurse should a. Teach parents first, and they, in turn, will teach the teenager. b. Provide information for their long-term health needs because teenagers respond best to long-range planning. c. Maintain the parents' role by providing explanations for treatment and procedures to the parents only. d. Give information privately to adolescents about how they can manage the specific problems that they identify.

ANS: D Feedback A Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. B Teenagers are more interested in immediate health care needs than in long-term needs. C Teenagers are at the developmental level that allows them to receive explanations about health care directly from the nurse. D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider.

A 17-month-old child is expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Sensorimotor period

ANS: D Feedback A Trust is Erikson's first stage. B Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. C Secondary circular reactions last from approximately ages 4 to 8 months. D The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. Learning in this stage occurs mainly by trial and error.

2 (try to determine the source of concern to acknowledge feelings and provide the appropriate information.)

After reading the vaccine information sheets the parent of a 2 month old infant is hesitant to consent to the recommended vaccinations. The nurse should first ask the parent: 1 Did you know that vaccinations are required y law for school entry 2. What concerns you about vaccinations? 3. Would you prefer that fewer vaccines are given at this time? 4. Can you please sign the vaccine waiver form?

The nurse is planning care for clients seen in a newborn clinic. Which is the priority for a newborn client during the first clinic visit? 1. Providing pamphlets to reinforce information provided at the visit 2. Assessing the newborn-and-family interactions 3. Modeling infant-nurturing behaviors 4. Informing the parents of the infants gains in height and weight

Correct Answer: 2 Rationale 1: The first step in the nursing process is assessment; therefore, the nurse should assess the interactions of the parents with the newborn. Providing pamphlets to help educate the parents should be done at each appropriate office visit; however, the pamphlets would be distributed after assessment of parent needs. While the nurse should be a role model for nurturing behaviors during the office visit, this would not be the first thing the nurse performs at the office visit. While parents are informed of the infants gains in height and weight, this activity does not take priority.

3

An uncle is shopping for a toy to give his niece. He has no children of his own and asks his neighbor, a nurse, what would be the most appropriate toy to give a 15 month old child. Which toy should the nurse recommend to facilitate learning and development? 1. a stuffed animal 2. a music box 3. a push pull toy 4. a nursery moblie

A mother who is bottle feeding her newborn asks to be discharged 24 hours post delivery, because she also has twin 2-year-old children at home. When should the nurse schedule the first office visit for this newborn? 1. Within 48 hours of discharge 2. Within one week of discharge 3. Within two weeks of discharge 4. When the infant is 1 month old

Correct Answer: 1 Rationale 1: Newborns discharged before 48 hours old should be seen within 48 hours of discharge. Waiting one week and/or two weeks after discharge of a 24-hour-old infant increases the chance that several common newborn conditions can go undiagnosed (e.g., jaundice, failure to gain weight). Waiting one month is too long for any infant who is discharged at 24 hours old.

A nurse is assessing an 11-month-old infant and notes that the infants height and weight are at the 5th percentile on the growth chart. Family history reveals that the infants two siblings are at the 50th percentile for height and at the 75th percentile for weight. Psychosocial history reveals that the parents are separated and are planning to divorce. Which of these nursing diagnoses takes priority? 1. Alteration in Growth Pattern Related to Parental Anxiety 2. Alteration in Growth Pattern Secondary to Familial Short Stature 3. Nutritional Intake: Excessive Secondary to Maternal Feeding Patterns 4. At Risk for Constitutional Growth Delay Related to Decreased Appetite

Correct Answer: 1 Rationale 1: The scenario reveals parental anxiety due to marital problems. The most appropriate nursing diagnosis is alteration in growth patterns related to parental anxiety. There is no data that indicates familial short stature. Since height and weight are at the 5th percentile, there is no indication of increased nutritional intake. This infant is not at risk for constitutional growth delay.

A nurse asks the mother of a 4-month-old infant to undress the infant. The nurse observes the mother taking off several layers of clothing and knows that the outdoor temperature is 70 degrees Fahrenheit. Which statement by the nurse is most appropriate in this situation? 1. My, you are dressing your infant warmly today. 2. Did you think it was cold when you left your home this morning? 3. I see that you have many layers of clothing on your baby. This may cause your babys temperature to rise. 4. When you leave the office, only put one layer of clothing on your baby.

Correct Answer: 3 Rationale 1: In this scenario, the mother has overdressed the infant. The nurse needs to gently inform the mother of this problem and to provide information to the mother on why it is a problem. Just making a statement on how warmly the child is dressed will not accomplish this goal or just telling the mother to only put one layer of clothing on the child does not provide a rationale for the mother to make a better decision the next time, so this statement also is not helpful to the mother.

Injury prevention is an important aspect of parent teaching. Which injury prevention strategy would reduce the risk of suffocation? 1. Measure crib slat spacing at 2-3/8 inches or less. 2. Never leave an infant alone in a bath. 3. Position the infant on her back to sleep. 4. Use only approved restraint systems.

Correct Answer: 3 Rationale 1: Measuring crib slats will reduce strangulation. Not leaving an infant alone in a bath will reduce drowning. Positioning an infant on her back will reduce suffocation. Using approved restraint systems will reduce motor vehicle injury.

The nurse is assessing an infant client and parents during a routine health supervision visit at 2 months of age. Which items will the nurse assess to determine if the infants mental health needs are being addressed? 1. Immunization record 2. Newborn screen results 3. Temperament during the visit 4. Feeding schedule 5. Sleep-wake patterns

Correct Answer: 3,4,5 Rationale 1: When addressing mental health issues, the nurse would assess the infants temperament during the visit, feeding schedule, and sleep-wake patterns. The infants mental health is related to early experiences, inborn characteristics such as temperament and resilience, and relationships with caregivers. The first year of life provides many opportunities for the infant to develop positive mental health; interventions during this important period can enhance the childs future mental status. The immunization record and the newborn screen results will not provide the needed information for the nurse in terms of whether the infants mental health needs are being addressed.

While teaching parents of a newborn about normal growth and development, which statement is most appropriate for the nurse to include in the session? 1. Weight should triple by 6 months of age. 2. Weight should double by 1 year of age. 3. Weight should double by 4 months of age. 4. Weight should triple by 1 year of age.

Correct Answer: 4 Rationale 1: An infant should triple its birth weight by 1 year of age. The other answers are not appropriate weight gains.

The nurse is providing anticipatory guidance instructions to the parents of a newborn. Which instruction should the nurse give as a strategy for illness/disease prevention? 1. Dont allow visitors for the first month. 2. Smoke outside only. 3. Take the newborn to weekly child-stimulation classes. 4. SIDS risk-reduction measures

Correct Answer: 4 Rationale 1: Several disease-prevention strategies are used during anticipatory guidance for the parents of newborns. Not allowing visitors is unreasonable but screening for illness is appropriate. Smoking outside will not prevent disease. Attending weekly stimulation classes is not a disease prevention strategy. SIDS risk-reduction measures can reduce the risk of sudden infant death syndrome.

2 (toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability and crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to understand or describe the nature and location of their pain because of limited verbal and cognitive skills. However preschool and older children have the verbal and cognitive skills to be able to respond appropriatley. While the FACES pain scale can be used in young children, numeric rating scales are more appropriate for children who are of school age or older. changes in VS do occur as a result of pain, but behavioral changes are usually noticed first)

When assessing pain in a toddler which method should be the most appropriate? 1. ask the child about the pain 2. observe the child for restlessness 3. use a numeric rating pain scale 4. assess for changes in vital signs

3 (vaccination in the prescence of a moderate to severe infection, with or without fever, increases the risk for injury and decreases the chance of mounting good immunity. There are currently no evidence to suggest vaccines raise the risk of SIDS. A mild temp may be expected with the DTaP. A fever of >105 F within 48 hrs of vaccination could warrant caution. The DTaP is not a live vaccine. No special precautions are needed regarding immunosuppressed family members)

The nurse assesses a 6 month old for vaccination readiness. Which finding would most likely indicate the need to delay administering the DTaP vaccine? 1. A family history of SIDS 2. A fever of 101.3 F following 4 month old vaccinations 3. An acute bilateral ear infection 4. living with a family member who is immunosuppressed.

4 (infants should be kept on formula or breast milk until 1 year of age. The protein in cows milk is harder to digest than is in formula. It does not matter what order fruits and veges are introduced as long as they are introduced slowly. Solids are introduced around 4-6 months, after the extrusion reflex has diminished and when the child will accept new textures. Iron def. develops in term infants between 4-6 months when the prenatal iron stores are depleted. Fortified cereals can be added to the diet at 4-6 months to prevent iron def. anemia.)

The nurse is teaching the parents of an 8 month old child about what the child should eat. The nurse should include which information points in the teaching plan? 1. veges should be introduced before fruits 2. solid foods should not be introduced until the infant is 10 months old 3. Iron fortified cereals should not be introduced until the child is 8 months old 4. The infants diet can be changed from formula to whole milk when the infant is 12 months old

3 (MOST likely to be influenced by example and atmosphere provided by parents. Coaxing and badgering most likely will aggravate poor eating habits)

The nurse discusses eating habits of school age children with their parents, explaining that these habits are most influenced by: 1. food preferences of their peers 2. smell and appearance of foods offered 3. examples provided by parents at mealtimes 4. parental encouragement to eat nutritious foods

2 (holding the head erect when sitting, staring at an object placed in the hand, taking the object to the mouth, cooing and gurgling, and sustaining part of the body weight when in a standing position are behaviors characteristic of 4 months. A 2 month infant typically vocallizes, follows objects to the midline and smiles. A 7 month old typically is able to sit without support, turns towards the voice and transfers objects from hand to hand. Usually, a 9 month old can crawl, stand when holding on, and initiate speech sounds)

The nurse notes that an infant stares at an object placed in his hand and takes it to his mouth, coos and gurgles when talked to, and sustains part of his own weight when held in a standing position. The nurse correctly interprets these findings as characteristic of an infant at which age? 1. 2 months 2. 4 months 3. 7 months 4. 9 months

4 (according to the Denver Developmental Screening Exam, a child of 8 months should sit without support for long periods of time. An 8 month old child does not have the ability to stand without hanging onto a stationary object for support. Their muscles are not developed enough to support all their weight without assistance. Their balance is not yet developed to the point they can stand and stoop to reach an object)

The nurse should refer the parents of an 8 month old child to a HCP if the child is unable to: 1. stand momentarily without holding onto furniture 2. stand unsupported well for long periods of time 3. stoop to recover an object 4. sit without support for long periods of time

3 (snacks are necessary for school age children because of their high energy level. They can learn to classify or categorize and cause and effect. By preparing their own snacks they learn basics of nutrition. The mother and child should make decisions together about appropriate foods. Instinct is not a factor)

The parent asks the nurse about the 9 year old childs apparent need for between meal snack, especially after school. When developing a sound nutritional plan for the child with the mother, the nurse should advise the parent that: 1. The child does not need to eat between meal snacks 2. The child should eat the snacks the mother thinks is appropriate 3. the child should help with preparing his or her own snacks 4. the child will instinctively select nutritional snacks

2 (Children this age have lots of energy and gross motor skills. A limitation of their motor ability is in moving quickly they may be unable to judge distances or estimate amount of balance and strength needed for activities so they have frequent mishaps. This level of activity is not usually associated with changes in home, however if it intensifies a referral to a pediatric neuro would be appropriate. Abused children are usually withdrawn not having endless energy.)

The parent of a 4 year old expresses concern that the child may be hyperactive. The parent describes the child as always in motion, constantly dropping and spilling things. Which action would be appropriate at this time? 1. determine whether there have been any changes in the home 2. explain that this is not unusual behavior 3. explore the possibility that the child is being abused 4. suggest that the child be seen by a pediatric neurologist

3 (Infants should remain on formula or breast milk until 1 year old. The nurse needs to first assess if the parent switched due to lack of info or resources. Then appropriate teaching and referrals may be made/determined. At 1 yr old the infant is switched to WHOLE Milk, which has higher fat content for brain growth. Demanding clients change behaviors without addressing the cause is unlikely to produce desired results.)

The parent of a 6 month old reports starting 2% milk. The nurse should first ask the parent: 1. Do you think your baby will be fine with this milk? 2. Is it possible to switch your baby to whole milk? 3. Can you tell me more about why you switched your baby to 2% milk? 4. You cannot switch to 2% milk right now. Did your pediatrician tell you to do this?

1 (many teens are fatigued from combo of fast food diets, many activities and a rapid growth spurt; this is normal behavior, and the nurse should explain possible reasons for the sleep pattern. Teens typically need 8.5-9.5 hrs of sleep. There is no data to suggest that activities are tiring this teen. It is not appropriate to suggest drug use based on this question)

The parents of a teen boy are concerned that their son seems to need 9 hrs of sleep a night. The nurse should advise the parents: 1. as long as he seems otherwise well this sounds typical teenager 2. teens need only 8 hrs sleep a night, anything over this is excessive 3. your son is probably engaged in too many activities and wearing himself out 4. the side effects of many drugs is sleepiness

3 (during the school age years children learn to socialize with other children of the same age. The "best friend" stage, which occurs around 9-10 years of age is important to provide the foundation for self esteem and future relationships. Thinking independently and organizing, and planning are cognitive skills. Active play is motor skills.)

To assess a 9 year olds social development, the nurse asks the parents if the child: 1. thinks independently 2. is able to organize and plan 3. has a best friend 4. enjoys active play

4 (A 1 month old infant is usually able to lift the head from a prone position. the full term infant with no complications has probably been able to do this since birth. Smiling and laughing is expected behavior at 2-3 months. Rolling from back to side and holding a rattle are characteristics of a 4 month old)

To assess the development of a 1 month old, the nurse asks the parent if the infant is able to: 1. smile and laugh out loud 2. roll from back to side 3. hold a rattle briefly 4. lift head from prone position

2 (parents can be asked to assist when their child become uncooperative during a procedure. Most commonly, the childs difficulty in cooperation is caused by fear. In most situations the child will feel more comfortable with the parent present. Other methods such as asking a nurse to assist or waiting until the child calms down may be necessary, but obtaining the parents assistance is the recommended first action. Restraints should be used only as a last resort. )

When assessing a 2 year old child brought to the clinic by her parents is uncooperative when the nurse first tries to look in her ears. What should the nurse try first? 1. ask another nurse to assist 2. allow parent to assist 3. wait until the child calms down 4. restrain the childs arms

3 (2 year olds can usually kick a ball forward. 3 year olds can usually ride a tricycle. 5 year olds tie shoes laces. 3 year olds use blunt scissors)

When assessing a child (2 year old) at the clinic for a routine check up, which skill should the nurse expect the child to perform? 1. ride a tricycle 2. tie his or her shoes 3. kick a ball forward 4. use blunt scissors

2

Which action initiated by the parents of an 8 month old indicates they need further teaching about preventing childhood accidents? 1. placing a fire screen in front of the fireplace 2. placing a car seat in a front seat front facing position 3. inspecting toys for loose parts 4. placing toxic substances out of reach or in a locked cabinet

4 (more than 90% of 9 month olds are able to stand holding onto objects. Rolling over is expected at 4-6 months, and sitting without support is expected at 6 months. Crawling is expected at 9 months)

Which infant most needs a developmental referral for a gross motor delay? 1. the 2 month old who does not roll over 2. 4 month old who does not sit without support 3. 6 month old who does not crawl 4. 9 month old who does not stand holding on

2 (simultaneous injection reduces anxiety from anticipation of the next injection. Needle length must be long enough to deposit the vaccine into the muscle. A 5/8 inch needle is appropriate for a newborn but is not long enough for a 1 month or older child. Aspirating for blood return does not confirm needle placement. Breast feeding during vaccines, not before, has been found to reduce pain.)

Which intervention should the nurse employ to reduce trauma caused by vaccine administration to an infant? 1. use a 5/8 inch needle 2. simultaneously admin vaccines at separate sites with a second nurse 3. Aspirate to verify needle placement 4. breast feed right before administering the vaccine

3 (It is important to assist parents to assess speech development in their child so developmental delays can be identified early. According to Denver Developmental Screening Exam, at 8 months of age, the child should say "mama" and "dada" nonspecifically and imitate speech sounds. children cannot say "dada" or "mama" specifically or use more than three words until they are about 12 months of age. A child can not respond to specific commands or point to objects on request until about 17 months of age)

Which is appropriate language development for an 8 month old? The child should be: 1. saying "dada to father and "mama" to mother. 2. saying three other words besides mama and dada 3. saying dada and mama nonspecifically 4. saying "ball" when parents point to a ball.

1 (guidlines recommend parents keep toddlers in rear facing seats until 2 years of age or they reach the max height and weight for the seat. Car seats are marked with expiration dates because the integrity of plastic deteriorates with age. Booster seats are recommended for older child until they are 4'9. (typically 8-12 years old). Children should ride in the backseat until the age of 13 to minimize injury from airbags)

Which statement by a parent reflects the need for further teaching regarding car seat safety? 1. My baby should stay in a rear facing car seat until he is 1 year old 2. I should check the car seats expiration date before using it 3. My older child will need to stay in a booster seat until he is 4' 9 4. My children should ride in the backseat until they are 13 years old