OB PEDS Test 3

A nurse is modeling play time with a 6-month-old infant. Which activity is appropriate? 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 Six-month-old children enjoy playing pat-a-cake and peek-a-boo. Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games. Four-month-old infants enjoy bright rattles and tactile toys. Twelve-month-old infants enjoy playing with push-and-pull toys.

The nurse is assessing an infant's growth and development. The parents want education on how to stimulate this process. What action suggested by the nurse is inconsistent with knowledge of this topic? a. Have the family draw a three-generation family pedigree. b. Show the family how to coo and babble with their child. c. Encourage the parents to buy interactive toys for the child. d. Involve the child in activities that are outside the home.

ANS: A A family pedigree can help show relationships and health care problems but will not stimulate growth and development. Activities that are stimulating for a child include the consistent use of language by the parents, allowing play time with interactive toys (toys that make noises or do something in response to the baby's actions), and exposing the child to new sights and sounds.

A 2-month-old child has not had any immunizations. Which ones should the nurse prepare to give? (Select all that apply.) a. Hib b. HepB c. MCV d. Varicella e. HPV

ANS: A, B, C, D Hib, HepB, MCV, and varicella are all appropriate vaccinations for this child. HPV is for adolescents.

The nurse plans a teaching session with a toddler's parents on car safety. Which will the nurse 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. Once the toddler outgrows the rear-facing car seat, the toddler can be placed in a forward-facing car seat.

ANS: A, C, E Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. Once the child outgrows the rear-facing car seat, the child can sit in a forward-facing car seat. 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.

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

Which does the nurse teach as an appropriate disciplinary intervention for the school-age child? a. Time-out periods b. Consequences that are consistent with the behavior c. Physical punishment d. Lectures about inappropriate behavior

ANS: B A consequence that is related to the inappropriate behavior is the recommended discipline. Responsibility can be developed in children through the use of natural and logical consequences related to actions. Time-out periods are more appropriate for younger children. Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child's inappropriate behavior. Lengthy discussions typically are not helpful.

What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down? a. ―You must never leave the child in the room alone with the side rails down.‖ b. ―I am very concerned about your child's safety when you leave the side rails down.‖ c. ―It is hospital policy that side rails need to be up if the child is in bed.‖ d. ―When parents leave side rails down, they might be considered as uncaring.‖

ANS: B To express concern and then choose words that convey a policy without appearing to cast blame on improper behavior is appropriate. Framing the communication in the negative does not facilitate effective communication. Stating a policy to parents conveys the attitude that the hospital has authority over parents in matters concerning their children and may be perceived negatively. It also does not give information as to why the side rails need to be up. This statement conveys blame and judgment to the parent.

A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding? a. The child is relaxed. b. Respiratory failure is likely. c. This child is in respiratory distress. d. The child's condition is improving

ANS: B Very slow breathing in an ill child is an ominous sign, indicating respiratory failure. Although the respiratory rate slows when an individual is relaxed, a rate of 10 breaths per minute in an ill preschool child is not a normal finding and is cause for concern. A rapid respiratory rate indicates respiratory distress. Other signs of respiratory distress may include retractions, grunting, and nasal flaring. A respiratory rate of 10 breaths per minute is not a normal finding for a preschool child nor does it demonstrate improvement.

A student nurse is preparing to administer an Hib vaccination to an infant. What action by the student requires the registered nurse to intervene? a. Gives the vaccine information statement prior to administering the vaccine b. Wipes the dorsal gluteal area with alcohol prior to injection c. Obtains written informed consent before giving the vaccine d. Assesses the family's beliefs and values about vaccinations

ANS: B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants. When the student prepares the wrong site, the registered nurse should intervene. Federal law requires parents be given vaccine information statements and sign informed consent prior to the nurse's administering vaccinations. The nurse should also assess the family's beliefs and values related to vaccination, which can help dispel myths and guide teaching.

Many adolescents decide to follow a vegetarian diet during their teen years. The nurse can advise the adolescent and his or her parents that a. this diet will not meet the nutritional requirements of growing teens. b. a vegetarian diet can be healthy for this population. c. an adolescent on a vegetarian diet is less likely to eat high-fat foods. d. a vegetarian diet requires little extra meal planning.

ANS: B A vegetarian diet is healthy for this population, and the low-fat aspect of the diet can prevent future cardiovascular problems. Several dietary organizations have suggested that a vegetarian diet, if correctly followed, is healthy for this population. As with any adolescent, nurses need to advise teens who follow a vegetarian eating plan to avoid low-nutrient, high-fat foods. The nurse can assist with planning food choices that will provide sufficient calories and necessary nutrients. The focus is on obtaining enough calories for growth and energy from a variety of fruits and vegetables, whole grains, nuts, and soymilk.

The nurse teaches the parents that which of the following is the primary purpose of a transitional object? a. It helps the parents with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

ANS: C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. Decreased parental guilt (distress) is an indirect benefit of a transitional object. A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

An effective technique for communicating with toddlers is to a. have the toddler make up a story from a picture. b. involve the toddler in dramatic play with dress-up clothing. c. use picture books. d. ask the toddler to draw pictures of his fears.

ANS: C Activities and procedures should be described as they are about to be done. Use picture books and play for demonstration. Toddlers experience the world through their senses. Most toddlers do not have the vocabulary to make up stories. Dramatic play is associated with older children. Toddlers probably are not capable of drawing or verbally articulating their fears.

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 Egocentric and narcissistic behavior, such as staring at oneself in the mirror, is normal during this period of development. The teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal development. More responsibility at home is not an appropriate response for this situation. The behavior is normal and needs no further investigation.

Which is the most appropriate question to ask when interviewing an adolescent to encourage conversation? a. ―Are you in school?‖ b. ―Are you doing well in school?‖ c. ―How is school going for you?‖ d. ―How do your parents feel about your grades?‖

ANS: C Open-ended questions encourage communication. Questions with ―yes‖ or ―no‖ answers do not encourage conversation. Questions that can be interpreted as judgmental do not enhance communication. Asking adolescents about their parents' feelings may block communication.

A positive, supportive communication technique that is effective from birth throughout adulthood is a. listening. b. physical proximity. c. environment. d. touch.

ANS: D Touch can convey warmth, comfort, reassurance, security, caring, and support. In infancy, messages of security and comfort are conveyed when they are being held. Toddlers and preschoolers find it soothing and comforting to be held and rocked. School-aged children and adolescents appreciate receiving a hug or pat on the back (with permission). Listening is an essential component of the communication process. By practicing active listening skills, nurses can be effective listeners. Listening is a component of verbal communication. Individuals have different comfort zones for physical distance. The nurse should be aware of these differences and move cautiously when meeting new children and families. It is important to create a supportive and friendly environment for children including the use of child-sized furniture, posters, developmentally appropriate toys, and art displayed at a child's eye level.

A father tells the nurse that his toddler wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should suggest that the family do which of the following? a. Do not take the child to restaurants until this behavior has stopped. b. Take the child but do not give in to this demand. c. Explain to the child that restaurants have their own dishes. d. Suggest the family take the dishes and use them at the restaurant.

ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. The family can take the dishes and serve the toddler's food and drink with them. Not taking the child out sometimes deprives him or her of a social experience. Not giving in sets the stage for temper tantrums. This child is too young to understand an explanation.

The nurse is planning to teach parents of a 15-month-old child. Which is the priority concern that the nurse should address? 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 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. 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. Parents of a 15-month-old child should have been advised to begin weaning from the breast or bottle at 6 to 12 months of age. 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.

The nurse is presenting information on burn safety to a toddler and preschool parenting group at a local community center. To avoid the most common cause of fire death in children this age, what information does the nurse provide? a. Practice family fire drills often. b. Cover outlets with plastic covers. c. Turn the water heater temperature to 110° F (43.3° C). d. Keep children out of the kitchen when cooking.

ANS: A Children younger than 5 years are at the greatest risk for burn deaths in a house fire. They often panic and hide in closets or under beds rather than escape safely. Parents need to practice fire drills with their children to teach them what to do in the event of a house fire. Covering outlets, turning the water heater down, and keeping children out of the kitchen when cooking are more appropriate for younger children.

A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The parents ask the nurse if they should be concerned about this behavior. Which response by the nurse is best? a. This is normal because of increase in body mass during this time. b. This is abnormal and suggestive of possible future obesity. c. His caloric intake would have to be excessive for him to gain weight. d. He is substituting food for unfilled needs.

ANS: 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. It is not suggestive of possible future obesity or unmet psychosocial needs. It may be true that the teen would need to eat an enormous amount of food in order to gain weight, but that does not give the parents the information they are requesting

A nurse is assessing a 1-year-old's food intake over the past 3 days. What information from the parent leads the nurse to provide education on nutrition? a. Child drinks 2 cups of 1% milk each day. b. Child loves to snack on fruit throughout the day. c. Child gets one 4-ounce cup of juice with breakfast. d. Parent allows child to regulate own portions at meals.

ANS: A A child this age should not be drinking low-fat milk. Snacking on fruit, 4 ounces of juice, and not forcing the child to eat everything on the plate are appropriate activity and do not require education.

The nurse advises the mother of a 3-month-old exclusively breastfed infant to a. start giving the infant a vitamin D supplement. b. start using an infant feeder and add rice cereal to the formula. c. start feeding the infant rice cereal with a spoon at the evening feeding. d. continue breastfeeding without any supplements.

ANS: A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets. An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods are not recommended for a 3-month-old infant. Rice cereal and other solid foods are contraindicated in a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age.

A nurse is making a home visit on a new mother with an infant. What action by the mother requires the nurse to intervene? a. Cooks while holding and cuddling infant to provide comfort b. Keeps hand on infant while reaching for supplies on changing table c. Shows the nurse the water heater setting that is on 110° F (43.3° C) d. Places baby to sleep in crib with no blankets, toys, or other objects

ANS: A Burns are a leading cause of injury in children. The mother should not be holding the baby while cooking, so the nurse must intervene at this point. The other actions all provide safety.

The nurse is assessing a preschool aged child during a well-child checkup. This child has gained 2 pounds in 1 year. What action by the nurse is best? a. Ask the parent to provide a 3-day diet diary. b. Assess the child's teeth and gums. c. Plot the weight gain on the growth chart. d. Instruct the parent on today's needed vaccinations.

ANS: A Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated. The other actions are part of a well-child checkup but are not related to the lack of weight gain.

When a child broke her favorite doll during a hospitalization, her primary nurse bought the child a new doll and gave it to her the next day. What is the best interpretation of the nurse's behavior? a. The nurse is displaying signs of overinvolvement. b. The nurse is a kind and generous person. c. The nurse feels a special closeness to the child. d. The nurse wants to make the child happy.

ANS: A Buying gifts for individual children is a warning sign of overinvolvement. Nurses are kind and generous people, but buying gifts for individual children is unprofessional. Nurses may feel closer to some patients and families. This does not make giving gifts to children or families acceptable from a professional standpoint. Replacing lost items is not the nurse's responsibility. Becoming overly involved with a child can inhibit a healthy relationship.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for ―being bad.‖ She shares her concern that if she dies, she will go to hell. What action by the nurse is most appropriate? a. Reassure the child that she is not being punished. b. Share concerns about development with the parents. c. Request a child-life specialist to intervene. d. Have the chaplain console the child.

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined transgression. The nurse should reassure the child that she is not being punished. Since this is a common belief at this age, there are no concerns to share with parents. A child-life specialist or chaplain visit may be appropriate, but the nurse needs to respond to this statement him- or herself.

Which statement, made by a nursing student to the father of a 4-year-old child, warrants correction by the nurse? a. ―Because the ‗baby teeth' are not permanent, they are not important to the child.‖ b. ―Encourage your child to practice brushing his teeth after you have thoroughly cleaned them.‖ c. ―Your child's ‗permanent teeth' will begin to come in around 6 years of age.‖ d. ―Fluoride supplements are needed if you do not have fluoridated water.‖

ANS: 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. Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. But encouraging the child to practice will aid in increasing his or her abilities. Secondary teeth erupt at approximately 6 years of age. If the family does not have fluoridated water, the child will need fluoride treatments.

Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth.

ANS: A Development, a continuous and orderly process, provides the basis for increases in the child's function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.

A nurse is interested in preventing injuries to children while they play. What action by the nurse would most likely lead to the biggest impact? a. Volunteering for an organization that gives away bicycle helmets. b. Providing education on the need for knee pads when skating. c. Teaching parents that children too big for child care seats should sit in the front seat. d. Encouraging children to play only on formal, constructed playgrounds.

ANS: A Head injuries from bicycles are a large part of serious injury to children in this age group. They need to be taught to only ride a bike while wearing a helmet. The nurse's best option is to volunteer for an organization that gives away helmets. Knee pads when skating is also a good idea, but that won't have the impact of helmets. Once a child is too big for a child care seat and the seat belt fits appropriately, the child should sit in the back seat. Playing on constructed playgrounds only will not prevent injuries and is unrealistic.

A nurse is teaching parents to avoid environmental injury to their 2-year-old child. What information does the nurse include in teaching? a. Avoiding sun exposure, secondhand smoke, and lead b. Living in a middle-class neighborhood c. Avoiding smoking and alcohol intake during pregnancy d. Limiting breastfeeding to avoid toxins being passed through breast milk

ANS: 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. The nurse is unable to influence socioeconomic status, and the family may not want or be able to move. 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. It is unlikely that a 2-year-old child will still be breastfeeding

A nurse wants to volunteer for an organization that helps prevent death in older adolescents. What action by the nurse would have the most impact? a. Volunteer for a suicide hotline. b. Teach firework safety classes. c. Work on a poison control hot line. d. Educate teens on gun safety.

ANS: A Of the four causes of death listed, suicide ranks highest, being the second most common cause of death in the 15 to 24 age group. The nurse would make the biggest impact volunteering for a suicide hotline.

The parents of a preschool-aged child are in the clinic and report the child is seen playing with the genitals frequently. What response by the nurse is best? a. Reassure parents this is normal at this age. b. Teach parents about behavior modification. c. Refer parents and child to a psychologist. d. Ask the provider to speak to the parents.

ANS: A Preschool children are in the Phallic or Oedipal/Electra Stage of Freud's theory during which the genitals become the focus of curiosity and interest. The nurse should explain that this behavior is normal at this stage. Teaching about disciplinary techniques and referrals to psychotherapy are inappropriate. The nurse may well want the provider to speak to the parents, but the nurse is responsible for patient/parent teaching and should provide education him- or herself.

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

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

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. What action by the school nurse is most appropriate? a. Assess the child for unusual stress. b. Perform a detailed physical exam. c. Call the parents in for a conference. d. Screen the child for developmental delay.

ANS: A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. The nurse should assess the child for stress. The other actions are not warranted although the nurse may want to have a conference with parents after screening the child.

A parent is worried that a child is not eating well. What does the nurse teach the parent to address this problem? a. Limit sports and team events that occur over the dinner hour. b. Pack a nutritious lunch to take to school every day. c. Teach about healthy snacks available at school. d. Ensure the child gets 2 cups of milk products a day.

ANS: A Sports and team schedules often disrupt mealtime, especially dinner, and families often find themselves eating fast food on the way to practices and games. The family's best option is to limit activities that occur during this time. The child may not eat a packed lunch and may choose unhealthy foods from the schools' vending machines. Children in this age group need 3 cups of milk and dairy products per day.

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

ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior fontanel closes between 2 and 3 months of age. There is no need for a recheck, a referral, or a developmental assessment.

The nurse teaches parents signs that a child might be being bullied or otherwise victimized. What signs does the nurse include in this teaching? (Select all that apply.) a. Spends an inordinate amount of time in the nurse's office b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.

ANS: A, B, C Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them. Improving school performance and talking about the day are not indications of bullying.

Which demonstrates the school-age child's developing logic in the stage of concrete operations? (Select all that apply.) a. Recognizes that 1 lb of feathers is equal to 1 lb of metal b. Recognizes that he can be a son, brother, or nephew at the same time c. Understands the principles of adding, subtracting, and reversibility d. Has thinking that is characterized by egocentrism, animism, and centration e. Often solves problems with random guessing instead of logic

ANS: A, B, C The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations. Egocentrism, animism, and centration occur in the intuitive thought stage, as does random guessing

A nurse works for an organization that seeks to limit adolescent violence. In talking with donors, which risk factors for violence may lead to programming decisions? (Select all that apply.) a. Drug or alcohol use/abuse b. Poverty c. Hopelessness about the future d. Narcissism e. Lack of supervision

ANS: A, B, C, E Drug and alcohol use/abuse, poverty, hopelessness, and lack of supervision all are risk factors for violence. Narcissism is not.

The school nurse is evaluating the school's athletic programs for safety. What factors should the nurse assess? (Select all that apply.) a. Students get adequate rest periods. b. Equipment is in good condition. c. Practices are appropriate for students. d. Post-game concussion assessment if needed e. Adequate fluids are available at all times.

ANS: A, B, C, E A safe athletic program has several features including adequate rest periods, good quality equipment, appropriate practice schedules and regimes, and adequate fluids. Concussion testing if warranted, should occur immediately as the student is withdrawn from the game, and not wait until after the game is over.

A nurse is assessing a child for toilet training readiness during a home visit. Which behaviors by the child are positive signs? (Select all that apply.) a. Removes own clothing b. Walks into bathroom on own c. Has been walking for 6 months d. Will give up toy when asked to e. Scratches as legs periodically

ANS: A, B, D Signs of readiness for toilet training include being able to remove own clothing, being willing to let go of a toy when asked, is able to sit, squat, and walk well, has been walking for 1 year, noticing if diaper is wet, pulls on diaper or exhibits other behavior indicating diaper needs to be changed, communicating the need to go to the bathroom or goes there by self and wanting to please parent by staying dry.

While developing a care plan for a school-age child with a visual impairment, the nurse knows that which of the following actions are important in working with this special needs child? (Select all that apply.) a. Obtain a thorough assessment of the child's self-care abilities. b. Orient the child to various sounds in the environment. c. Tell the child's parents to stay continuously with their child during hospitalization. d. Allow the child to handle equipment as procedures are explained. e. Encourage the child to use a dry erase board to write his needs.

ANS: A, B, D Conducting a thorough assessment of the child's self-care abilities, orienting the child to various sounds in the environment, and allowing the child to handle equipment are all ways to enhance communication with a visually impaired child. Mandating that the child's parents stay continuously with their child may not be possible and is not usually necessary if the school-age child is at the expected level of growth and development. Encouraging a child to write his needs on a dry erase board would be an appropriate intervention for a child who is hearing impaired, not for a child with a visual deficit.

The nurse preparing to administer the Denver Developmental Screening Test II (DDST-II) should understand that it assesses which functional areas? (Select all that apply.) a. Personal-functional b. Fine motor c. Intelligence d. Language e. Gross motor

ANS: A, B, D, E The four functional areas assessed by this tool are personal-functional, fine motor, language, and gross motor. It is not an intelligence test.

Which interventions should the nurse teach that are appropriate for preventing childhood obesity? (Select all that apply.) a. Establish consistent times for meals and snacks. b. Sign your child up for sports teams. c. Teach the family and child how to prepare foods in a healthy manner. d. Show the family how to read food labels. e. Limit computer and television time.

ANS: A, C, D, E Preventing obesity includes encouraging families to establish consistent times for meals and snacks, teaching them how to select and prepare healthful foods, and limiting computer and television time. Participating in sports is a great activity, but parents should not sign their kids up for teams without consulting them first.

Which behaviors by the nurse may indicate professional separation or under-involvement? (Select all that apply.) a. Avoiding the child or his or her family b. Revealing personal information c. Calling in sick d. Spending less time with a particular child e. Asking to trade assignments

ANS: A, C, D, E Whether nurses become too emotionally involved or find themselves at the other end of the spectrum—being under-involved—they lose effectiveness as objective professional resources. These are all indications of the nurse who is under-involved in a child's care. Revealing personal information to a patient or his or her family is an indication of overinvolvement.

Which factors contribute to early adolescents engaging in risk-taking behaviors? (Select all that apply.) a. Peer pressure b. A desire to master their environment c. Trying to separate from their parents d. A belief that they are invulnerable e. Impulsivity

ANS: A, D, E Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability (―It can't happen to me‖) are evident in adolescence. Impulsivity places adolescents in unsafe situations. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training.

A preschool-age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which phrases when explaining procedures to the child? (Select all that apply.) a. Fluids will be given through tubing connected to a tiny tube inserted into your arm. b. After surgery we will be doing dressing changes. c. You will get a shot before surgery. d. The doctor will give you medicine that will help you go into a deep sleep. e. We will take you to surgery on a bed on wheels.

ANS: A, D, E A preschool child needs simple concrete explanations that cannot be misinterpreted. An IV should be explained as fluids going into a tube connected to a small tube in your hand; anesthesia can be explained as a medicine that will help you go into a deep sleep (put to sleep should be avoided); and a stretcher can be described as riding on a bed with wheels. The term ―dressing changes‖ is ambiguous and will not be understood by a preschooler. The term ―get a shot‖ should not be used. A preschooler or young child is likely to misinterpret this information.

The nurse is teaching a community group about preventing sudden infant death syndrome (SIDS). What information does the nurse provide? (Select all that apply.) a. Placing the baby supine to sleep b. Covering the baby warmly with blankets c. Have the baby sleep upright in the infant carrier d. Provide ―tummy time‖ while awake e. Do not allow smoking in the house

ANS: A, D, E Recommendations to prevent SIDS include placing the baby supine in a crib with a well-fitting bottom sheet without covers or toys, providing tummy time during play, and avoiding exposure to environmental hazards such as smoke. The child should not be put to sleep in an infant carrier or covered warmly with blankets.

Which action should the nurse working in the emergency department implement in order to decrease fear in a 2-year-old child? a. Keep the child physically restrained during nursing care. b. Allow the child to hold a favorite toy or blanket. c. Direct the parents to remain outside the treatment room. d. Let the child decide whether to sit up or lie down for procedures.

ANS: B Allowing a child this age to hold a favorite toy or blanket is comforting. It may be necessary to restrain the toddler for some nursing care or procedures. Because toddlers need autonomy and do not respond well to restrictions, the nurse should remove any restriction or restraint as soon as safety permits. Parents should remain with the child as much as possible to calm and reassure her. The toddler should not be given the overwhelming choice of deciding which position she prefers. In addition, the procedure itself may dictate the child's position.

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. ―Try to collaborate to set limits that are perceived as being reasonable.‖ c. ―Increasing your teen's involvement with her peers will improve her behavior.‖ d. ―Allow your teenager to choose the type of discipline that is used in your home.‖

ANS: 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. Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. Increasing peer involvement does not typically improve behavior. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

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 An infant triples birth weight by 1 year of age. The other calculations are incorrect.

The nursing student has planned teaching for a toddler parent group on poison prevention in the home. In reviewing the presentation with the nurse, what information requires the nurse to provide more instruction to the student? a. Lock all medications away securely. b. Place cleaning supplies in a top cabinet. c. Try not to let your child watch you take pills. d. Call Poison Control right away for an exposure.

ANS: B Anything potentially poisonous including things like medication, cleaning supplies, or personal care items must be stored in places completely inaccessible to children. Toddlers view climbing as a challenge, so a top cabinet is not inaccessible. The other instructions are appropriate.

A school nurse reports to the parents that their child is complaining of frequent headaches. What suggestion does the nurse offer to the parents? a. A complete neurologic workup b. A vision screening exam c. Decreased amount of household stress d. Assessment for seasonal allergies

ANS: B Children often manifest visual problems during the school-age period. These children may squint, move closer to the television or to the front of the class if possible, or complain of headaches. The parents should obtain a visual screening exam for their child. None of the other options is needed at this point.

Which statement made by a mother is consistent with a developmental delay? a. ―I notice my 9-month-old infant responds consistently to his name.‖ b. ―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 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. An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. A social smile is present by 2 months of age. Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.

A nurse uses Erikson's theory to guide nursing practice. What action by a hospitalized 4-year-old child would the nurse evaluate as developmentally appropriate? a. Dressed and fed by the parents b. Independently ask for play materials or other personal needs c. Verbalizes an understanding of the reason for the hospitalization d. Asks for a parent stay in the room at all times

ANS: B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is not a developmental 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.

Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization? a. A detailed explanation of the procedure b. A description of what the child will feel and see during procedure c. An explanation about the dye that will go directly into his vein d. An assurance to the child that he and the nurse can talk about the procedure when it is over

ANS: B For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child's ability to cope with the events of the procedure and will decrease anxiety. Explaining the procedure in detail is probably more than the 5-year-old child can comprehend, and it will likely produce anxiety. Using the word ―dye‖ with a preschooler can be frightening for the child. The child needs information before the procedure.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What response by the nurse is best? a. ―That's OK. formula is just as good for a 5-month-old.‖ b. ―Be sure to use an iron-fortified formula instead.‖ c. ―The baby will need immunizations earlier now.‖ d. ―Be sure to monitor how many diapers the baby wets.‖

ANS: B For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. There is no need to provide immunizations on a different schedule or specific reason for monitoring wet diapers

Parents tell the nurse that their preschool-age child seems to have an imaginary friend named Bob. Whenever their child is scolded or disciplined, the child in turn scolds Bob. What response by the nurse is most appropriate? a. Ask the child to introduce Bob when the parents are not present. b. Inform the parents that this is normal behavior in this age group. c. Suggest the parents discuss the situation with the provider. d. Refer the child for hearing and vision screening

ANS: B In the early preschool years, boundaries between reality and fantasy blur. Children at the age may develop imaginary friends who can keep them company or take the blame when the child misbehaves. The nurse informs the parents that this is normal behavior. The child likely will not ―introduce‖ Bob to a stranger. The nurse him- or herself needs to provide this anticipatory guidance and not just suggest the parents talk to the provider. There is no reason for sensory screening

Which nursing action facilitates care being provided to a child in an emergency situation? a. Encourage the family to remain in the waiting room. b. Include parents as partners in providing care for the child. c. Always reassure the child and family. d. Give explanations using professional terminology

ANS: B Include parents as partners in the child's treatments. Parents may need direct guidance in concrete terms to help distract the child. Allowing the parents to remain with the child may help calm the child. Telling the truth is the most important thing. False reassurance does not facilitate a trusting relationship. Professional terminology may not be understood. Speak to the child and family in language that they will understand.

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 a nutritious choice at this time.‖ b. ―Children should not get cow's milk until 1 year of age.‖ c. ―Limit cow's milk to one bedtime bottle.‖ d. ―Mix cereal with cow's milk and feed it in a bottle.‖

ANS: 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 gastrointestinal problems, such as bleeding. Cow's milk protein intolerance is the most common food allergy during infancy. 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. Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. Food and milk or formula should not be mixed in a bottle.

A mother of a 2-month-old infant tells the nurse, ―My child doesn't sleep as much as his older brother did at the same age.‖ What is the best response for the nurse? a. "Have you tried to feed the baby more often or play more before bedtime?" b. "Infant sleep patterns vary widely, some infants sleep only 2 to 3 hours at a time." c. "Keep a record of your baby's eating, waking, sleeping, and elimination patterns and to come back to discuss them." d. "This infant is difficult. It is important for you to identify what is bothering the baby."

ANS: B Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. Infants typically do not need more caloric intake to improve sleep behaviors. Stimulating activities before bedtime may keep the baby awake. There is no need for the mother to keep behavior records. Just because an infant may not sleep as much as a sibling did does not justify labeling the child as being difficult. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep.

The parent 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 parent is, a. ―It is important for your toddler to eat three meals a day and no snacks.‖ b. ―It is not unusual for toddlers to eat less due to slower growth.‖ c. ―Be sure to increase your child's milk consumption, which will improve nutrition.‖ d. ―Give your child a multivitamin daily to increase your toddler's nutrition.‖

ANS: B Physiologically, growth slows and appetite decreases during the toddler period. So the nurse should assure the parent that this is normal behavior. Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. 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. Supplemental vitamins are important for all children, but they do not increase appetite.

A nurse wants to assess a chronically ill child's feelings regarding a lengthy hospitalization and treatments. What action by the nurse is best? a. Ask direct questions of the child as to feelings. b. Watch the child play on several occasions. c. Discuss the situation with the parents. d. Refer the child to the child life specialist for assessment.

ANS: B Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments. The nurse can best decipher the child's emotional state by observing this activity. Children often are threatened by direct questions, especially if the questioner is not well known to the child. The nurse may want to discuss the situation with the parents or enlist the help of the child life specialist, but these will not give the nurse the rich data that can be obtained through watching the child play.

A nurse observes that a 3-month-old infant will hold a rattle if it is put in the hands, but the baby will not voluntarily grasp it. What action by the nurse is most appropriate? a. Provide anticipatory guidance. b. Document the findings in the chart. c. Refer the family to a neurologist. d. Perform a developmental screening.

ANS: B This child is displaying normal age-appropriate behavior. The nurse should document the findings, but no other action is necessary. The nurse should always provide appropriate anticipatory guidance, but this answer is too vague to be the best response.

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children should be forced to sit on the toilet when first learning.

ANS: B Voluntary control of the anal and urethral sphincters is achieved some time after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing himself or herself by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

A preschool aged child is in the clinic for a well-child checkup. Which statement identifies an appropriate level of language development in this child? (Select all that apply.) a. Vocabulary of 300 words b. Relates elaborate tales c. Uses correct grammar in sentences d. Able to pronounce consonants clearly e. Expresses abstract thought

ANS: B, C The 4-year-old child is able to use correct grammar in sentence structure and can tell elaborate tales and stories. A vocabulary of 300 words is appropriate for a 2-year-old. The 4-year-old child typically has difficulty in pronouncing consonants. The use of language to express abstract thought is developmentally appropriate for the adolescent.

A nurse is planning for a sports pre-participation physical exam day. What goals for this event does the nurse set? (Select all that apply.) a. Comprehensive physical examination b. Assess general health c. Identify limiting conditions d. Provide wellness counseling e. Adhere to insurance requirements

ANS: B, C, D, E In a pre-participation sports examination, goals are to identify the teen's general health, identify any condition that would limit participation, provide wellness counseling, and ensure that participants meet insurance guidelines for participation. It is not meant to be a comprehensive physical examination.

In planning care for a preschool-age child, the nurse knows that which open body postures encourage positive communication? (Select all that apply.) a. Leaning away from the preschooler b. Frequent eye contact c. Hands on hips d. Conversing at eye level e. Asking the parents to stay in the room

ANS: B, D Frequent eye contact and conversing at eye level are both open body postures that encourage positive communication. Leaning away from the child and placing your hands on your hips are both closed body postures that do not facilitate effective communication. Asking the parents to stay in the room while the nurse is talking to the child is helpful but is not an open body posture.

According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the __________ period of cognitive development. a. sensorimotor b. formal operations c. concrete operations d. preoperational

ANS: C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant's world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. The preoperational stage is a period of egocentrism in which the child's judgments are illogical and dominated by magical thinking and animism.

The nurse is explaining Tanner staging to an adolescent and mother. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronologic age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics

ANS: C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. The puberty stage in girls begins with breast development. Puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the basis of Tanner staging.

A nurse is caring for a child who does not speak English. The parents are able to understand and speak only limited English. What action by the nurse is best? a. Allow the patient's 12-year-old sister to interpret. b. See if there is another family member who can interpret. c. Use a professionally trained interpreter for this family. d. Use the Internet to translate written information in the native language.

ANS: C A professional interpreter is the best option in this situation. They are trained in medical interpreting and do not allow cultural influences into their work. A child should never be asked to interpret; the child may be too young to understand sophisticated concepts involved in the discussion and the information from the patient may be misconstrued and disturbing to the child. An adult family member may have to do temporarily in an emergency, but the best option is a professional interpreter.

Which action should the nurse incorporate into a care plan for a 14-year-old child in the emergency department? a. Limit the number of choices to be made by the adolescent. b. Insist that parents remain with the adolescent. c. Provide clear explanations, and encourage questions. d. Give rewards for cooperation with procedures.

ANS: C Adolescents are capable of abstract thinking and can understand explanations. They should be offered the opportunity to ask questions. Because adolescents are capable of abstract thinking, they should be allowed to make decisions about their care. Adolescents should have the choice of whether parents remain with them. They are very modest, and this modesty should be respected. Giving rewards such as stickers for cooperation with treatments or procedures is more appropriate for the younger child.

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

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 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. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development is orderly and proceeds in a predictable pattern based on each individual's abilities and potentials.

The parent of a 2-week-old infant asks the nurse whether the baby needs fluoride supplements, since mom is exclusively breastfeeding the baby. What response by the nurse is best? a. ―Yes, the baby needs to begin taking them now.‖ b. ―Is your water fluoridated?‖ c. ―She may need to begin taking them at age 6 months.‖ d. ―You can use infant cereal mixed with fluoridated water instead.‖

ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. Asking if the water is fluoridated and advising to mix water and cereal are not the best responses since the child is only 2 months old

When meeting a toddler for the first time, the nurse initiates contact by a. calling the toddler by name and picking the toddler up. b. asking the toddler for his or her first name. c. kneeling in front of the toddler and speaking softly to the child. d. telling the toddler that you are his or her nurse today.

ANS: C More positive interactions occur when the toddler perceives the meeting in a nonthreatening way. Placing yourself at the toddler's level and speaking softly can be less threatening for the child. Picking a toddler up at an initial meeting is a threatening action and will more likely result in a negative response from the child. Toddlers are unlikely to respond to direct questions at a first meeting. Telling the toddler you are the nurse is not likely to facilitate or encourage cooperation. The toddler perceives you as a stranger and will find the action threatening

A parent of an overweight 8-year-old wants to know how to keep the child from gaining more weight. What response by the nurse is best? a. Do not allow your child to snack. b. Make a school lunch every day. c. Model the behaviors you'd like to see. d. Place your child on a restricted diet.

ANS: C One good option for obesity prevention is to model the behaviors the parents want the child to emulate. The parents should set good examples with eating health and engaging in regular exercise. Snacks, if healthy, can be an important part of a nutritious day. Even if the parent makes a lunch for school each day, there is no guarantee the child will eat it. Children will likely rebel against a strict diet.

A group of boys ages 9 and 10 years have formed a ―boys-only‖ club that is open to neighborhood and school friends who have skateboards. This should be interpreted as a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development of this age. d. characteristic of children who are at risk for membership in gangs.

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.

What is an appropriate preoperative teaching plan for a school-age child? a. Begin preoperative teaching the morning of surgery. b. Schedule a tour of the hospital a few weeks before surgery. c. Show the child books and pictures 4 days before surgery. d. Limit teaching to 5 minutes and use simple terminology.

ANS: C Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate. Preoperative teaching a few hours before surgery is more appropriate for the preschool child. Preoperative materials should be introduced 1 to 5 days in advance for school-age children. Preparation too far in advance of the procedure can be forgotten or cause undue anxiety for an extended period of time. A very short, simple explanation of the surgery is appropriate for a younger child such as a toddler.

An 8-year-old girl asks the nurse how the blood pressure equipment works. The most appropriate nursing action is to a. ask why the child wants to know. b. determine why the child is so anxious. c. explain in simple terms how it works. d. tell the child he or she will see how it works as it is used

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

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 he needs immediate help.‖ d. ―If your friend mentions suicide again get your friend some help.‖

ANS: C Suicide is the second most common cause of death among American adolescents and young adults aged 15 to 24. 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. 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. The teen should not be responsible for getting more information from the friend. Waiting until the teen discusses suicide a second time may be too late.

In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor to include in this teaching? a. The child needs to be able to sit still. b. The child should be able to count to 25. c. The parent should have interaction and be responsive to the child. d. The child should attend a preschool program first.

ANS: C The earliest interactions between parent and infant lay the foundation for school readiness. Probably the most important factor in the development of academic competency is the relationship between parent and child. Sitting still and counting are important skills but are not as vital as parental involvement and responsiveness. Preschool is a helpful experience but not required to enter kindergarten.

A student nurse asks the faculty why peer relationships become more important during adolescence. Which of the following is the nurse's best response? 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 The peer group serves as a strong support to teenagers, providing them with a sense of belonging (versus individuality) and a sense of strength and power. During adolescence, the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. This does not mean teens do not like their parents who continue to play an important role in their personal and health-related decisions.

A nurse is planning to teach about injury prevention to a group of parents. What action by the nurse would best ensure a successful event? a. Have handouts listing community resources. b. Provide free safety gear like bike helmets. c. Group parents by child's developmental stage. d. Present the material in an interactive way.

ANS: C When providing anticipatory guidance to prevent injury, the most important thing for the nurse to know and understand is developmental levels of the children involved. Grouping parents by their child's developmental level allows the nurse to know this information about the group and to provide teaching specific to the group. The other options will help but are not as important as tailoring teaching to the specific needs of the children.

When counseling parents and children about the importance of increased physical activity, the nurse will emphasize which of the following? 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. Make exercise a fun and habitual activity

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

The nurse is talking to a 7-year-old boy during a well-child clinic visit. The boy states ―I am a Power Ranger, so don't make me angry!‖ What action by the nurse is best? a. Ask the child about other friends he might play with. b. Find out why the child thinks he is a Power Ranger. c. Ask the parents if he has any opposite sex friends. d. Conduct further developmental screening on the child.

ANS: D Magical thinking is developmentally appropriate for the preschooler not a 7-year-old. The nurse should assess this child's development further. Asking about other friends or special powers will not provide information related to development. A 7-year-old does not typically have opposite sex playmates.

What is the most important consideration for effectively communicating with a child? a. The child's chronologic age b. The parent-child interaction c. The child's receptiveness d. The child's developmental level

ANS: D The child's developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child. The child's age may not correspond with the child's developmental level; therefore it is not the most important consideration for communicating with children. Parent-child interaction is useful in planning communication with children, but it is not the primary factor in establishing effective communication. The child's receptiveness is a consideration in evaluating the effectiveness of communication.

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 with other people so he can adjust." b. "You might consider taking her to the doctor because she 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 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. The child does not need to see a doctor, and teething is unrelated.

A nurse is teaching a parent group about dental hygiene for their babies. What information does the nurse provide? a. Babies don't need dental care until they are three. b. Start brushing teeth when all of them have come in. c. Children are ready for dental care when they can hold a toothbrush. d. Start with the first tooth using a cotton swab and water to wipe the teeth.

ANS: 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. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. Being able to hold a toothbrush is not necessary as the parents should clean the teeth.

The father of a child in the emergency department is yelling at the physician and nurses. Which action is contraindicated in this situation? a. Provide a nondefensive response. b. Encourage the father to talk about his feelings. c. Speak in simple, short sentences. d. Tell the father he must wait in the waiting room

ANS: D Because a parent who is upset may be aggravated by observers, he should be directed to a quiet area. When dealing with parents who are upset, it is important not to be defensive or attempt to justify anyone's actions. Encouraging the father to talk about his feelings may assist him to acknowledge his emotions and may defuse his angry reaction. People who are upset need to be spoken to with simple words (no longer than five letters) and short sentences (no more than five words)

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. ―If we have a fire, we have to meet at the neighbor's house.‖ d. ―If there is a fire, I will go back for my cat Fluffy because she will be scared.‖

ANS: D Fire safety is important at any age, but for this age group children should know two different ways out of the house, how to call 911, and where the family will meet outside the house. Children should be taught never to return to a burning house, not even for a pet

What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby? a. ―Have you talked with your parents about this?‖ b. ―Do you have plans to continue school?‖ c. ―Will you be able to support the baby?‖ d. ―Can you tell me how your life will be if you have an infant?‖

ANS: D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen's perception and reality orientation. Asking the teenager whether she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. A direct question about continuing school will not facilitate communication. Open-ended questions encourage communication. Asking the teenager about how she will support the child will not facilitate communication. Open-ended questions encourage communication.

Which strategy is most likely to encourage a child to express feelings about the hospital experience? a. Avoiding periods of silence b. Asking yes/no questions c. Sharing personal experiences d. Using open-ended questions

ANS: D Open-ended questions encourage conversation. Periods of silence can serve to facilitate communication, but this is not the most effective means of getting the child to communicate. Yes/no questions are closed ended and do not encourage conversation. Talking about yourself shifts the focus of the conversation away from the child.

In providing anticipatory guidance to parents, which parental behavior does the nurse teach as most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe

ANS: D Parents living what they believe gives non-ambivalent messages and fosters the child's moral development and reasoning. Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children. Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child. Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning.

What is an appropriate nursing intervention for a 6-month-old infant in the emergency department? a. Distract the infant with noise or bright lights. b. Avoid warming the infant. c. Remove any pacifiers from the baby. d. Encourage the parent to hold the infant.

ANS: D Parents should be encouraged to hold the infant as much as possible while in the emergency department. Having the parent hold the infant may help to calm the child. Distraction with noise or bright lights is most appropriate for a preschool-age child. In an emergency health care facility, it is important to keep infants warm. Infants use pacifiers to comfort themselves; therefore, the pacifier should not be taken away.

Which statement made by a mother of a school-age boy indicates a need for further teaching? a. ―My child is playing soccer on a team this year.‖ b. ―He is always active with his friends playing games.‖ c. ―I limit his television watching to about 2 hours a day.‖ d. ―I am glad his coach emphasizes winning and discipline in today's society.‖

ANS: D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group. Team sports such as soccer are appropriate for exercise and refinement of motor skills. Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities.

What should the nurse teach a parent who is concerned about preventing sleep problems in a 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Have the child's daytime caretaker eliminate naps. d. Use a nightlight in the child's room.

ANS: D The boundaries between reality and fantasy are not well defined for children of this age, so monsters and scary creatures that lurk in the preschooler's imagination become real to the child after the light is turned off. A nightlight may help ease the child's fears. A dark room may be scary to a preschooler. High-carbohydrate snacks increase energy and do not promote relaxation. Most 2-year-olds take one nap each day. Many give up the habit by age 3 years. Insufficient rest during the day can lead to irritability and difficulty sleeping at night.

A parent is very frustrated by the amount of time a toddle says ―no‖ and asks the nurse about effective strategies to manage this negativism. The most appropriate recommendation is to a. punish the child for the behavior. b. provide more attention to the child. c. ask the child to not always say ―no.‖ d. reduce the opportunities for a ―no‖ answer

ANS: D The nurse should suggest that the parent phrase questions or directives with restrictive choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young for this approach.

A nurse is assessing an 8-year-old child. Which finding leads the nurse to conduct further assessment? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Demonstrates the principle of object conservation d. Engages in fantasy and magical thinking

ANS: D The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development. If the child demonstrated this type of thinking, the nurse would need to follow up with more developmental screening. School-age children enter the stage of concrete operations. They learn that their point of view is not the only one. The school-age child has a sense of humor. The child's increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. The school-age child understands that properties of objects do not change when their order, form, or appearance does (object conservation).

Which nursing action is most appropriate to assist a preschool-age child in coping with the emergency department experience? a. Explain procedures and give the child at least 1 hour to prepare. b. Remind the child that she is a big girl. c. Avoid the use of bandages. d. Use positive terms, and avoid terms such as ―shot‖ and ―cut.‖

ANS: D Using positive terms and avoiding words that have frightening connotations assist the child in coping. Preschool-age children should be told about procedures immediately before they are done. Allowing 1 hour of time to prepare only allows time for fantasies and increased anxiety. Children should not be shamed into cooperation. Bandages are important to preschool-age children. Children in this age-group believe that their insides can leak out and that bandages stop this from happening. Plus a fancy bandage can be used as a reward.

An immunocompromised child is in the clinic for immunizations. Which vaccine prescriptions should the nurse question? (Select all that apply.) a. DTaP b. Hep A c. IPV d. Varicella e. MMR

ANS: D, E 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. DTaP, HepA, and IPV can be given safely.