Pedi- Growth and Development

The nurse prepares a 7 year old client for an influenza injection. The nurse explains that the client will receive "medicine under the skin," and the client is visibly anxious. Which nursing intervention is appropriate? 1. Ask the client to count to 10 during injection 2. Ask the parent to hold the child's arm tightly 3. Explain to the child that the injection will not hurt 4. Keep the injection needle out of the child's view

1 According to Piaget's cognitive developmental stages, school-age children develop concrete thought and may fear a loss of control. To improve the child's sense of control, the nurse should offer a specific, task-based coping technique (counting aloud, deep breathing) Option 2: A caregiver should hold or embrace a child during the injection process, with the child on the caregiver's lap or standing in front of a seated caregiver. Tightly holding the child's arms is extreme and may distress the child and caregiver Option 4: Keeping objects that may alarm the child out of view is an appropriate intervention for a toddler but not for a school-age child. Hiding a procedural object from a 7 year old will hinder rapport with the nurse and may heighten the child's anxiety

The nurse is providing care to a 9 year old client who is awaiting surgery. Which intervention is developmentally appropriate for this client's plan of care? 1. Discuss the procedure with the client using simple diagrams with correct anatomical terminology 2. Explore the client's perception of how the surgery will positively affect their future 3. Focus primarily on the client's feelings and concerns regarding surgical scar appearance 4. Provide initial education about the procedure to the client immediately before it is performed

1 For the school-age child (age 6-12 years), developing a sense of INDUSTRY (confidence in skills and abilities) is a primary psychosocial need, and cognitive development is marked by CONCRETE THINKING (based on actual objects or activities) During preprocedural education, the nurse should foster a sense of industry by involving the child in discussions about the procedure, interacting with the child directly, and using correct anatomical terminology. In addition, the use of simple diagrams helps to meet the child's needs for concrete learning

The nurse is providing teaching to the parents of a child with Marfan syndrome. Which topic is the priority for the nurse to address? 1. Avoiding participation in contact sports 2. Informing the dentist of the child's condition 3. Monitoring for development of scoliosis 4. Scheduling annual eye exams

1 Marfan syndrome is an autosomal dominant disorder affecting the connective tissues of the body. Abnormalities are mainly seen in the cardiovascular, musculoskeletal, and ocular systems. Clients with Marfan syndrome are very TALL AND THIN, with disproportionately long arms, legs, and fingers Cardiovascular manifestations of Marfan syndrome include abnormalities of the aorta and cardiac valves, including aneurysms, tears (dissection), and leaky heart valves that may requires replacement or repair. Therefore, competitive or contact sports are discouraged due to the risk of cardiac injury and sudden death Option 2: The client may also experience crowding of the teeth from a very high-arched palate. Preventative antibiotics prior to dental work may be needed to provide prophylaxis against infective endocarditis, especially in clients with an artificial valve replacement. However, this is not a priority Option 3: These clients have an increased risk for scoliosis. But this is not a priority Option 4: Ocular problems (lens dislocation [ectopia lentis], retinal detachment, cataracts, glaucoma) can be common for this child with Marfan Syndrome. Annual eye exams are important to monitor for developing issues

What play behavior would the nurse be most likely to observe in a group of 4 year old children? 1. Children playing and borrowing blocks from each other without directing others 2. Children playing and working together to build a castle out of blocks 3. Children playing next to each other with blocks, but not interacting 4. Children playing with blocks by themselves in separate ares of the room

1 Preschoolers (age 3-6) enjoy ASSOCIATIVE PLAY, in which they engage in similar activities or play with the same or similar items, but the play is unorganized without specific goals or rules. They often borrow item from each other without directing each other's play. Preschoolers also enjoy play involving motor activities and imaginative, pretend play Option 2: Cooperative play is common in school-age children (age 6-12). These children play with one another with a specific goal (building a castle from blocks), often within a rigid set of rules. Option 3: Parallel play is more common in toddlers (age 1-3). During parallel play, these children play next to each other and are happy to be in the presence of peers, but they do not play directly with one another Option 4: Solitary play is common in infants (birth to 1 year). Children at this stage are focused on their own activity and will play alone in the presence of others

The parents of a hospitalized 3 month old have to leave the infant while they work. One parent fears that the baby will cry as soon as they walk out. The nurse teaches both parents about separation anxiety. Which statement by the parent indicates that teaching has been effective? 1. "At this age, my baby will not cry because we are leaving." 2. "I know my baby will feel abandoned when we leave." 3. "My baby is too young to sense my anxiety about leaving." 4. "My baby understands that we will return later in the day."

1 Separation anxiety starts around 6 months, peaks at age 10-18 months, and can last until age 3 years. Separation anxiety produces more stress than any other factor (pain, injury, change in surroundings) for children in this age range Option 3: A 3 month old might sense a parent's anxiety but is cognitively unable to process it

The parent of a 2 year old tells the nurse at the well-child clinic, "I am concerned because my child does not like to be cuddled, does not respond when called by name, and does not may eye contact when being fed." What is the priority question for the nurse to ask when completing the health history? 1. "How many words can your child say?" 2. "Is your child potty trained?" 3. "What are your child's favorite foods?" 4. "What kind of toys does your child like to play with?"

1 The concerns presented by this child's parent are suggestive of a developmental delay and very possibly autism spectrum disorder ASD is a complex neurodevelopmentaldisorder characterized by the onset of abnormal functioning before age 3. The 2 core symptoms of ASD are abnormalities in social interactions and communication, and patterns of behavior, interests, or activities that can be restricted and repetitive. Social skills, especially communication, are delayed more significantly than other developmental functioning and are the focus during client assessment

The nurse is reviewing the plan of care for a 4 year old client who will receive daily dressing changes for an infected leg wound. Which of the following interventions should the nurse include in the plan of care for a preschool-aged child? Select all that apply 1. Allow the child's parents to stay during the procedure 2. Emphasize that dressing changes are not punishment for misbehavior 3. Encourage the child to voice questions and concerns about the procedure 4. Have the child place bandages on a doll when reinforcing education 5. Introduce the child to other clients with the same health condition

1, 2, 3, 4 For the preschool-age child (3-5 years), developing a sense of initiative (start and accomplish tasks, learn new things) is a primary psychosocial need, and cognitive development is marked by preoperational thinking (egocentrism, poor causality, continuing language development) During preprocedural education, the nurse should: -Promote a sense of security and reduce fear by allowing the parents to stay with the child during the procedure -Address misconceptions related to preoperational thinking (state that the procedure is not punishment for misbehavior) -Foster initiative by encouraging the child to ask questions, voice concerns, and participate during dressing changes -Enhance the child's learning ability and confirm the child's understanding of the procedure by allowing the child to imitate the procedure using a doll or toy equipment

A nurse on a pediatric unit is reviewing interventions for a toddler with a practical nurse who will be caring for this child. Which of the following are appropriate activities to minimize the effect of hospitalization on a toddler? Select all that apply 1. Integrate preferred snack foods in the day's routine 2. Plan quiet play prior to usual nap time 3. Point out body changes that may occur 4. Post a daily schedule by the child's bed 5. Provide 1 or 2 options when choosing toys

1, 2, 5 Toddlers (age 1-3) displace an EGOCENTRIC approach as they strive for autonomy. They attempt to control their experiences through intense emotional displays, such as temper tantrums or forceful negative responses (no!). Hospitalization results in loss of a toddler's usual routines, often resulting in regressive behavior. The toddler may also be frequently separated from the parents, leading to separation anxiety Nursing care activities should be similar to home routines, such as providing preferred snacks and anticipating nap time. The toddler should be given options rather than asked yes/no questions to limit the potential negative responses Option 3: This is an appropriate activity when working with an adolescent. Adolescents are often very concerned with outward changes that may occur as a result of illness or surgery Option 4: This is an appropriate activity when working with school-age children after they have grasped the concept of time. Toddlers have not yet reached this level of cognition

The nurse on a pediatric unit is caring for a preschooler who exhibits separation anxiety when the parents go to work. Which interventions should the nurse implement? Select all that apply 1. Encourage the parents to leave the child's favorite stuffed animal 2. Establish a daily schedule similar to the child's home routine 3. Give the child time to calm down alone when visibly upset 4. Provide frequent opportunities for play and activity 5. Remove visual reminders of the parents from the room

1, 2, 4 Separation anxiety, also known as anaclitic depression, particularly affects children age 6-30 months. Nursing care of hospitalized clients experiencing separation anxiety focuses on maintaining a calm environment and a supportive demeanor to build trust between the nurse and child. Key interventions include: -Encouraging the parents to leave favorite toys, books, and pictures from home -Establishing a daily schedule that is similar to the child's home routine -Maintaining a close, calming presence when the child is visibly upset -Facilitating phone or video calls when parents are available -Proving opportunities for the child to play and participate in activities

The nurse assists with a staff education conference about appropriate nonpharmacological pain-management interventions for newborns and infants. Which of the following strategies should be included in the presentation? Select all that apply 1. Administer an oral sucrose solution to a newborn during a circumcision procedure 2. Apply a cold pack to a newborn's heel 30 minutes before performing a heel stick 3. Assist the parent to hold a newborn skin to skin during an immunization injection 4. Offer a pacifier to an infant while performing venipuncture 5. Swaddle an infant while leading one arm unwrapped during an IV dressing change

1, 3, 4, 5 Offering concentrated sucrose, if prescribed, which is associated with reduced indicators of pain Option 2: Before a heel stick is performed, a warm (not cold) pack should be applied to help facilitate blood flow to the area

The nurse is educating a group of parents about ways to decrease the risk of sudden infant death syndrome. Which of the following recommendations should the nurse suggest? Select all that apply 1. Breastfeed the infant 2. Co-sleep with the infant in the parent's bed 3. Ensure the infant's vaccinations are updated 4. Maintain a smoke-free environment 5. Place the infant to sleep in a side-lying position 6. Provide a firm sleep surface for the infant

1, 3, 4, 6 SIDS is the unexpected, unexplained death of an infant age <1 year, occurring most frequently in those age < 6 months during sleep/naps. The nurse should recommend that parents place their infant to sleep on the back in a safe place (crib). The sleep surface should be firm with no loose or soft items to prevent suffocation Option 5: Due to the infant's body shape, side lying positions facilitate rolling over to a prone position. Instead, the nurse may recommend supervised time during the day for the infant to lay on the stomach while awake (tummy time) to promote muscle development and prevent positional plagiocephaly

A nurse is speaking with the parent of a toddler who believes then child has a hearing deficit. Which findings support this suspected diagnosis? Select all that apply 1. Behavior appears withdrawn 2. Intelligible speech began at age 12 months 3. Monotone speech 4. Seems attentive, nods, and smiles when given direction 5. Speaks with a loud voice

1, 3, 5 Hearing impairment in children may be related to family history, an infection, use of certain medications, or a congenital disorder. Toddlers with hearing deficits may appear shy, timid, or withdrawn, often avoiding social interaction. They may seem extremely inattentive when given directions and appear "dreamy." Speech is usually monotone, difficult to understand, and loud. Increased use of gestures and facial expressions is also common Option 2: Children typically begin to use well-formed syllables such as "mama" and "dada" by approximately age 7 months. A referral from a hearing test should be made if there is an absence of well-formed syllables by age 11 months or intelligible speech is not present by 24 months

The nurse assessing a 2 year old should expect the child to be able to perform which actions? Select all that apply 1. Build a tower with blocks 2. Draw a square 3. Hop on one foot 4. Say own name 5. Walk without help

1, 4, 5 Developmental milestones that a 2 year old toddler should meet include: -Motor skills: Walks alone, builds block towers, draws lines, kicks a ball -Language: Knows 300+ words, uses 2 to 3 word phrases. states name -Cognitive/social skills: Engages in parallel play, imitates others, exerts independence Option 2: Normally, a child will develop the ability to draw or copy a square later during the preschool years (age 3-5) Option 3: A 2 year old client will not yet demonstrate the balance required for this activity. The ability to hop and stand on one foot for 5-10 seconds develops during the preschool years (age 3-6)

The nurse is performing a physical assessment on a 2 year old with cold symptoms and a fever at home of 101.7. The parent is concerned about the child's ability to cooperate during the examination. Place the components of assessment in the order the nurse would perform them -Auscultate the child's heart and lung sounds -Interact with the parent in a friendly manner -Measure the child's height and weight -Play with the child using a finger puppet -Take the child's vital signs

1. Interact with the parent in a friendly manner 2. Play with the child using a finger puppet 3. Measure the child's height and weight 4. Auscultate the child's heart and lungs 5. Take the child's vital signs Always complete the assessment by performing the least invasive parts first and then progressing to the most invasive. By first establishing a rapport with the parent, the nurse will elicit the child's trust and cooperation

The nurse is performing a well-child assessment on a sleeping 2 month old client. Organize the assessment in the correct order based on the developmental age of the client Elicit Moro reflex Observe skin color and respiratory pattern Palpate fontanelles and abdomen Assess pupillary response Auscultate heart and lungs

1. Observe skin color and respiratory pattern 2. Auscultate heart and lungs 3. Palpate fontanelles and abdomen 4. Assess pupillary response 5. Elicit Moro reflex

The nurse cares for a 4 year old who is on long-term, strict bed rest. Which toy is most appropriate to provide diversion and minimize developmental delays? 1. Board games 2. Puppets 3. Soap bubbles 4. Stacking and nesting toys

2 Preschoolers enjoy play that enables them to imitate others and be dramatic. They have rich imaginations and enjoy make-believe. Their play often centers on IMITATING ADULT BEHAVIORS by playing dress up and using housekeeping toys, telephones, medical kits, dolls and puppets. Quiet play appropriate for the preschooler includes finger paints, crayons, illustrated books, puzzles with large pieces, and clay. Through playing with objects such as dolls or puppets, preschoolers can often process fears and anxieties that are difficult for them to express. Option 1: Board games are appropriate for children of school age, when play becomes more complex and competitive Option 3: Soap bubbles are appropriate for toddlers, who learn from tactile play and environmental exploration Option 4: Stacking and nesting toys are appropriate for toddlers who are developing fine motor skills

The nurse is caring for a pre-school age child whose grandparent died 3 days ago. Which intervention is inappropriate? 1. Assign the same nurses and caregivers to the child each day 2. Avoid mentioning the loved one's death in the child's presence 3. Explain the importance of being with the child to the parents 4. Schedule time each day for age-appropriate play

2 The preschool-age (3-5 years) child's view of death is related to their developmental stage. They believe death is temporary and reversible, similar to a prolonged nap. The child may ask repeatedly when the deceased individual will return, or they may feel guilty and responsible for the death because of their wishes or thoughts (magical thinking)

What socioeconomic indicators would the nurse identify as risk factors for a 2 month old infant to develop failure to thrive? Select all that apply 1. Both caregivers work outside the home 2. Infant lives only with mother, who is currently unemployed 3. Infant's primary caregiver has cognitive disabilities 4. Parents are socially and emotionally isolated 5. Parents live together but are not married

2, 3, 4 FTT, or growth failure is a state of undernutrition and inadequate growth in infants and young children. Most cases of FTT are related to an inadequate intake of calories, which can be tied to many different etiologies. Physiologic risk factors for FTT include preterm birth, breastfeeding difficulties, gastroesophageal reflex, and cleft palate

The nurse in a clinic is obtaining a developmental history of an 18 month old during a well-child visit. Which activities should the child be able to perform? Select all that apply 1. Calls self by name 2. Goes up stairs while holding a hand 3. Stacks 6 blocks in a tower 4. Turns two pages in a book at a time 4. Twists doorknob to open doors

2, 4 By 18 months, the toddler can manage stairs while holding a hand and turn 2 or 3 pages in a book. Options 1, 3, and 5: A 24 month old should be able to build a tower of 6 or 7 blocks, call self by name, and use a doorknob to open a door

A nurse is performing an assessment of a 12 month old child. Which of the following findings would the nurse expect? Select all that apply 1. Approaches strangers with ease 2. Birth weight is tripled 3. Can skip and hop on one foot 4. Fully developed pincer grasp 5. Sits from a standing position

2, 4, 5 The first 12 months of life are characterized by rapid growth and development. By 12 months, the child's birth weight should be about tripled A 12 month old child should have mastered the gross motor skill of sitting down from a standing position without assistance. The pincer grasp is an important fine motor skill that should also be fully developed by this age Option 1: Stranger anxiety is well developed by age 8 months and continues into the toddler years. At age 12 months, the child typically prefers the parents and exhibit fear when separated Option 3: The gross motor skills of skipping and hopping on one foot do not usually occurs until around age 4

The pediatric nurse cares for a 16 year old client who is scheduled for an appendectomy in the morning. Which of the following interventions are appropriate to support the client's psychosocial needs? Select all that apply 1. Create a strict daily schedule for the client while hospitalized 2. Encourage the client to have peers visit while hospitalized 3. Ensure parental presence during any client procedure 4. Include the client as an active participant when planning care 5. Support the client in discussing concerns about body image changes

2, 4, 5 Developmentally appropriate nursing care for an adolescent client includes: -Encouraging interaction with peers -Involving the client in care planning -Assisting the client to discuss emotions or fears related to treatment Option 3: Loss of privacy (forced parental presence) can increase anxiety in the adolescent client. Adolescents should be asked if they want parents present for procedures

The nurse is caring for a 10 year old diagnosed with osteomyelitis. What is the best activity the nurse can suggest to promote age-specific growth and development during hospitalization? 1. Fantasy play with puppets 2. Invite friends to come visit 3. Provide missed schoolwork 4. Watch favorite movies

3 According to Erikson's stages of psychosocial development, school-age children deal with the conflict of industry vs inferiority. Attaining a sense of industry (competence) is the most significant development goal for children age 6-12. Parents should therefore be encouraged to provide a hospitalized child with missed school work on a regular basis. This will help the child keep up with school demands, learn new skills, cope with the stressors of hospitalization, and avoid a sense of inferiority Option 1: Fantasy play with puppets is more appropriate for a preschool-age child as imaginary play and magical thinking peak during this stage of development Option 2: Peer relationships are significantly more important during the adolescent period Option 4: Watching tv is a good diversion for all hospitalized children, but it does not promote age-specific growth and development

The nurse is caring for a 4 year old who was hospitalized with influenza. Which nursing action would be most effective to maintain psychosocial integrity? 1. Encouraging use of puzzles for play 2. Offering the child stacking blocks for diversion 3. Providing crayons to draw noses on facemasks 4. Suggesting that playmates visit the child

3 Clients with influenza are maintained on droplet precautions, and anyone entering the room must wear a facemask. Medical play during the preschool period (age 3-5 years) facilitates psychosocial integrity. Crayons are age-appropriate toys. Drawing noses on facemasks will help the child feel more comfortable with procedures and provides a developmentally appropriate diversion Option 1: Puzzles would be more appropriate for the school-aged child (6-12) Option 2: Stacking blocks would be more appropriate for the toddler (1-3 years)

A 15 year old parent brings a 4 month old infant for a well-baby checkup. The parent tells the nurse that the baby cries all the time; the parent has tried everything to keep the infant quiet but nothing works. What is the priority nursing action? 1. Advise the parent to give a pacifier whenever the infant cries 2. Ask the parent to describe what is done to "keep the baby quiet." 3. Assess the infant's pattern and frequency of crying 4. Explore the parent's support system

3 During the first 3-4 months of life, it is not unusual for an infant to cry 1-3 hours a day in response to being hungry, thirsty, tired, in pain, bored, or lonely. A very young, first-time parent may not have an appreciable understanding of normal infant behavior and may perceive normal crying as excessive. It is most important for the nurse to assess the infant's pattern and quality of crying to better understand whether it is normal behavior or a sign of something more serious that requires further evaluation and treatment. The nurse needs to determine: -What "all the time" means -When the "all the time" crying started -What makes the crying worse and what makes it better -The quality of the crying (tone, pitch, loudness) -Length and quality of periods of silence

The nurse is assessing an 8 month old client during a well-child visit. Which assessment finding should the nurse report to the HCP? 1. Infant responds to their name when called but has not spoken any words 2. Infant was gaining 5 oz per week at age 6 months and is now gaining 3 oz per week 3. Infant's head stays behind the shoulders when raised from a supine to a sitting position 4. Infant's posterior fontanel is not palpable when performing assessment of the head

3 Head and neck strength are critical assessments in an infant. In general, infants display head lag from birth through age 4-6 months. Head lag remaining after age 6 months is an abnormal finding often associated with cerebral palsy or autism Option 1: An infant age 6 to 7 months may start responding to their name by turning toward the sound when spoken. An infant may not speak first words with meaning (mama, dada) until approximately 9-11 months Option 2: During the first 6 months, infants should grow 5-7 oz per week. From age 6-12 months, infants grow 3-5 oz per week Option 4: The posterior fontanel is a membrane-filled space between the parietal and occipital bones that normally closes by age 2 months. Therefore, posterior fontanel should not be palpable in an infant age 8 months

The nurse assesses 4 infants. Which assessment finding would require follow-up by the HCP? 1. 3-week old whose anterior fontanelle bulges when with crying 2.4-week old whose posterior fontanelle is soft 3. 6-month old with birth weight of 7 lb 3 oz who now weighs 12 lb 4. 12-month old with birth weight of 6 lb 4 oz who now weighs 20 lb

3 Infant growth is fast paced during the first year of life, with birth weight doubling by age 6 months and tripling by age 12 months. During the first year, birth length increases by approximately 50%. At birth, head circumference is slightly more than chest circumference, but these equalize by age 12 Fontanelles should be flat, but slight pulsations noted in the anterior fontanelle are normal as is temporary bulging when the infant cries, coughs, or is lying down. The posterior fontanelle fuses by age 2 months, and the anterior fontanelle fuses by age 18 months

A 12 month old is found to have a moderately elevated blood lead level. Which of the following is the most serious concern for this child? 1. GI bleeding 2. Growth retardation 3. Neurocognitive impairment 4. Severe liver injury

3 Lead poisoning still occurs in the US, although not as often as in previous decades. A common source of exposure is lead-based paints found in houses built before 1978, when such paint was banned. Blood lead level (BLL) screenings are recommended at ages 1 and 2, and up to age 6 if not previously tested Because lead poisoning particularly affects the neurological system, elevated BLLs (>5 mcg/dL) are dangerous in young children due to immature development of the brain and nervous system. A mild to moderate increase in BLL can manifest with hyperactivity and impulsiveness; prolonged low-level exposure can cause developmental delays, reading difficulties, and visual-motor issues. Extremely elevated BLLs can lead to permanent cognitive impairment, seizures, blindness, or even death

A 10 year old is implementing behavioral strategies to manage nocturnal enuresis. The client tells the nurse, "I want to go to sleep-away camp during the summer, but if I have an accident, i'm afraid that other kids will tease me." What is the best response by the nurse? 1. "Don't worry. Your problem will be resolved by then." 2. "It would be better if you thought about going to day camp instead." 3. "We can ask your HCP about a medication trial that may help." 4. "You could always wear a pull-up just in case."

3 Pharmacological interventions are often used as second-line treatment for nocturnal enuresis in children age >5 years; this is done when there has been little or no response to behavioral approaches and/or when short-term improvement of enuresis is desired for attending sleepovers or overnight camp. A trial run is usually done at least 6 weeks before camp to determine the appropriate drug dose and effectiveness. However, there is a high risk of relapse once the drug is discontinued Medications used to treat nocturnal enuresis include the following: 1. Desmopressin reduces urine production during sleep 2. Tricyclic antidepressants such as imipramine, amitriptyline, and desipramine improve functional bladder capacity Option 4: Wearing a pull-up could embarrass the child at overnight camp

A nurse in a pediatric clinic is performing a physical examination of a 30 month old child. Which finding requires further evaluation? 1. Bladder and bowel control achieved 2. Chest circumference is greater than abdominal circumference 3. Current weight is 6 times greater than birth weight 4. Head circumference increased by 1 inch in the past year

3 Weight gain slows during the toddler years with an average gain of 4-6 lbs. By age 30 months, current weight should be 4 times greater than birth weight. A toddler weighing 6 times the initial birth weight requires further evaluation Option 1: A toddler achieves bowel and bladder sphincter control by age 24 months as bladder capacity increases Option 2: Chest circumference exceeds abdominal circumference after age 2, resulting in a taller a more slender appearance

The parent of a 1 year old says to the nurse, "I would like to start toilet training my child as soon as possible." What information does the nurse provide to the parent that correctly describes a child's readiness for toilet training? 1. "A good time to start toilet training is when your child can dress and undress autonomously." 2. "When your child can sit on the toilet until urination occurs, you can start toilet training." 3. "Your child may be ready to start toilet training when able to communicate and follow directions." 4. "Your child will be ready to start toilet training at about age 15 months."

3 Toilet training is a major developmental achievement for the toddler. The degree of readiness progresses relative to development of neuromuscular maturity with voluntary control of the anal and urethral sphincters occurring at age 18-24 months. Bowel training is less complex than bladder training; bladder training requires more self-awareness and self-discipline from the child and is usually achieved at age 2 1/2 to 3 1/2 years In addition to physiological factors, developmental milestones rather than the child's chronological age signal a child's readiness for toilet training. These include the ability to: -Ambulate to and sit on the toilet -Remain dry for several hours or through a nap -Pull clothes up and down -Understand a two-step command -Express the need to use the toilet -Imitate the toilet habits of adults or older siblings -Express an interest in toilet training

The clinic nurse reviews teaching provided to the parent of a child being considered for growth hormone replacement therapy at home. Which statement by the parent indicates that teaching has been effective? 1. "Treatment will be considered a success when my child grows at a rate equal to peers." 2. "Treatment will be required throughout my child's life." 3. "Treatment will begin when my child becomes an adolescent." 4. "Treatment will require a daily injection under my child's skin."

4 A child who demonstrates a slow growth pattern will undergo diagnostic evaluation to determine the cause. If the cause is found the be growth hormone deficiency, the child may undergo growth hormone replacement therapy. The biosynthetic hormone is administered via subcutaneous injection on a daily basis. Despite replacement therapy, the child may still have a FINAL HEIGHT LESS THAN "NORMAL." Treatment is most successful when diagnosis and replacement therapy BEGIN EARLY IN THE CHILD'S LIFE. When to stop therapy is decided by the client, family, and provider. However, growth less than 1 inch per year and bone age of 14 years in girls and 16 years in boys are the criteria often used to stop therapy Option 1: Growth hormone replacement does not guarantee that a child will grow at a rate equal to peers. Treated children often remain shorter than their peers

A 2 month old infant has been admitted to the hospital with suspected shaken baby syndrome (abusive head trauma). In reviewing the infant's chart, the nurse expects to encounter which of these clinical findings? 1. A reported history of recent trauma 2. Abdominal bruising 3. External signs of trauma 4. Irritability and vomiting

4 Shaken baby syndrome is a type of abusive head injury and is defined as severe physical child abuse resulting from violet shaking of an infant by the arms, legs, or shoulders. The impact of the shaking causes bleeding within the brain or the eyes It is not uncommon for the diagnosis of SBS to be missed as the clinical findings are often vague and nonspecific- vomiting, irritability, lethargy, inability to suck or eat, seizures, and inconsolable crying. Usually there are no external signs of trauma except for occasional small bruises on the chest or upper arms where the child was held during the shaking episode The most common reasons that caregivers seek medical attention for children with SBS are breathing difficulty, apnea, seizures, and lifelessness

The public health nurse has received a referral to make a follow-up home visit to a 1 year old recently diagnosed with failure to thrive. Which intervention is the priority nursing action for this child? 1. Assess overall parenting skills 2. Complete a 240hour dietary intake 3. Measure the child's height, weight, and head circumference 4. Observe the child feeding

4 FTT is generally defined as weight less than 80% of ideal for age and/or depressed weight for length, correcting for gestational age, sex, and special medical conditions. The underlying cause of FTT is inadequate dietary intake; contributing factors include a disturbance in feeding behavior and psychosocial factors OBSERVING THE CHILD FEEDING or when hungry will provide the nurse the opportunity to identify potential factors contributing to insufficient intake. The nurse can observe the type of food being offered, the quantity of food consumed, how the child is held or positioned while being fed, the amount of time for feeding, the parent's response to the child's cues, the tone of feeding, and the interaction between the child and the parent Option 3: This is an appropriate nursing action, but it provides no information about the factors contributing to the child's insufficient intake

The clinic nurse is asked by the mother of a 15- month old, "I am worried about my child's thumb sucking and its effect on tooth alignment. What should I do?" What is the nurse's best response? 1. "As long as your child's thumb sucking stops by age 2-3 years when all of the primary teeth have erupted, there is little concern." 2. "Because your child already has teeth, it is important to implement a plan to stop the thumb sucking as soon as possible." 3. "Newer research shows that thumb sucking has little effect on a child's teeth" 4. "The risk for misaligned teeth occurs when thumb sucking persists after eruption of permanent teeth."

4 Rooting and sucking are a part of an infant's natural reflexes. Nonnutritive sucking assists in helping the infant to feel secure. Some parents become very concerned about their infants sucking fingers, thumbs, or pacifier and try to stop the behavior. As a rule, if thumb sucking stops BEFORE THE PERMANENT TEETH begin to erupt, misalignment of the teeth and malocclusion can be avoided

The parent of an 8 year old client asks the nurse for guidance on how to help the client cope with the recent death of the other parent. When developing a response to the parent, the nurse considers that a school-aged child is most likely to do what? 1. React anxiously to altered daily routines 2. Realize that death eventually affects everyone 3. Think about the religious or spiritual aspects of death 4. Understand that death is permanent but be curious about it

4 The nurse should educate the parent of an 8 year old client about how to assist with coping based on the knowledge that school-aged children (age 6-12 years) most likely have both a CURIOSITY AND FEAR about the implications of death and understand that death is permanent. Therefore, it is important for the parents to be honest during discussions about death, talk about the lost loved one, and provide anticipatory guidance to reduce fears Option 1: Infants and toddlers mostly react to separation from caregivers, both temporary and permanent, because it affects daily routines Option 2: A child will most likely be aware that death affects everyone and also perceive it as evil by age 10-12 years Option 3: Adolescents are most likely to think about the religious and spiritual aspects of death, although this may occur earlier for some children

The parents of a 5 year old asks the school nurse for advice on how to tell their child about being adopted. Which developmentally appropriate thought about adoption by the child does the nurse counsel the parents to anticpate? 1. Feels responsible for being placed for adoption 2. Imagines what life would be like with a different family 3. Is unable to conceptualize differences between adoptive and biological parents 4. Worries about what peers will say or think

1 Children age 3-6 (preschool) are in Piaget's preoperational stage of cognitive development. At age 5, children are not able to fully understand cause and effect and will therefore ascribe inappropriate causes to phenomena (scraped knee was caused by earlier misbehavior) 5 year olds are developmentally capable of understanding adoption on a basic level; however, it may be difficult for them to understand the concept of having another family. The child might notice that friends are not adopted. Preschool-age children may also believe they are responsible for being adopted and may develop separation issues and fear abandonment Option 2: School-age children may imagine how life would be different if they were with their biological parents. Self-esteem issues begin to develop around this time with the possible sense of loss of the biological family. School-age children may be sensitive to physical differences between themselves and their adoptive family

The nurse is caring for a hospitalized 6 month old client. Which of the following interventions should the nurse implement to provide developmentally appropriate care for this client? Select all that apply 1. Adhere to the child's home routine when possible during hospitalization 2. Encourage parents to bring the child's favorite toy from home 3. Have the parents step out of the room during procedures 4. Promote a quiet sleep environment with reduced stimuli 5. Provide a parent's shirt for the child to hold during procedures

1, 2, 4, 5 Around 6 months of age, infants begin to experience separation anxiety. This anxiety may be heightened during hospitalization because of exposure to many unfamiliar stressors. Appropriate nursing care can play a significant role in reducing the infant's physiologic and psychologic stress. Key interventions include: -Adhering to the infant's home routine (meal and sleep times) as closely as possible -Providing a favorite toy or pacifier -Encouraging caregivers to remain whenever possible during hospitalization -Providing a quiet sleep environment with reduced stimulation to promote restful sleep -Offering a familiar object (caregiver's shirt, blanket, voice recording) during stressful situations

A nurse is discussing the fine motor abilities of a 10 month old infant with the infant's parent. Which are developmentally appropriate skills for an infant of this age? Select all that apply 1. Grasps a small doll by the arm 2. Stacks 3 wooden blocks 3. Transfers small objects from hand to hand 4. Turns single pages in a book 5. Uses a basic pincer grasp

1, 3, 5 By 3 months, infants with reflexively grasp a rattle placed in their hand. At 5 months, they are able to voluntarily clasp it with their palm. Around 7 months, infants are able to transfer an object from one hand to the other. By 8-10 months, infants have replaced the palmar grasp with a CRUDE PINCER GRASP to pick up round oat cereal and other finger foods. By 11 months, this develops into a neater pincer grasp Options 2 and 4: By 12 months, infants may attempt to turn multiple book pages at once, and they also begin attempts to stack 2 blocks.

The nurse is assessing a 3 month old during a well-child visit. Which developmental finding should the nurse expect to observe in the client? 1. Infant cries and clings to parent when members of the health team come near 2. Infant kicks legs, smiles, and coos when a familiar face comes into view 3. Infant transfers a ball from one hand to the other 4. Infant turns from the back to the abdomen

2 By age 3 months, the infant RECOGNIZES FAMILIAR ITEMS AND FACES. Any 3 month old who does not respond to familiar faces may have visual impairment or an underlying neurological disorder (autism) Option 1: Stranger anxiety is part of the infant's normal social and cognitive development and usually begins around age 6 Option 3: Transferring objects from one hand to the other hand is a fine motor skill that usually develops between ages 6 and 9 months Option 4: A 3 month old is usually not strong enough to roll from the back to the front. Infants should be able to turn from the abdomen to the back at around 4 months and then from back to the abdomen by 6 months

The nurse is admitting an infant who has severe growth deficiency and facial characteristics of indistinct philtrum, a thin upper lip, and short palpebral fissures. Which question should the nurse ask to assess the cause of these clinical findings? 1. "Is the mother of advanced age?" 2. "Is there a history of cigarette use during pregnancy?" 3. "Is there a history of exposure to alcohol in utero?" 4. "Is there a maternal history of valproate use?"

3 Fetal alcohol syndrome is a leading cause of INTELLECTUAL DISABILITY AND DEVELOPMENTAL DELAY. Diagnosis includes history of prenatal exposure to any amount of alcohol, GROWTH DEFICIENCY, neurological symptoms (microcephaly), or specific facial characteristics (indistinct philtrum, thin upper lip, epicanthal folds, flat midface, and short palpebral fissures) Option 1: Advanced maternal age has been associated with a higher incidence of trisomy 21 (Down syndrome). Characteristic features include a single palmar crease and a short neck with excessive skin (nuchal fold) Option 2: Cigarette smoking is linked to perinatal loss, sudden infant death syndrome, low birth weight, and prematurity. Option 4: Valproate (Depakote), a medication used to control seizures. This can cause neural tube defects such as spina bifida

The clinic nurse is caring for a 3 year old client. Which task, if not observed or reported by the parents as accomplished, will cause the nurse concern? 1. Catches a ball at least 50% of the time 2. Copies a square with a pencil or crayon 3. Eats with a spoon 4. Hops on one foot

3 Normally, a toddler develops the ability to use a spoon by 18 months. Therefore, a 3 year old should be able to eat with a spoon Option 1: Catching a ball 50% of the time is a developmental expectation for a 4 year old Option 2: A 4 year old can copy or draw a square with a pencil or crayon. Copying shapes other than a circle is a developmental expectation for a 5 year old Option 4: Hopping on one foot is a developmental expectation for a 4 year old

The nurse is teaching a group of new parents about oral hygiene for their children. One of the parents asks, "When should I take my child to the dentist?" What would be the best response from the nurse? 1. "It is recommended that your child's first dental visit be after age 1." 2. "The first visit should be when all of your child's baby teeth have come in." 3. "The initial dentist visit should be soon after the child's first tooth appears." 4. "Your child will need to be taken to the dentist before starting preschool."

3 The recommendation is that children have their first dental visit within 6 months of first tooth eruption or by their first birthday. A child's first tooth usually erupts around 6 months, and the child should be seen by a dentist soon after. The purpose of the first visit include: -Assessing risk for dental disease -Providing dental care and treatment of dental caries -Providing anticipatory guidance about dental hygiene, fluoride, diet, and dietary habits, and non-nutritive sucking -Establishing care with a licensed dentist and scheduling future visits

The registered nurse has completed a well-baby assessment of an 18 month old. Which assessment findings promoted the nurse to make a referral for a formal developmental screening test? 1. Cannot climb steps by self, pulls a toy, turns the pages of a book 2. Is bottle fed, can hold a spoon, creeps down stairs 3. Throws a ball, is able to point 2 or 3 body parts, cannot draw a picture 4. Uses 2 words, cannot hold a cup, can seat self in a small chair

4 An 18 month old should have a vocabulary of 10 or more words and able to hold and drink from a cup. Option 1: An 18 month old can climb stairs with assistance, use a pull-toy, and turn the pages of a book Option 2: An 18 month old may continue to be bottle fed at times, can hold and clumsily use a spoon, and can creep down stairs Option 3: An 18 month old might be able to scribble but would not be able to draw a picture; an 18 month old can throw a ball and point to body parts

A nurse in a clinic is talking with a parent about the onset of puberty in boys. What is the first sign of pubertal change that occurs? 1. Appearance of upper lip hair 2. Increase in height 3. Presence of axillary hair 4. Testicular enlargement

4 Testicular enlargement, including scrotal changes, is the first manifestation of puberty and sexual maturation. This typically occurs at age 9 1/2- 14. It is followed by the appearance of pubic, axillary, facial, and body hair. The penis increases in size and the voice changes. Some boys also experience an increase in breast size. Growth spurt changes of increased height and weight may not be apparent until mid-puberty

The public health nurse conducts a teaching program for parents of infants. Which statement by a participant indicates that teaching has been successful? 1. "After age 6 months, it is safe to use honey to sweeten my infant's formula." 2. "I should wait until my infant is 1 year old to introduce egg products." 3. "I will switch my 1 year old to low fat milk instead of commercial formula." 4. "My infant should be able to pick up small finger foods by age 10 months."

4 The pincer grasp develops at age 8-10 months. This is the time to start offering small finger foods, such as crackers or cut-up pieces of nutritious foods. Caregivers should inform their HCP if the infant does not achieve this significant milestone in fine motor development Option 1: Formula should never be sweetened. Honey should not be offered to children age <12 months because their immature gut systems are susceptible to botulism infection Option 2: Common allergenic foods (eggs, fish, peanuts) may be introduced along with other foods starting at age 4-6 months. Option 3: Infants should be transitioned to whole milk, not low-fat milk, at age 12 months. Due to rapid growth, a child's brain requires the nutrition from the fat found in whole milk