Pediatric Application Day

2. An 8 year old girl is hospitalized with pneumonia after already missing 10 days of school. She is being treated with IV fluid and antibiotics and is expected to be in the hospital for at least 3 days. When the patient tells the nurse "I am sure my friends have forgotten all about me", the nurse correctly interprets this comment as: A The patient is feeling sorry for herself and just wants more attention from the nurse. B A need to educate the patient's parents about how they could have better prepared their child for her hospital stay. C An age appropriate response because of the increased importance of friendships to a school age child. D A need to assess the child's self-esteem.

C is the correct answer because friendships become important to the school age child. A is not correct because it is normal for a school age child to fear being forgotten by her friends. The nurse is disregarding her concern. B is not correct because this is judgmental and based on an assumption the nurse has made. D is not correct because the concern is developmentally normal and can occur in children with high or low self-esteem.

4. A father is very concerned about his 11 year old son's sudden competitiveness. He states that the boy has always been good-natured and enjoyed playing sports just to play. Now his son gets angry after his team loses and at times even shouts at his teammates. His father asks the nurse what is going on with his son. The nurse correctly responds by saying: A Boys are just naturally competitive. B You may want to consider taking sports away from him until he changes his bad behavior. C School age children become competitive and winning becomes important; your son is developmentally normal. D Your son's behavior is developmentally normal but you should not tolerate such bad behavior towards his teammates.

C is the correct answer because school age children become interested in competing and winning becomes very important. A is not correct because this is not accurate or helpful and is a generalized statement. B is not correct because the nurse is judging the child's behavior and jumps immediately to punishment as the solution. D is not correct because the nurse is being judgmental and offering unsolicited advice. Reference: Ward, S.L. & Hisley, S.M. (2009). Maternal-Child Nursing Care. Philadelphia, PA: F.A. Davis Company

A 15 year old male who is active in sports demonstrates his understanding for nutritional needs by stating the following I will skip breakfast because I don't have enough time Eating before practice makes me sick so I will skip lunch I will bring snacks to school to supplement my nutritional needs Drinking Gatorade instead of eating is fine its filled with good stuff

Answer - C - The active adolescent is likely to not have time to go home and eat or have time for sit down meals. Snacking between meals provide energy boost and satifies high caloric needs Option A is most often done by adolescents because of lack of time but is not recommended Option B - working out without eating for long periods of time is no recommended Option D - although Gatorade is good. It is not a dietary supplement

A 16 year old female asks the nurse " Why do I always feel like I am hungry even after I have eaten ?" The nurse demonstrates her understanding of adolescent nutritional needs by stating the following You have an eating disorder Adolescents lack self control - don't worry it will develop with age Eating enough for two? Lets take a pregnancy test Your body is growing and the need for nutrients is increasing.

Answer - D - adolescent nutritional needs are the highest they will be for the entire life Options ABC are inappropriate

Sulfisoxazole (Gastrisin), 1g orally four times daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads "500mg tablets." A nurse has determined that the dosage prescribed is safe. The nurse administers how many tablets per dose to the adolescent? 1) ½ tablet 2) 1 tablet 3) 2 tablets 4) 3 tablets

Answer 3 Rationale: change 1g to milligrams knowing that 1000mg=1g. Also, when converting from grams to milligrams (larger to smaller), move the decimal point three places to the right: 1g=1000mg. Next use the formula for calculating the correct dose. Formula Desired X Tablet = 1000mg X Tablet = 2 tablets Available 500mg

A 6 year old child with human immunodeficiency virus (HIV) has been admitted to the hospital for pain management. The child asks the nurse if the pain will ever go away. The nurse should make which best response to the child? 1 "The pain will go away if you lie still and let the medicine work." 2 "Try not to think about it. The more you think it hurts, the more it will hurt." 3 "I know it must hurt, but if you tell me when it does, I will try and make it hurt a little less." 4 "Every time it hurts press on the call button and I will give you something to make the pain go all away."

Answer 3 A nurse must acknowledge a child's pain and let the child know that everything will be done to decrease the pain. Rationale: The multiple complications associated with HIV are accompanied by a high level of pain. Aggressive pain management is essential for the child to have an acceptable quality of life. A nurse must acknowledge a child's pain and let the child know that everything will be done to decrease the pain. Telling the child that movement or lack thereof would eliminate the pain is inaccurate. Allowing a child to think that he or she can control the pain simply by thinking or not thinking about it oversimplifies the pain cycle associated with HIV. Giving false hope by telling the child that the pain will be taken "all away" is neither truthful nor realistic. Reference

A nurse has just administered acetaminophen (Tylenol) to a child with a temperature of 38.8 ̊ C (102.0 ̊ F). The nurse should also take which action? 1 Withhold oral fluids for 8 hours 2 Sponge the child with cold water.. 3 Plan to administer salicylate (aspirin) in 4 hours. 4 Remove excess clothing and blankets from the child.

Answer 4 remove excess blankets and clothing from child. The child can be sponged with tepid water, not cold water, cold water can cause shivering, which increases metabolic requirements above those already caused by fever. Aspirin is not administered to a child with a fever because of the risk of Reye's syndrome. Fluids should be encouraged to prevent dehydration.

There are many myths regarding children and pain levels. The pediatric nurse is aware that the following is true of pain management in pediatrics. 1 Children cannot tell where they hurt. 2 The child who is neurologically impaired does not feel pain. 3 Children should not receive narcotics because they will become addicts. 4 The use of special pain scales allow children to better express their level of pain.

Answer 4 the use of special pain scales allows children to better express their level of pain. • 1 & 2 are incorrect because pain is subjective to each individual • 3 is incorrect because responses to analgesia, time, route and dose are documented to enable nurses across all shifts to provide a continuum of care for the child Reference

Which of the following adolescents is MOST likely to become deficient in iron? 14 year old male who has gained 8 pounds in one month An active 13 year old female who has heavy menstrual bleeding 17 year old female who is active in sports 16 year old male who eats fast food every day

Answer = B A growing 13 year old female causing the need for more blood volume combined with a heavy menstrual cycle put her at the highest risk to become deficient in iron Although options A C and D are at risk, they are not the most likely

4. While giving nursing care to a hospitalized adolescent, the nurse should be aware that the MAJOR threat felt by the hospitalized adolescent is a) Altered body image b) Pain management C) Restricted physical activity d) Separation from family

Answer A The hospitalized adolescent may see each of these as a threat, but the major threat that they feel when hospitalized is the fear of altered body image, because of the emphasis on physical appearance.

1. An adolescent with a history of surgical repair for undescended testes comes to the clinic for a sport physical. Anticipatory guidance for the parents and adolescent would focus on which of the following as most important? a) Technique for monthly testicular self-examinations b) The adolescent sterility c) The adolescent future plans d) Need for a lot of psychosocial support

Answer A Because the incidence of testicular cancer is increased in adulthood among children who have undescended testes. It is extremely important to teach the adolescent how to perform the testicular self-examination monthly.

2. When teaching an adolescent with a seizure disorder who is receiving Valproic acid (Depakene), which of the following would the nurse instruct the client to report to the health care provider? a) Three episodes of diarrhea b) Loss of appetite c) Jaundice d) Sore throat

Answer C A toxic effect of valproic acid (Depakene) is liver toxicity, which may manifest with jaundice and abdominal pain. If jaundice occurs, the client needs to notify the health care provider as soon as possible.

The leading cause/s of death of preschool aged children (ages 3-5) is/are: select all that apply A Poisonings B Drowning C Child abuse and/or neglect D Burns E Motor vehicle accidents

Answer: A, B, D, E According to Paul S. Kaplan, The Human Odyssey: Life Span Development, the leading cause of death in preschool aged children is accidents. Accidents include burns, drowning, poisonings and motor vehicle accidents. While accidents cannot be totally eliminated precautions such as car seats & restraints, fencing in the pool area with a locked gate and installing child proof locks on cabinets where chemicals are stored are preventive measures that the nurse should discuss with parents as an educative measure. Option C can, and does, result in the death of preschool aged children, however child abuse & neglect are not characterized as accidents.

Prescribed: Children's acetaminophen oral suspension 320 mg q 4hrs for fever. Available: Children's acetaminophen oral suspension 160 mg per 5 mL. Brittney's Mom cannot measure mg or mL and asks the nurse what to do. What is the nurse's response. A. Measure out 1 teaspoon B. Measure out 2 teaspoons C. Measure out 3 teaspoons D. Give her a swig from the bottle and call it good E. Call the doctor to clarify

Answer: B Using dimensional analysis solve for teaspoons. 320 mg 5 mL 1 teaspoon dose 160 mg 5 mL 320/160 = 2 teaspoons per dose

Matthew, aged 5, is admitted for a inguinal hernia repair. Select the appropriate nursing actions to prepare Matthew for the procedure. A. Allow the parents to hold Matthew while she describes the procedure in detail to them. B. Prepare a 15 minute slide presentation using cartoon characters to review the process. C. Demonstrate the procedure on a teddy bear, allowing the child to repeat the process to show understanding. D. Using simple words explain the procedure directly to the child. E. Begin preparation immediately before the procedure to prevent unnecessary anxiety for the child.

Answer: C, D, E The nurse should prepare the preschooler using language he/she can understand and should do so immediately before the procedure to alleviate any undue worry on the part of the child. Simulating the procedure using play and having the child demonstrate the procedure increases understanding and reduces fear. Setting limits with the child also increases awareness of expectations. Option a, explains the procedure to the parents, not the child. Option b exceeds the 5-10 minute attention span of the average preschooler.

Nicholas, age 3, watched his father use a screwdriver to fix the screen door hinge. Later that evening his mother observed him imitating his father by using a spoon and banging on the door hinge. This is an example of A Symbolic function B Deferred imitation C Animisim D Both A & B E Both A& C

Answer: D Jean Piaget, a renowned developmental psychologist , identified four major developmental stages . Preschoolers age 2-6 are in the Preoperational Stage. In this stage a child can relate to symbolism, play pretend, and can understand past and future. Symbolic function is the ability to use one thing to represent another. Whereas, deferred imitation is the ability to observe an act and imitate it at a later time. Both symbolic function and deferred imitation are characteristic of the preoperational stage and preschool behavior. Animism, giving attributes if living things to inanimate objects, is also a characteristic of the preoperational stage but is not described in this scenario.

The major determinate of the preschoolers diet selection is the: Parent Preschool teacher Siblings and/or playmates Television commercials Preschooler

Answer: E According to Paul S. Kaplan, The Human Odyssey: Life Span Development, there are multiple factors to the preschooler's diet selection. Parents act as models for the child to follow, preschool teachers create influence through education and foods offered during snack time, and peer pressure leads to certain food selections. However, the child's food preference is the major determinate of their diet. Simply put children will not eat what they do not like.

5. A 9 year old boy has a broken arm that caused sepsis when one of the pin sites became infected. He is on IV vancomycin and has pain medication ordered q 4-6 hours PRN. The boy's mother steps out of the room to take a phone call just as the nurse enters the room. The boy tells the nurse he is having a lot of pain and would like some pain medication. The nurse knows the last time he received pain medication was about 5 hours ago. The most appropriate nursing intervention at this time is to: A Wait until the boy's mother returns to the room so the mother can provide details about his pain. B Assess the patient's pain characteristics including intensity using the Wong-Baker FACES scale. C Immediately administer the PRN medication since it has been long enough since the last dose. D Tell the patient that too much pain medication is not good and suggest he try a gingerale instead.

B is the correct answer because school age children have the ability to communicate about pain. A is not correct because the patient is capable of discussing his pain. C is not correct because the nurse did not assess the patient's pain. D is not correct because suggesting gingerale may be an attempt to offer a diversional activity but she did not assess the pain and is disapproving/making value judgments.

1. A nurse is instructing a mother of a 10 year old child about automobile seat safety. The nurse knows no further teaching is required if the mother says: A As long as my child is over 10 years old and weighs more than 40 pounds she doesn't have to sit in a booster. B My child will remain in a booster seat in the back seat of my car until she is at least 4'9" and weighs over 40 pounds. Then as long as her legs bend at the knees over the seat and the shoulder belt fits properly, she can sit in the back seat without a booster seat. C Weight is not important just my child's height is important when deciding if she still needs a booster seat. D Since my child weighs 75 pounds I can move her to the front seat as long as she is in a booster seat.

B is the correct answer children must be at least 4'9", weigh over 40 pounds, have their knees bend over the edge of the seat and have the shoulder strap fit away from the face and neck and go across the thighs not the stomach. A is not correct because the height of the child was not considered. C is not correct because weight is important in determining child seat safety. D is not correct because a child must remain in the back seat until they are at least 13 years old and out of a booster seat.

During the Adolescent years a teen is expected to grow: 3-6 inches for girls and 6-9 inches for boys 2-8 inches for girls and 4-12 inches for boys 2-8 inches for boys and 4-12 inches for girls 3-6 inches for boys and 6-9 inches for girls

B. Between the ages of 12 to 19 years, girls grow 2-8 inches while boys grow 4-12 inches.

1. A parent brings a toddler, age 19 months, to the clinic for a regular check-up. When palpating the toddler's fontanels, what should the nurse expect to find? a. Closed anterior fontanel and open posterior fontanel b. Open anterior and fontanel and closed posterior fontanel c. Closed anterior and posterior fontanels d. Open anterior and posterior fontanels

C. By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between ages 9 and 18 months. The triangular posterior fontanel normally closes between ages 2 and 3 months

4. When educating a parent on safe toy selection for their toddler you know the parent understands the teaching when they say... A I will make sure all toys are no smaller than a quarter. B Most toys are safe otherwise they would not be on the market. C As long as art supplies are washable they are safe D Toys with batteries are safe as long as battery compartments have a screw down cover.

CORRCT ANSWER IS D Toys with batteries are safe as long as battery compartments have a screw down cover. A is incorrect as toys should be no smaller than 3 cm X 6 Cm C is incorrect as art supplies must be non-toxic D is incorrect as not all toys on the market are safe for all ages.

5. Play time for children is beneficial in which of the following ways (select all that apply) A Imagination stretching B Discoveries via exploration C Increase IQ D Builds socialization skills E Aids in working through emotions

CORRECT ANSWER IS A,B,D,E C is incorrect as IQ does not change throughout ones life.

4. An antihypertensive medication has been prescribed for a client with hypertension. The client tells a clinic nurse that she would like to take an herbal substance to help her lower her blood pressure. The nurse should take which appropriate action? 1. Ask the client if she plans on smoking marijuana to lower her blood pressure 2. Encourage the client to discuss the use of an herbal substance with the physician 3. Teach the client that that marijuana can also be baked into cookies or brownies 4. Sit with client and therapeutically watch Cheech & Chong's Up in Smoke

Correct Answer 2. Rationale: Although herbal substances may have some beneficial effects, not all herbs are safe to use. Clients who are being treated with conventional medication therapy should be encouraged to avoid herbal substances with similar pharmacological effects because the combination may lead to an excessive reaction or to unknown interaction effects. Options 1, 3 and 4 are inappropriate nursing actions

3. The nurse is planning care for a child who is a Jehovah's Witness. The child's parents have been told that surgery is necessary. The nurse considers the client's religious preferences and documents that: 1. Religious sacraments are important 2. Medication administration is not allowed 3. The child cannot eat goose 4. The Administration of blood and blood products is forbidden.

Correct Answer 3. Rationale: Among Jehovah's witnesses, surgery is not prohibited, but the administration of blood and blood products is. This religious group does not believe in sacraments therefore option one is incorrect. Administration of medication is acceptable practice except if the medication is derived from blood products.

2. Which of the following meal trays would be appropriate for a nurse to deliver to a client of Orthodox Judaism faith who follows a kosher diet? 1. Pork roast, rice, vegetables, mixed fruit, milk 2. Crab salad on a croissant, vegetables with dip, potato salad, milk 3. Sweet and sour chicken with rice and vegetables, mixed fruit, juice 4. Fettuccini Alfredo with shrimp and vegetables, salad, mixed fruit, iced tea

Correct Answer 3. Rationale: Orthodox Judaism believers adhere to dietary kosher laws. In this religion the dairy-meat combination is unacceptable. Only fish that have scales and fins are allowed; meats that are allowed include animals that are vegetable eaters, cloven-hoofed, and ritually slaughtered Options 1, 2 and 4 are inappropriate and incorrect.

4. A 3-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. Which sign or symptom suggests excessive I.V. fluid intake? a. Worsening dyspnea b. Gastric distension c. Nausea and vomiting d. Temperature of 102°F (38.9° C)

Correct Answer A. Dyspnea and other signs of respiratory distress signify fluid volume excess (overload), which can occur quickly in a child as fluid shifts rapidly between the intracellular and extracellular compartments. Gastric distention may suggest excessive oral fluid intake or infection. Nausea and vomiting or an elevated temperature may indicate a fluid volume deficit.

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. A nurse caring for the child monitors for which of the following, knowing that it indicates a worsening of the condition? Warm, dry skin Decreased wheezing Pulse rate of 90 beats/min Respirations of 18 breaths/min

Correct Answer B. Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. Warm, dry skin indicates improvement in the child's condition as they are normally diaphoretic during exacerbation. The pulse rate and respiratory rate are within the normal limits for a child of that age.

The mother of a 6-year-old child arrives at the clinic because the child has been experiencing scratchy, red and swollen eyes. The nurse notes a discharge from the eyes and sends a culture to the lab for analysis. Chlamydial conjunctivitis is diagnosed. Based on the diagnosis, the nurse determines that which of the following requires further investigation? A Possible trauma B Possible sexual abuse C Presence of an allergy D Presence of a respiratory infections

Correct Answer B. Conjunctivitis is an inflammation for the conjunctiva. A diagnosis of chlamydial conjunctivitis in a child who is not sexually active should signal the health care provider to assess the child for possible sexual abuse. Allergy, infection and trauma can cause conjunctivitis, but the causative organism is not likely to be chlamydia.

2. Assessment of a 7 year old with Guillain-Barre reveals absent gag and cough reflexes. Which of the following nursing diagnoses should receive the highest priority during the acute phase A. Risk for infection due to altered immune system. B Ineffective breathing pattern related to neuromuscular impairment. C Impaired swallowing related to neuromuscular impairment. D Total urinary incontinence related to fluid loss.

Correct Answer B. Ineffective breathing pattern caused by the ascending paralysis of the disorder interferes with the child's ability to maintain an adequate oxygen supply. Therefore, this nursing diagnosis takes precedence. Risk for infections related to an altered immune system is not involved in Guillian-Barre syndrome. Although impaired swallowing and incontinence may occur with the ascending paralysis of the disorder oxygenation is the highest priority.

A school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent, indicates a need for further instruction? A "It is extremely contagious" B "It is most common in humid weather" C "Lesions most often located on the arms and chest" D "It might show up in an area of broken skin, such as an insect bite"

Correct Answer C Lesions usually are located around the mouth and nose, but may be present on the hands and extremities. Impetigo is an extremely contagious bacterial infection of the skin caysed by beta-hemolytic streptococci or staphylococci, or both. Impetigo is common during hot, humid summer months. Impetigo may begin in an area of broken skin, such as an insect bite.

A nurse is providing home care instructions to the mother of a 10-year-old child with hemophilia. Which of the following activities should the nurse suggest that the child could participate in safely with peers? Soccer Basketball Swimming Field hockey

Correct Answer C The safe activity for them is swimming. Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports.

3. Nurse Kelly is teaching the parents of a young child how to handle poisoning. If the child ingests poison, what should the parents do first? a. Administer ipecac syrup b. Call an ambulance immediately c. Call the poison control center d. Punish the child for being bad

Correct Answer C. Before interviewing in any way, the parents should call the poison control center for specific directions. Ipecac syrup is no longer recommended. The parents may have to call an ambulance after calling the poison control center. Punishment for being bad isn't appropriate because the parents are responsible for making the environment safe.

5. The nurse is finishing her shift on the pediatric unit. Because her shift is ending, which intervention takes top priority? a. Changing the linens on the clients' beds b. Restocking the bedside supplies needed for a dressing change on the upcoming shift c. Documenting the care provided during her shift d. Emptying the trash cans in the assigned client room

Correct Answer C. Documentation should take top priority. Documentation is the only way the nurse can legally claim that interventions were performed. The other three options would be appreciated by the nurses on the oncoming shift but aren't mandatory and don't take priority over documentation.

A 9 year-old child with type 1 diabetes mellitus has soccer practice three afternoons a week. The school nurse provides instructions regarding how to prevent hypoglycemia during practice. The school nurse tells the child to: A Eat twice the amount of normally eaten at lunch time. B Take half the amount of prescribed insulin on practice days. C Take the prescribed insulin at noontime rather than in the morning D Eat a small box of raisins or drink a cup of orange juice before practice.

Correct Answer D Hypoglycemia is a blood glucose level less than 70mg/dL and results from to much insulin, not enough food, or excessive activity. An extra snack of 15-30 g of carbohydrates eaten before activities would prevent hypoglycemia. The child or parents should not be instructed to adjust the amount or time of insulin administration. Meal amounts should NOT be doubled.

A school nurse is conducting pediculosis capitis (head lice) assessments. A child with a "positive" head check would have: A Maculopapular lesions behind the ears B Lesions in the scalp that extend to the hairline or neck C White flaky particles throughout the entire scalp region D White sacs attached to the hair shafts in the occipital area.

Correct Answer D Pediculosis capitis is an infestation of the hair and scalp with lice. The nits are visible and attach firmly to the hair shaft near the scalp. The occiput is an area which nits can be seen. White flaky particles are indicative of dander. Maculopapular lesions behind the ears or lesions extending to the hairline or neck are indicative of an infectious process not pediculosis.

A 7-year-old child is seen in a clinic and the primary health care provider documents a diagnosis of primary nocturnal enuresis. When the mother asks the nurse about the diagnosis, the nurse plans to respond by knowing that: A Primary nocturnal enuresis does not respond to treatment B Primary nocturnal enuresis is caused by a psychiatric problem. C Primary nocturnal enuresis requires surgical intervention to improve the problem D Most children outgrow the bed-wetting problem without therapeutic intervention.

Correct Answer D Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow it without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. Surgical intervention is inappropriate. The condition is not caused by a psychiatric problem.

2. Sheena, tells the nurse that she wants to begin toilet training her 22-month-old child. The most important factor for the nurse to stress to the mother is: a. Developmental readiness of the child b. Consistency in approach c. The mother's positive attitude d. Developmental level of the child's peers

Correct answer A. If the child isn't developmentally ready, child and parent will become frustrated. Consistency is important once toilet training has already started. The mother's positive attitude is important when the child is ready. Developmental levels of children are individualized and comparison to peers isn't useful.

3. Appropriate toys for a 3-month old infant would include A. Soft, colorful squeeze toys and teething toys. B. Teething toys with small, removable parts. C. Push and pull toys, and pounding toys. D. Balls and toys that stimulate the senses.

Correct answer is A Toys should be visually appealing without small parts which could choke and infant. Exploration through the mouth begins at 3 months. Push and pull toys and balls appropriate for the mobile, older baby.

2. Completing a general assessment on a 6 month old, the nurse knows that this age infant is able to A. Sit for a short time, look toward sounds, and begin babbling. B. Sit well without support, transfer objects hand to hand, and speak one or two words. C. Use jargon, triple their birth weight, and display a closed anterior fontanel. D. Hold a spoon well, use index and first finger grasp, and reach for objects beyond their grasp.

Correct answer is A A 6-month old child can sit for a short time-this is a major milestone in development. Most other options occur much later in development.

4. Assessing an infant, the nurse knows that a pincer grasp normally appears A. At the same time as the palmar grasp. B. Between 9 and 12 months of age. C. Between 5 and 7 months of age. D. Along with the ability to "rake" objects toward themselves.

Correct answer is B The ability to use thumb and index finger to grasp usually appears at 10 to 11 months. Raking occurs much earlier, at around 6 months, and the palmar grasp is present at birth.

5. A 5-month old infant is being discharged from the hospital. Which two suggestions that pertain to the development stage of this age group would it be important for the nurse to include in a discharge conference? A. Provide a safe place for the infant to practice standing and give her blocks to encourage hand-to-hand transfer. B. Place the infant in a playpen with another baby to encourage socialization, and start her on junior foods. C. Place the infant in a high chair for meals and give her finger foods. D. Support the infant in a sitting position for a short period each day and give her a teething ring.

Correct answer is D At about 6 to 7 months, a child begins to sit without support, so encouraging sitting with support would be appropriate. It is also at this time that the teeth begin to erupt, so a teething ring is helpful. It is too early to encourage standing and, in fact, may be detrimental to the child's growth. (A). The infant is too young to socialize, and solid foods should not be given until the child is 6 months old. (B). The infant is too young for finger foods (C)

The mother of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that the ibuprofen (Motrin) is not effective. The nurse should tell the mother to: A Increase the dose of the ibuprofen B Increase the frequency of the ibuprofen C Encourage the child to lie on the left side D Encourage the child to lie on the right side

D Pneumonia is an inflammation of the pulmonary parenchyma or alveoli or both caused by a virus, myoplasmal agents, bacteria, or aspiration of foreign substances. Splinting of the affected side by lying on that side may decrease discomfort. It would be inappropriate to advise the mother to increase the dose or frequency of the ibuprofen. Lying on the left side would not be helpful in alleviating discomfort.

1. A 4 year presents to the ED with deformity in her forearm after a falling off the monkey bars. What is the most appropriate method for assessing her pain? A. Verbal Numeric scale (1-10) B. COLOR SCALE C. FACE SCALE D. FLACC SCALE

D is correct because a child in pain may not be able to accurately express pain verbally or by visual image. The child's behavior would be the best indicator of the amount of pain he/she is in. A, B, and C may be effective, but are not the most reliable indicators.

3. A 12 year old boy who underwent a tonsillectomy tells his nurse he doesn't think he can feed himself and asks the nurse to help him. The best response by the nurse is: A You are 12 years old and can feed yourself. B You don't feel up to feeding yourself right now then you must not be hungry. C I have 4 other patients to see so maybe your parents can help you when they get here. D I can help you eat and if you are up to it you can help too.

D is the correct answer because it is normal for the hospitalized school age child to regress while in the hospital. It is okay for the nurse to accept the regression but she should do so while encouraging independence. A is not correct because while a true statement it is not addressing the real issue nor is it therapeutic. B is not correct because it is not helpful or therapeutic. C is not correct because it is not therapeutic.

According to Erickson the teen is working through which stage of development? Initiative versus Shame and Doubt Initiative versus Guilt Industry versus Inferiority Identity versus Role Confusion

D. Identity versus Role Confusion - Teens are working to develop a clear sense of themselves as an individual. Working through conflicting belief and desires. Develop life goals.

John is upset that when his mother came from Europe to see their 11 month old son the child would have nothing to do with her when she tried to hold him. The child would cry and reach for his mother. What would be the appropriate response by the nurse? Show me a picture of your mother, she might just look scary. You should bring the child in for a neurologic review as a child should not be behaving that way. John, this is not uncommon, a child often develops "stranger anxiety" around 8 to 10 months. He should be given a bit more time to adjust to your mother. Stranger anxiety is not normal at that age, have you tried having your wife leave the room when your mother wants to hold the child?

Rationale (A) Incorrect - but then again she may be really scary. (B) Incorrect - it is not unusual for a child to have anxiety around strangers at that age., ( C ) Correct - "Stranger Anxiety" begins between 8 and 10 months and is a normal development. ( D) Incorrect - having the mother leave the room will more likely increase the infants anxiety.

A young mother calls the nurse and says her mother told her that her 2 week old newborn son should have adapted to a regular sleeping cycle by this time. The mother is worried that the child may have a developmental problem. What would be the proper response by the nurse? Your newborn is still a bit young to have developed a regular sleep /wake cycle, this usually occurs 7th month. You should have your husband put the child to bed as boys, even newborns, want to please their fathers. Perhaps you should switch to formula and see if the child can get on a proper sleep cycle. Your newborn is still a bit young to have developed a regular sleep /wake cycle, this usually occurs around the 1st or 2nd month

Rationale (A) Infants begin to have the ability to self-regulate sleep cycles between the 1st and 2nd month. So this answer is incorrect . (B) while infants at this age are just becoming aware of care givers and have not yet reached the development stage where they have preferential caregivers., ( C ) Formula will not help an infant to self regulate their sleep cycle ( D) Correct! Infants begin to have the ability to self regulate their sleep cycles between the 1st and 2nd month.

On one of your many free days as a student nurse you decide to have lunch in the park. You watch parents playing with their 9 month daughter. Which behavior by the child may indicate that the child is developing object permanence? She looks for the toy that Dad hid under the table. She cries and reaches for her mother. She picks up the other blocks and throws them to the ground. She recognizes that the balloon with the air let out is still a balloon

Rationale (A)The beginnings of object permanence occurs around 8 or 9 months . Object permanence is the ability to recognize that simply because you cannot see an object does not mean its no longer there. (B) is more reflective of attachment , ( C ) this is just what a kid does at this age ( D) requires the development of the concept of conservation and does not occur until the child is early school age.

Which suggestion by the nurse about nutrition to an adolescent male is most effective? Tell the male fast food should never be eaten You should be home for dinner every night to avoid missing meals You should go on a diet Suggest healthy choices at their favorite place to eat

Rationale Answer - D Adolescents do not like being told what to do and are more likely to respond well if they have a say in their health care choices - knowing this rules out options ABC

Nick is bragging about his 4 month old son at work. He tells his friends that he heard his boy said "pa" and that the boy was obviously doing was trying to get his attention. Was the infant intentionally trying to get Nicks intention by calling him "pa? Chose the best answer. A. No - the infant at this age stage of development can only babble. B. No - the boy was actually calling for mom and got the name wrong. C. Yes - at 4 months the child has passed the attachment milestone understands who his parents are and will aggressively seek their attention. D. Yes - at this stage of development the child it is not uncommon for a child to attempt meaningful communications with the parent.

Rationale A is the most correct. An infant just begins vocalizing and babbling around 4 to 6 months this progresses to understanding words at 8 to 9 months, and speaking first word intentionally between 9 and 12 months. B is incorrect child was babbling. C is incorrect in that while the infant may have reached the attachment developmental milestone, he has not reached the stage at which he can intentional seek attention and D is incorrect in that such communications skills have not yet developed.

Jane, a 24 year old single mom with a six month old daughter, tells the nurse "I know she is crying because she is trying to upset me!" What would be the proper response by the nurse? A She is having attachment issues and its not all uncommon for infants that age to know what buttons to push to get you going. B Jane, what you are suggesting is not developmentally possible at her age because she is not aware that you have your own perspective on things. C Have you done anything to upset her and make her angry or resentful? D Just ignore her when she finds out she can't get what she wants by crying, she will stop.

Rationale B. Is the only correct answer. For the infant to purposely do something to upset the parent the infant would have to be aware that the parent has a perspective or point of view. At six months the infant has not yet reached that development milestone which just begins to develop at 9-12 months. This understanding of perspective is best noticed by 2 years of age who begins crying while obviously checking to see the impact of crying on the adult

1. When communicating with a client who speaks a different language, the best practice for a nurse is to: 1. Speak loudly and slowly 2. Stand close to the client and speak loudly 3. Arrange for an interpreter when communicating with the client 4. Speak to the client and family together to increase the chances that the topic will be understood.

Rationale: Arranging for an interpreter would be the best practice when communicating with a client who speaks a different language Options 1 and 2 are inappropriate and are ineffective ways of communicating . Option 4 is incorrect because it violates privacy and does not ensure correct translation

1. An 8 year old child has been diagnosed to have iron deficiency anemia. Which of the following activities is most appropriate for the child to decrease oxygen demands on the body A Dancing B Playing interactive video games C Reading a book D Riding a bike

Reading a book is a restful activity for the child to enjoy. Choices A, B, &D require too much energy for a child with anemia and can increase oxygen demands on the body.

The Nurse would expect that most children would be using sentences of six to eight words by what age? 18 months 24 months 3 years 5 years

The correct answer is D. Five years. Rationale At the age of 5, preschoolers understand and speak correct syntax and complete sentences. Between 18 and 24 months, they have a vocabulary of only about 50 words and are unable to string them together. 3-year-old children typically use mostly 3-word combinations.

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of what? Identity Industry Intimacy Initiative

The correct answer is D. Initiative. There is increased initiative in approaching new tasks and experiences during the preschool years. A sense of identity, industry, and intimacy are garnered in other stages of Erikson's stages of development theory.

6-12

address safety issues including car seat, bike safety, fire safety, stranger safety, gun safety, traffic safety

age 6-12

when in hospital, this age group is stressed and worried about not being missed by friends, regression is common

A 16 year old girl is hospitalized for appendicitis. When discussing treatment the nurse should... A Discuss treatment with the parents. B Discuss treatment with the teen. C Discuss treatment with both the teen and parents. D Neither parents nor teen need to be part of the decision making process.

C. Discuss treatment with both the teen and parents. Parent consent is required for treatment however the teen has the right to autonomy and self-determination. The teen is gaining critical thinking skills and is often able to understand procedures, rationales, and associated risks.

1. Cristina, a mother of a 4-year-old child tells the nurse that her child is a very poor eater. What's the nurse's best recommendation for helping the mother increase her child's nutritional intake? Select all that apply. a. Offer the child a selection of foods and allow the child to feed herself accepting that it may take longer. b. Use specially designed dishes for children - for example, a plate with the child's favorite cartoon character c. Only serve the child's favorite foods d. d. Allow the child to eat at a small table and chair by herself

1. Answer: A,B The best recommendation is to provide options and allow the child to feed herself because the child's stage of development is the preschool period of initiative. Special dishes would enhance the primary recommendation. The child should be offered new foods and choices, not just served her favorite foods. Using a small table and chair would separate the child from the family and the child would not be able to observe proper eating habits.

2. Nurse Oliver is teaching a mother who plans to discontinue breast-feeding after 5 months. The nurse should advise her to include which foods in her infant's diet? a. Iron-rich formula and baby food b. Whole milk and baby food c. Skim milk and baby food d. d. Iron-rich formula only

2. Answer: D The American Academy of Pediatrics recommends that infants at age 5 months receive iron-rich formula and that they shouldn't receive solid food -(even baby food) until age 6 months. The Academy doesn't recommend whole milk until age 12 months, and skim milk until after age 2 years.

3. The client tells the nurse she is going to begin giving a 3 month old infant rice cereal at bedtime so the infant will sleep through the night. What will the nurse tell the client? a. Introducing solid food before 4 to 6 months will reduce the likelihood that the infant will develop allergies. b. Make sure the cereal is iron fortified. c. That is a good way to get the baby to sleep through the night d. The introduction of solid foods before the age of 4 to 6 months is not recommended.

3. Answer: D The introduction of solid foods before the age of 4 to 6 months is not recommended. It is thought that the early introduction of solid foods may increase the possibility of the development of food allergies.

When asked about adolescent nutrition a new nurse demonstrates the need for further teaching by stating the following (Select All That Apply) a. All teenagers grow at the same rate B. Teenage boys need higher caloric intake than teenage girls C. Cheese Whiz is a good supplement for iron D. A good snack choice is one that fits into the pyramid

Answer - ABC - All of these statements are false - adolescents grow at different rates - adolescents boys and girls require the same caloric intake and cheese whiz is not high in iron

4. The client asks the nurse why the infant cannot have cow's milk before 1 year of age. Which of the following are reasons the nurse could give? Select all that apply. a. Cow's milk doesn't provide sufficient calories. b. Cow's milk will damage the infants liver. c. Dehydration can result. d. The fat is not absorbed as efficiently as that in human milk. e. The kidneys are challenged by its high protein and mineral content. f. The proteins are more difficult to digest.

4. Answer: C, D, E, F Infants under the age of 1 year should not be given regular cow's milk. Because its protein is more difficult and slower to digest than that of human milk, it can cause gastrointestinal blood loss. The kidneys are challenged by its high protein and mineral content, and dehydration and even damage to the central nervous system can result. In addition, the fat is not absorbed as efficiently as that in human milk.

3. Which of the following statements indicate that the adolescent is having an early sign of anorexia nervosa? a) I have my menses every month b) I go out to eat with my friends c) I run three times a day for a total of 5 hours per day d) I try to maintain my weight around 115 lbs. for my height of 5 feet

Answer C ExcessivE exercise, consumption of very small amounts of food and food rituals, amenorrhea, and excessive weight loss or weight is below normal, lanugo, dry skin, bradycardia, are all signs of anorexia nervosa.

5. During the nutritional assessment of a preschool age child, the mother explains that the child only wants to eat raisins, cookies, and sugary-cereals. Which of the following could the nurse recommend to help improve the child's nutritional intake? a. withhold sweets and deserts, only using them for good behavior b. substitute milk, juice, fruit wedges, cheese, or peanut butter for the sugary snacks c. nothing; the child's eating habits will improve with time d. use the preferred sweet foods as a reward for eating all of the nutritional foods first

5. Answer : B Snacks are necessary because of the child's high level of activity but should be chosen wisely. Deserts are normal but should furnish protein, minerals, vitamins, and calories and can be a natural part of the meal. The child will learn lifetime food habits from the pattern established in the home with the parents. Parents should avoid using food as a reward as this will also form unhealthy habits.

2. Between the ages of 12 months and 36 months the child has a growth rate that is... A. Equivalent to that of the first 12 months B. Faster than that of the first 12 months C. Slower than the first 12 months D. Has a growth rate of approximately 9 lbs per year.

Answer C is correct as toddlers grwoth rate decelerates from ages 1-3. D is incorreect as the average weight gain per year during this period is 5 lbs per year not 9 Both A and B are incorrect

3. A school-aged child is preparing to undergo a minor procedure. Which statement by the nurse is most appropriate regarding the presence of his parents in the room during the procedure? AIt is your choice if you would like to have your parents in the room with you. BYou are at an age where you need to go in the room alone. CYour parents really want to be in the room. You should let them come in. DBecause of the seriousness of this procedure your parents must stay in the waiting room.

A is the correct answer because school aged children have a growing sense of privacy that needs to be respected. Therefore, the child should decide if he wants his parents there.

4. An 8 year old child is recovering from an appendectomy. Which actions by the nurse are appropriate? (SELECT ALL THAT APPLY) AGive the child a small toy or stuffed animal. BPraise the child for coming through the procedure. CLet the child know that the procedure is over and he has nothing to worry about now. DExpress to the parents how well the child did.

A, B, and D are appropriate responses. C is incorrect because the nurse is giving the impression to the child that there will be no pain or complications following the procedure.

1. When educating a parent on proper techniques used to assist her toddler in dealing with pain you would know the parent needs further teaching of she states ways of doing this is.... A. Asking them to help her color a picture B. Putting on a movie C. Asking them to deep breath D. Telling them the pain will be "all gone" when the meds kick in.

A,B & C are correct as they are all methods of distraction or coping skills D is incorrect as pain meds may not rid the child of ALL the pain.

According to Piaget the teen should be operating at which stage of the cognitive process? Formal Operation Concrete Operational Preconception Intuitive

A. Formal Operational - the teen is able to use abstract reasoning, can recognize multiple view points.

To therapeutically communicate with a teen the nurse understands that she must: (Select all that apply) A Listen to what the teen is saying as well as body language. B Discuss without judging. C Encourage critical thought. D Use distractions.

A. Listen to what the teen is saying as well as body language, B. Discuss without judging, and C. Encourage critical thought all support the teen in making good decisions. D. distracting the teen avoids discussing the topic at hand and is not therapeutic.

5. Mandy, age 14, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective? a) Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model b) Initiating a teenage parent support group with first - and - second-time mothers c) Using audiovisual aids that show discussions of feelings and skills d) Providing age-appropriate reading materials

Answer D Because adolescents absorb less information through reading, providing age-appropriate reading materials is the least effective way to teach parenting skills to an adolescent. The other options engage more than one of the senses and therefore serve as effective teaching strategies.

1. A 6-month old infant is admitted to the pediatric unit with a tentative diagnosis of dehydration. The nurse knows that early clinical sings of dehydration in infants are A. Irritability, sunken fontanels, dry mucous membranes, and weakening peripheral pulses B. Tachycardia, lethargy, and decreased urine output. C. Gray skin color, poor turgor, bulging fontanels, and decreased urine output. D. Lethargy, sunken fontanels, rapid respiration and pulse.

Correct answer is A Sunken fontanels, dry membranes, and weak peripheral pulses are signs of decreased extracellular fluids. Tachycardia, decreased urine output and lethargy are later findings.

According to Piaget's Preoperational Stage, preschoolers should be able to: (select all that apply) a. Understand cause and effect b. Understand basic number concepts c. Children recognize that their thoughts and perceptions may be different from those around them d. think logically about events

The correct answer is A and B. The preoperational stage, or second stage of Piaget's theory, includes being able to understand cause and effect, and basic number concepts. A child in this stage has an egocentric view, thinking that their point of view can be the only point of view, and therefore are not yet able to recognize that other points of view exist. They are not yet able to think logically. For instance, they might think that a car which won't start is "sick", believing that even inanimate objects have the same feelings and emotions as they.

The parents of a 4-year-old are worried about their child's imaginary playmate. The nurse understands that the best response would be based on knowing that: a. this is not a normal finding and the child should have a psychosocial evaluation. b. this is the direct result of parent-child conflict. c. having imaginary playmates is normal and useful at this age. d. having imaginary playmates is abnormal after about age 2 years.

The correct answer is C. Having imaginary playmates during this age helps children to mitigate feelings and express emotions and is a beneficial precursor to the process of realistic social interaction. It is not a reason for your child to have a psychosocial evaluation, nor is it a direct result of parent-child conflict. There is no evidence to suggest that having an imaginary playmate is unhealthy at any age in the child development process.

By preschool age the child's body image has developed to include: well-defined body boundary. knowledge about internal anatomy. fearing intrusive procedures. anxiety and/or fear of separation from family.

The correct answer is C. Fearing intrusive procedures At this age, preschoolers have a fear of intrusive procedures, the dark, and dogs. Preschoolers have poorly defined body boundaries, and no cognitive understanding of internal anatomy. Anxiety and fear of separation are associated with psychosocial development, and not with body image.

What age range does an infant belong? a. 1-12 months b. 1-3 years c. 3-6 years d. 6-12 years

a. correct b. incorrect. 1-3 years is toddler c. incorrect. 3-6 years is early childhood d. incorrect. 6-12 years is school age

What age range does a toddler belong? a. 1-3 years b. 0-1 month c. 6-12 years d. 3-6 years

a. correct. b. incorrect. 0-1 month is a newborn c. incorrect. 6-12 years is school age d. incorrect. 3-6 years is early childhood.

Which of the following educational techniques is effective for a toddler? a. using play. b. charades. c. offer the free wifi service the unit is debuting for a Google search. d. flow charts and diagrams.

a. correct. Encourage the toddler to demonstrate the teaching using a stuffed toy. b. incorrect. Although charades can be fun, how would one act out an ERCP? c. incorrect. This will not help prepare the child or gain an understanding of the child's preparedness. d. incorrect. Flow charts and diagrams are not personable and cannot convey empathy like a nurse.

When assessing the family and patient's educational needs it is important to consider: a. Developmental characteristics dictate how to approach the child and what to say. b. the highest level of education achieved by the parents. c. talking like a baby to convey empathy with the patient. d. what time lunch is.

a. correct. The procedure could mean nothing to an adult, but could be terrifying to a child. b. incorrect. although you need to avoid very technical explanations, the education of the parents is irrelevant. c. incorrect. Age appropriate language is important, however baby talk is not. d. incorrect. Not relevant to the question.

What are appropriate nursing actions when preparing an infant for IV insertion? (select all that apply) a. Describe the procedure to parents, relatives, and clergy. b. Allow parents to decide whether or not to stay with their child during procedure. c. Identify what restraints may need to be used. d. Educate on length of time for procedure.

a. incorrect. It is unnecessary to inform anyone other than the family and patient. b. correct. The parent may feel squeemish themselves and may not want to transfer these feelings to the child. c. correct. Restraining the patient may be necessary to facilitate a life saving intervention. d. correct. It is important to not only describe the procedure, but how long it will take, and what the result may indicate.

6-12

able to communicate about pain and will ask questions about body and illness

ages 6-12

friends important competitiveness increases winning important rules important

The most appropriate time to discuss a procedure with a preschool aged child is

it is most appropriate to discuss a procedure with a preschool aged child immediately before so that they will not worry about it.

6-12 activities

team sports, video games, board games, biking, skate boarding

3. During the toddler stage your child is more prone to injury primarily due to A Decrease in sleep hours B Increase in mobility C Vision changes D Sibling altercations

Answer is B . MOBILITY Although any of the others are potential causes of injury during this phase of childhood the increase in mobility is a greater and more common risk for injury than any of the others

A nurse assesses the vital signs of a 12 month old infant with respiratory infection and notes that the RR is 35 breaths/min. Based on this finding which action is appropriate? 1. Administer oxygen 2 Notify the physician 3 Document the finding 4 Reassess the RR in 15 minutes

Answer: 3 document the finding 1, 2, & 3 are incorrect since RR is within range