Pediatrics Nursing Exam 2 (Wong Chp. 9, 10, 11, 12, 13)

A parent brings a 2-year-old to the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention?

"We stopped using the car seat and put our child in the seat belt now that he is older." Rationale: A car seat should be used until the child weighs 18 kilograms (40 pounds) and is approximately 4 years old. Locking up medicines and any other harmful household products is an appropriate action; therefore, there is no need for further instruction. Turning down the thermostat on the hot water heater is an appropriate action; therefore, there is no need for further instruction. Placing gates at the top and bottom of the basement stairs is an appropriate action; therefore, there is no need for further instruction.

Locomotion:

*Cephalocaudal *Increased coordination of extremities at 4 months *Crawling 6/7 months *Creeping at 9 months *Walk with assistance at 11 months *Walk alone at 12 months

Gross Motor Development Summary:

*Head lag in first 2 months *Head control at 4 months *Rolling over (from abdomen to back) at 5 to 6 months *Parachute reflex by 7 months (Arms extend down in protection when hold them facing couch and quickly lower them) *Sit alone by 7 months *Move from prone to sitting position by 10 months

Burns

*TBSA < 10% = minor, outpatient care Usually: might go to ER and d/c *TBSA 10-20% = admission to hospital, burn unit or ICU/med-surg trauma or telemetry floor. *TBSA >20% = Admission to burn center. (Or ICU if no burn center.) *TBSA > 30% results in systemic response. (Could happen earlier. Cardio/RR, e- loss) Increased capillary permeability **Plasma proteins, fluids, electrolytes to be lost **Anemia caused by heat destruction of RBCs Small Burns **Edema formation in 8-12 hours Large Burns **Hypovolemia slows rate of edema formation 18-24 hours

A nurse is presenting a class on injury prevention to parents of preschoolers. Which injuries should the nurse identify as occurring in this age group? (Select all that apply.)

-Falls -Drowning -Poisoning -Tricycle and bicycle accidents Rationale: Falls occur frequently in preschoolers. Closely monitor playground activities such as climbing jungle-gym. Closely supervise around any water and ensure swimming pools are securely fenced to prevent submersion injury. Place all medications and poisons out of reach and in locked cabinets. Administer medications as a drug, not as candy. Keep poison control phone number by telephone. When riding tricycles and bicycles, children often forget not to ride in the streets. Sports injuries occur in older children.

Common Types of burns

-Hot water scalds (toddlers) (bathtub) -Flame-related burns (older children) (Can reach matches/lighters) -Matches/lighters (1/10 house fires) -Non-accidental burns (abuse--punishment/cigarette burns)

Parents are concerned about the behavior of their preschool child as he is exhibiting aggressive behavior in interactions with other children. Which information would be relevant in determining if the behavior represents an abnormal pattern? (Select all that apply.)

-How many times this type of behavior has occurred in recent weeks? -Does the behavior seem to be escalating? Rationale: In terms of making an evaluation as to whether or not this aggressive behavior is a problem, the nurse would want to obtain information related to quantity, severity, distribution, onset and duration. Asking the parent if they think the behavior is justified given the situation does not address any of the aforementioned variables of concern but rather reflects a judgment value.

Which finding would be considered to be abnormal with regard to growth and development principles? (Select all that apply.)

-Increased height is most likely due to size of limbs rather than torso by the end of the first year. -Increase in weight of the brain about 1.5 times by the end of the first year. -Primitive reflexes remain consistently within the first year of life. Rationale: Increased height is mostly seen in the trunk as opposed to limbs. Brain weight increases up to 2.5 times in the first year of life. Primitive reflexes are replaced by voluntary purposeful movements based on neural pathways.

Infants in the first few days of life are expected to have a weight loss between 5 and 10% based on the following principles (Select all that apply.)

-Increased renal tubular function. -Increased glomerular filtration rate. -Decrease in percentage of body water. Rationale: Expected weight loss in the first few days of life is associated with contraction of ECF compartment resulting in decrease in percentage of body water, increased tubular function and increased glomerular filtration rate. Shivering thermogenesis is the mechanism whereby the infant seeks to maintain body temperature.

Based on the nurse's knowledge of wounds and wound healing, what are factors that can delay or cause dysfunctional wound healing? (Select all that apply.)

-Overweight -Corticosteroid therapy Rationale: Poor nutrition without proper protein and calorie intake affects healing more than being overweight itself. Corticosteroid therapy or other immunocompromising therapy prevents macrophages from migrating to the site of injury, thus suppressing epithelialization. Hypovolemia, not hypervolemia, inhibits wound healing due to low circulating blood volume and oxygenation of tissues. Hypoxemia makes tissues more susceptible to infection due to insufficient oxygenation. Prolonged infection affects the healing process and causes increased scarring.

Characteristics of physical development of a 30-month-old child are (Select all that apply.)

-Sphincter control is achieved. -Primary dentition is complete. Rationale: Sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age. Primary dentition is usually completed by 30 months of age. Anterior fontanel closes between 12 and 18 months of age. Birth weight should double at 5-6 months of age and quadruple by 2½ years of age. Genital fondling is not a characteristic of physical development of this age group. This is part of the development of gender identity.

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? (Select all that apply.)

-The child is brought to the emergency department by an unrelated adult. -The child has red, green, and yellow bruises on more than one plane of the body. Rationale: A child brought to a health care provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse. Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse. Falling down stairs can be an unintentional injury. A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse. An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.

Which food activities would be considered to be normal adaptations for toddlers? (Select all that apply.)

-They often pick up many types of foods, preferring snacking rather than eating just at mealtimes. -Toddlers often exhibit "picky" eating behaviors which is considered to be a normal abnormal. -Foods should not be given to children during playtime. Rationale: Toddlers exhibit grazing or nibbling behaviors and sometimes prefer to snack throughout the day. Toddlers often exhibit "picky" preferential behaviors in their food choices. Foods should not be given to children during playtime as a safety measure to prevent possible choking or aspiration. Appetite and food choices are inconsistent during this time frame. Toddlers will eat more during growth spurt periods.

Emergency treatment of Poison

1) Assess victim (If they aren't alive, won't matter what you do) *CPR, mental status, VS, evaluate 2) terminate exposure (chemical) *Flush body surface with water, empty mouth of pills, remove contaminated clothing, fresh air 3) identify poison *Question victim if awake—what did you do, what did you take, witnesses, look for clues, call Poison Control Center if haven't already 4) Prevent absorption *Place child in side lying, sitting or kneeling position (recovery position)

By what age would the nurse expect most children to use sentences of four or five words?

4½ years Rationale: Children ages 4 to 5 years use sentences of four or five words. An 18-month-old child has a vocabulary of approximately 10 words. A 24-month-old child uses two- or three-word phrases. A 3-year-old child uses sentences of three or four complete words.

What is the most important nursing consideration in the management of cellulitis?

Administration of oral or parenteral antibiotics Rationale: Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. Antibiotics need to be administered systemically (orally or parenterally), not topically. If incision and drainage are implemented, there is a risk of spreading infection or making the lesion worse.

Health Promotion of the Preschooler and Family: Fears

A great number and variety of real and imagined fears are present during the preschool years. Fear of objects, fear of potential annihilation, and parent-induced fears are common, including fear of the dark, being left alone (especially at bedtime), animals (particularly large dogs), ghosts, sexual matters (castration), and objects or persons associated with pain.

Which strategy might be recommended to increase caloric intake in an infant with failure to thrive?

Be persistent through 10 to 15 minutes of food refusal. Rationale: Calm perseverance is important. Parents often cannot persist through the child's refusals, but they should be encouraged to do so and supported. Feeding should take place in a nonstimulating environment so that the focus is on feeding, enhancing the chances of increasing caloric intake. Solids should be introduced slowly to decrease dependence on the bottle, beginning at 6 months of age. The feeding schedule should be structured for the infant to have consistency and develop a routine for feeding.

Health Promotion of the infant and family: Injuries

Because injuries are a major cause of death during infancy, parents should be alerted to aspiration of foreign objects, suffocation, falls, accidental poisoning, burns, motor vehicle injuries, and bodily injury, as well as preventive actions needed to make the environment safe for infants. The three leading causes of accidental death in infants are suffocation, motor vehicle-related injuries, and drowning.

Health Promotion of the Toddler and Family: injury

Because of increased locomotion, toddlers are at high risk for sustaining injuries. Fatal injuries are primarily a result of motor vehicle accidents, drownings, and burns. Many of the deaths are caused by injuries within the car when restraints have not been used or have been used improperly. Unrestrained children riding in the vehicle's front seat are at highest risk for injury.

Health Promotion of the Toddler and Family: Biologic development

Biologic development during the toddler years is characterized by the acquisition of fine and gross motor skills that allow children to master a wide variety of activities. In general, adult height is about twice the child's height at 2 years of age. Accurate measurement of height and weight during the toddler years should reveal a steady growth curve that is steplike rather than linear (straight), which is characteristic of the growth spurts during the early childhood years.

Health Promotion of the infant and family: Nutrition

Breast milk is the most desirable food for the infant during the first 6 months. Commercial iron-fortified formula is an acceptable alternative to breast milk, followed by gradual introduction of solid food during the period of 4 to 6 months. Iron-fortified rice cereal is recommended as the first solid food. Whole milk is not recommended until after 12 months. Infants, whether breast- or bottle-fed, do not require additional fluids, especially water or juice, during the first 4 to 6 months of life. Honey should be avoided in the first 12 months because of the risk of infant botulism.

Health Problems of Toddlers and Preschoolers: Burn injuries

Burn injuries are usually attributed to extreme heat sources but may also result from exposure to cold, chemicals, electricity, or radiation. Most burns are relatively minor and can be treated in an outpatient setting. However, burns involving a large body surface area, critical body parts, or the geriatric or pediatric population often benefit from treatment in specialized burn centers.

Health Problems of Toddlers and Preschoolers: Burn-injuries

Burn-related injuries include inhalation injury and wound sepsis. Early signs of sepsis: decreased level of consciousness, lethargy, hypotension, tachycardia

Health Problems of Toddlers and Preschoolers: Burns

Burns are classified as minor, moderate, or major, which is useful in determining the disposition of the patient for treatment.

Health Promotion of the Preschooler and Family: Abilities

By 36 months, preschoolers are walking, running, climbing, and jumping well. Refinement in eye-hand and muscle coordination is evident in several areas. At age 3, the preschooler rides a tricycle, walks on tiptoe, balances on one foot for a few seconds, and broad jumps. By age 4, the child skips and hops proficiently on one foot and catches a ball reliably. By age 5, the child skips on alternate feet, jumps rope, and begins to skate and swim.

Health Problems of Infants: ALTE

An apparent life-threatening event (ALTE) generally refers to an event that is sudden and frightening to the observer, in which the infant exhibits a combination of apnea, change in color (pallor, cyanosis, redness), change in muscle tone (usually hypotonia), choking, gagging, or coughing; the event usually involves a significant intervention and even cardiopulmonary resuscitation by the caregiver who witnesses the event. The treatment of the infant with an ALTE depends on the underlying condition but may involve continuous home monitoring of cardiorespiratory rhythms with a multichannel pneumogram and, in some cases, the use of a pharmacologic agent.

Health Problems of Infants: Apnea

Apnea is defined as a cessation of breathing for 20 seconds. Apnea of infancy is an unexplained respiratory pause of 20 seconds or more, or pauses of less than 20 seconds that are accompanied by pallor, cyanosis, bradycardia, or hypotension in the term infant.

In terms of play behavior, which observation would be considered to be an abnormal finding based on normal growth and development patterns?

At 1 month of age, they extend arms to be picked up by their parent or caregiver. Rationale: Infants typically extend their arms by 6 months of age, thus this would be considered abnormal if present by 1 month. All of the other options would be considered to be normal play behavior presentations.

When discussing risk factors for sexual abuse and children, the nurse is aware which of the following is most common?

C. A. The abuser is often a stranger B. The offender is never seen again C. The abuser gains the child's trust over time. D. The parent is often aware of the abuse

Macrominerals refer to those minerals with daily intake requirements greater than 100 mg. Which is a macromineral?

Calcium Rationale: Calcium is a macromineral. Iron, fluoride, and selenium are microminerals.

Health Problems of Infants: Colic

Colic is generally described as paroxysmal abdominal pain or cramping that is manifested by loud crying and drawing the legs up to the abdomen. Treatment of colic may involve a change in infant feeding practices, correction of a stressful environment, behavior modification, and support of the parent. Medications such as antispasmodics or mild sedatives may decrease symptoms in some infants. Perhaps the most important nursing intervention (once the diagnosis of colic is established) is reassuring parents that they are not doing anything wrong and that the infant is not experiencing any physical or emotional harm.

Health Problems of Infants: Sleep problems

Common sleep problems that develop during infancy, and that are easily prevented, are associated with night crying and feeding. Nurses should instruct the parents, after careful assessment, in strategies to deal with the specific problem.

Health Problems of Toddlers and Preschoolers: Poison control

Communication with the area poison control center is essential in the treatment of any poisoning.

Health Promotion of the Toddler and Family: body image/gender

Development of body image occurs with increasing motor ability, at which point toddlers recognize the importance and capacity of body parts. A sense of maleness or femaleness— gender identity—is formed by age 3 years.

Health Promotion of the infant and family: Body image

Development of body image parallels sensorimotor development. As motor skills develop, infants learn that parts of the body are useful; for example, the hands bring objects to the mouth, and the legs help them move to different locations.

In order for an infant/child to formulate an attachment with another human being, they must (Select all that apply.)

Discriminate self between individuals. achieve object permanence. Rationale: In order to form attachments, the infant/child must be able to discriminate themselves from others as separate human beings. They also must understand the concept of object permanence. Attachment is not based on understanding of moral principles, time or self-recognition of their image in a mirror.

Corrosives (Strong Acids or Alkalis)

Drain, toilet, oven cleaners Electric dishwasher detergent Batteries Denture cleaners Bleach Clinical Manifestations Corrosives: *Severe burning pain in the mouth, throat, and stomach *White, swollen mucous membranes; edema of the lips, tongue, and pharynx (respiratory obstruction) *Coughing, hemoptysis (bloody sputum) *Drooling and inability to clear secretions *Signs of shock (Anxiety and agitation)

Health Promotion of the Preschooler and Family

During the preschool period, the separation-individuation process is completed. Preschoolers have overcome much of their anxiety associated with strangers and the fear of separation of earlier years. They relate to unfamiliar people easily and tolerate brief separations from parents with little or no protest. However, they still need parental security, reassurance, guidance, and approval, especially when entering preschool or elementary school.

Health Promotion of the Toddler and Family: Discipline

Effective discipline techniques for toddlers include reward, ignoring or extinction, and time-out.

Health Promotion of the infant and family: Injury prevention

Effective teaching for injury prevention optimally begins in infancy by helping parents understand their child's normal development. It must be reiterated continually that infants cry because a need is not being met, not to intentionally irritate an adult. The fussy or irritable infant is a potential victim of shaken baby syndrome (or other bodily harm) because adults and caretakers may not understand the nature of the infant's crying.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy?

Encourage the toddler to do things for himself or herself when he or she is capable of doing them. Rationale: Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy.

Which characterizes the development of a 2-year-old child?

Engages in parallel play Rationale: Two-year-olds play alongside each other, otherwise known as parallel play. Toddlers need help with dressing because this is a task they are just beginning to learn; learning this extends into the preschool years. A toddler commonly has a vocabulary of 300 words. A toddler has attained one half of his or her adult height.

Health Promotion of the Preschooler and Family: Play

Probably the most characteristic and pervasive preschooler activity is imitative, imaginative, and dramatic play. Dress-up clothes, dolls, housekeeping toys, dollhouses, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, and medical kits provide hours of self-expression.

Health Problems of Infants: Malnutrition

Protein-energy malnutrition (severe acute malnutrition) may occur as a complication of social unrest and catastrophe, lack of parental education about infant nutrition, inadequate food availability after weaning, inappropriate management of food allergy, poor food storage and handling, or incorrect preparation of formula. Protein-energy malnutrition may be seen in persons with chronic health problems such as cystic fibrosis, cancer, HIV, and GI malabsorption.

The nurse is providing education to a parent of a 10-month-old infant with the diagnosis of cow's milk allergy. What will be included in the teaching? (Select all that apply.)

Reading of all food labels to avoid products with milk. Rationale: Reading of all food labels to avoid products with milk will be included in the teaching. This infant will not be desensitized to milk. Milk and milk-based products should be avoided with this child. Introduction of soy-based products to replace milk will be included in the teaching. Signs and symptoms associated with potential accidental ingestion of milk will be included in the teaching.

Health Promotion of the Toddler and Family: Oral care

Regular dental examinations, fluoride supplementation, removal of plaque, and provision of a low-cariogenic diet promote optimum dental health.

A child has been stung by a bee and the parents call the walk in clinic asking for instructions on what to do as they make their way to the clinic. The nurse responds by stating?

Remove the stinger from the site. Rationale: First action is to remove the stinger, then cleanse the area with soap and water and apply a cool compress. There is no need to remove the child's clothing or provide fluid hydration. There is no indication tha the child is experiencing any evidence of anxiety provided by the parent's communication.

Health Problems of Toddlers and Preschoolers: Gastric lavage

Gastric lavage may be performed to empty the stomach of the toxic agent; however, this procedure is associated with serious complications (gastrointestinal perforation, hypoxia, aspiration), and it is no longer recommended in all cases of ingestion.

Which is the most appropriate recommendation for relief of teething pain?

Give the child a frozen teething ring to relieve inflammation. Rationale: Cold reduces inflammation and should be used for relief of teething irritation. Aspirin and aspirin products should never be used in infants and children for inflammation or pain relief. Hydrogen peroxide will not be effective and may irritate the gums more. Cold, not warm, reduces inflammation; therefore, heat is not effective for teething pain.

Health Problems of Toddlers and Preschoolers: Skin disorders

Skin disorders of the preschool years may include contact dermatitis; poison ivy, oak, and sumac; anthropod bites and stings; pet and wild animal bites; and human bites.

Health Promotion of the infant and family: Development from play

Social development of the infant is guided by attachment, language development, personal-social behavior, and participation in play. Play is a major socializing event that provides stimulation needed to learn from and interact with the environment. By 6 months of age, infants play games such as peek-a-boo.

Health Promotion of the Toddler and Family: Psychosocial

Specific tasks in the psychosocial development of a toddler include differentiating self from others, tolerating separation from parent, coping with delayed gratification, controlling bodily functions, acquiring socially acceptable behavior, communicating verbally, and interacting with others in a less egocentric manner. Achievement of toilet training is a major developmental milestone for the toddler.

What should the nurse recommend to the parents to help a toddler cope with the birth of a new sibling?

Give the toddler a doll with which he or she can imitate the parents. Rationale: The toddler can participate in the activity of caring for a new family member, which will make him or her feel included and important. The child should be encouraged to participate within his or her capabilities. The toddler should never be discouraged, because this will make him or her feel isolated and left out. Preparation should begin when obvious changes begin to happen to the mother's body and at home. This will establish unrealistic expectations for the toddler. Toddlers take language literally, and therefore will be disappointed when the new baby cannot play when he or she arrives home.

Which statement about bottle-mouth caries should be taught to the parents?

Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. Rationale: Sweet liquids, or the sugars in milk and even breast milk, pooling in a toddler's mouth during sleep increase the incidence of dental caries. Changes in the positioning of the teeth may result from pacifier use or thumb sucking and are not related to bottle-mouth caries. Frequent breastfeeding before sleep can cause bottle-mouth caries, since breast milk does contain lactose, which is present in higher concentrations than in cow's milk-based formula. Juice, which contains varying concentrations of sugar, in bottles before sleep contributes to bottle-mouth caries.

Health Promotion of the infant and family: Erikson

Erikson's theory of psychosocial development (birth to 1 year) is concerned with acquiring a sense of trust while overcoming a sense of mistrust. The crucial element for the achievement of this task is the quality of both the parent (caregiver)-child relationship and the care the infant receives.

Health Promotion of the infant and family: Fine motor

Fine motor development includes the use of the hands and fingers in the prehension (grasp) of objects. Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary.

A child relates that every time he eats a certain food, he gets a stomachache. No other discernable physical symptoms have been correlated with the food intake. Based on this information, the nurse would suspect that the child may be exhibiting?

Food intolerance Rationale: Food intolerance occurs when a food substance elicits a reproducible reaction without an immunological basis. Food allergies would have discernable symptoms accompanying the food intake due to an immunological response. There is no information to suspect that the child is exhibiting a food preference or food refusal behavior as the description of the food event is noted as being the same each time.

Health Problems of Infants: Food intolerance

Food intolerance encompasses food allergies and food sensitivities, which can have a number of systemic and local clinical manifestations. Food allergy or hypersensitivity involves immunologic reactions, which can be immediate or delayed and mild or severe. Food intolerance refers to reactions involving nonimmunologic mechanisms, such as lactose intolerance. Children with extremely sensitive food allergies should wear a medical identification bracelet and have an injectable epinephrine cartridge (EpiPen) readily available.

Which food combination will generally provide the appropriate amounts of essential amino acids for an individual who is a vegetarian?

Grains and legumes Rationale: Grains and legumes form complete proteins when eaten together, providing appropriate amounts of essential amino acids. Grains should be eaten with milk products or legumes to provide appropriate amounts of essential amino acids. Legumes should be eaten with grains or seeds to provide appropriate amounts of essential amino acids. Milk products should be eaten with grains to provide appropriate amounts of essential amino acids.

Health Promotion of the infant and family: Gross motor

Gross motor development is demonstrated throughout the first 12 months of life by increasing ability to control head movement, sit without support, crawl, and stand holding on to an object.

Health Problems of Infants: Growth failure/failure to thrive

Growth failure, or failure to thrive, may occur in children who have a chronic illness or in a family environment where healthy infant feeding practices are poorly managed or understood. Growth failure is not always associated with a pattern of disturbed maternal-infant relationship. The primary management is aimed at reversing the cause of the growth failure; therefore assessment of the child, family, and environment is crucial.

Which observation is associated with nightmares as opposed to sleep terrors?

Has a hard time returning to sleep following the event. Rationale: Nightmares are associated with difficulty returning to sleep as opposed to sleep terrors where the individual easily goes back to sleep. With the advent of a nightmare, the child has a memory of the dream like state, is comforted by traditional methods of contact and thrashing type behaviors cease upon awakening. In sleep terrors, the child has no memory of the event, continues thrashing behaviors when awaken, and is not comforted by traditional methods of contact.

Infancy Hematopoietic Changes

Hbgf is present for five months 3-6 months: pysiologic anemia (Normal response to postnatal life, NOT blood disorder) May need iron supplementation. Admin iron w/ dropper towards back of mouth Can cause teeth staining, even before teeth come in. In older children administer through straw Give with vitamin C

Health Promotion of the Preschooler and Family

Health promotion continues to be directed toward proper nutrition, adequate sleep, proper dental care, and injury prevention.

Health Problems of Toddlers and Preschoolers: Abuse

Identification of abuse entails securing evidence of maltreatment, taking a history pertaining to the incident, and assessing parental and child behaviors.

Health Promotion of the Toddler and Family: Piaget

In Piaget's sensorimotor and preoperational phases of development, the toddler experiments by incorporating the old learning of secondary circular reactions with new skills and applies this knowledge to new situations. There is the beginning of rational judgment, an understanding of causal relationships, and discovery of objects as objects. Preoperational thought is characterized by egocentrism, centration, global organization of thought processes, animism, and irreversibility.

Health Promotion of the Preschooler and Family: Early learning

In selecting an early learning program, parents should inquire about daily programs, teacher qualifications, accreditation, student-staff ratio, safety, meals, fees, and health practices.

The nurse notices that a toddler is more cooperative taking medicine from a small cup than from a large cup. This is an example of which characteristic of preoperational thought?

Inability to conserve Rationale: The smaller cup makes it look like less medicine to the child at this stage of cognitive development. The inability to see situations from other perspectives, besides their own, does not facilitate medication administration. The inability to reverse or undo actions physically initiated does not facilitate medication administration. Focusing on particulars does not explain the cooperation with the smaller medication cup.

A newborn who is suspected of having atopy would most likely have which diagnostic finding?

Increased levels of IgE in umbilical cord blood Rationale: Newborns who have a hereditary component are more likely to present with atopy and as such would have increased levels of IgE noted in umbilical cord blood. SGA and a precipitous delivery would not be associated with atopy.

Which statement best describes colic to parents who are inquiring as to whether their infant is experiencing this alteration?

Infants with colic have paroxysmal abdominal pain or cramping manifested by episodes of loud crying. Rationale: Colic, or paroxysmal abdominal pain, occurs primarily in infants under the age of 3 months and is manifested by episodes of excessive crying and the infant drawing the legs up toward the abdomen. The infant with colic experiences abdominal pain but gains weight and usually thrives. Colic most commonly occurs in infants under 3 months of age. There is no identified relationship between mothering behavior and the development of colic.

The nurse is giving anticipatory guidance to the parent of a 5-year-old. What is the most appropriate information to include?

Inform the parent that he or she can expect a more tranquil period at this age. Rationale: The end of preschool and the beginning of school age is a more tranquil period. Preparing the parent for increased aggression is anticipatory guidance for 4-year-old children. Encouraging the parent to offer the child choices is anticipatory guidance for 3-year-old children. Advising the parent that this is the age when stuttering may develop is anticipatory guidance for 3-year-old children.

A child is brought into the hospital following a fire at his home. The child appears to be sleeping on the stretcher bed. No observable burn injuries are noted based on preliminary survey. However, the nurse would place a priortiy observation on the possibility of the child having?

Inhalation Injury Rationale: Inhalation injury in the form of carbon monoxide poisoning or smoke inhalation should be considered in this situation. It is critical for the nurse to make these observations in order to prevent further complications. Thermal and chemical burns would cause evident tissue destruction which would be foun on preliminary survery. In burn states, incresaed metabolism would occur.

Which is the most descriptive of kwashiorkor?

Kwashiorkor has a multifactorial etiology. Rationale: Cultural, environmental, and infectious components contribute to kwashiorkor, a deficiency of protein with an adequate supply of calories. Kwashiorkor occurs in infants and children who are beyond the age of breastfeeding. There is no correlation between excessive amounts of vitamin K and kwashiorkor. Kwashiorkor is a disorder in which there are adequate calories but a deficiency of protein.

Health Promotion of the Preschooler and Family: Language

Language becomes more sophisticated and complex during the preschool years. Both cognitive ability and environment, particularly consistent role models, influence vocabulary, speech, and comprehension. Language becomes a major mode of communication and social interaction. Vocabulary increases dramatically, from 300 words at age 2 to more than 2100 words at the end of 5 years.

Health Promotion of the Toddler and Family: Language

Language is the major cognitive achievement in toddlerhood. Although the number of words acquired is notable—from about four at 1 year of age to approximately 300 at age 2 years— the ability to comprehend and understand speech is much greater than the number of words the child can say.

Ashley, age 4½ years, is afraid of dogs. What should the nurse recommend to her parents to help her with this fear?

Let her watch other children play with a dog. Rationale: The parents should actively seek ways to deal with fear. By observing other children at play with dogs, the child can adapt. Keeping their child away from dogs avoids the object of fear rather than addressing the fear and finding solutions. Buying a child a stuffed dog toy avoids the object of fear rather than addressing the fear and finding solutions. Forcing the child to touch a dog without working up to it may increase the level of fear.

An infant is more likely to be at increased risk for infections based on the immunological premise that:

Limited ability to reach adult levels until 1 year of age. Rationale: Infants reach 40% of their immunoglobulin levels by 1 year of age and are therefore at risk to develop an infection. Infants have an increased amount of immunoglobulin M at birth, have maternal transfer until 3 months of age, and are able to synthesize immunoglobulin at decreased rates.

Health Promotion of the Toddler and Family: Locomotion

Locomotion is the major gross motor skill acquired during toddlerhood, followed by increased eye-hand coordination. By 12 to 13 months of age, toddlers walk alone. They are able to jump using both feet and climb stairs by age 2 to 2½ years.

Parents of a preschooler relate that their child is having some difficulties falling asleep. This is a recent occurrence and the parents report that they have tried virtually everything to get their child to go to sleep. Based on this self-report, the nurse would advise the parents to?

Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns. Rationale: Children in this age group often experience changes in their sleep patterns but consistent approaches in bedtime rituals may help to promote sleep patterns. By the parents self-report that they have "tried virtually everything" may have contributed to the child's altered sleep pattern. There is no enough information provided for the nurse to make any other of the provided options.

Animal bites

Management of bite: Rinsing wound with LR with pressure syringe, (irrigate), wash with mild soap, sometimes. Typically: Pressure Dressing, elevation (for swelling) Assess for rabies, tetanus Prophylactic antibiotics Education on prevention!

Acetaminophen

Most common accidental drug poisoning Toxic dose is 150mg/kg or greater Clinical Manifestations - 4 stages post ingestion 1) 0-24 hrs Nausea, vomiting, sweating, pallor 2) 24-72 hrs Slight improvement, abdominal pain 3) 72-96 hrs RUQ pain, jaundice, confusion, stupor, coagulation 4) > 5 days Hepatotoxicity, multiple organ failure Antidote: N-acetylcysteine (mucomyst) - intravenous or orally Loading dose followed by 17 additional doses IV is continuous

A toddler is admitted to the emergency room with a possible diagnosis of accidental poisoning. Which information if noted on the admission form would indicate a potential cause for this clinical diagnosis?

Mother has been taking Tylenol OTC for sinus headaches for several days and keeps medication in a tote handbag Rationale: The fact that the Tylenol is being kept in a handbag may pose concern as access to the tote handbag is not restrictive. The toddler may have been able to access the medication. The other options do not pose a significant concern as a possible etiology for this clinical diagnosis.

A 4-year-old child is seen playing with his father while waiting in the clinic area for a well checkup visit. The nurse observing the interaction notes that this behavior as being an example of?

Mutual play Rationale: Children playing with a parent is an example of mutual play. Play can be described as being imaginative or dramatic as a characteristic but there is no specific information given that defines the type of play interaction that is occurring. The concept avoidance play does not exist as a characteristic term describing play behaviors.

Health Promotion of the Toddler and Family: Negativism

Negativism is not an expression of being stubborn or insolent, but a necessary assertion of self-control.

Health Problems of Toddlers and Preschoolers: NR interventions burns

Nursing interventions for burn injuries include fluid replacement therapy, nutrition, medication, burn wound management, comfort measures, prevention of complications, scar management, and prevention. Psychosocial support of the burn victim focuses on fostering independence and autonomy.

Health Promotion of the Toddler and Family: Nutrition

Nutrition is important at this stage because eating habits established in toddlerhood tend to have lasting effects in subsequent years. At approximately 18 months of age, most toddlers manifest a decreased nutritional need with a decreased appetite, a phenomenon known as physiologic anorexia. The amount of food consumed by the toddler is not as important as the quality of the food consumed because growth is considerably less than in infancy. Conditions such as obesity and cardiovascular disease can be prevented by encouraging healthy eating habits in toddlers and their families.

If an infant understands that an object, even if out of sight still exists then it would be correct to note that the infant has achieved

Object permanence. Rationale: Piaget's cognitive theory states that object permanence is the ability of the infant to understand that an object still exists even if placed out of sight. This action is not correlated with moral comprehension or mental representation. It is not associated with reflex activity which is where reflexes are replaced by voluntary actions.

Parents of an infant report that the child is extremely fussy at times. Which parental response might lead to potential poor outcomes in later life for the child?

Offering the infant more food to decrease fussiness. Rationale: Research suggests that providing additional feedings to fussy infants may stimulate a potential pattern for development of obesity as the child ages. All of the other options could be used in response to the infants being fussy without adverse outcomes.

Health Problems of Toddlers and Preschoolers: Abuse

Once abuse is identified, it is important to remove the child from the situation or environment to prevent further injury.

Health Promotion of the Toddler and Family: Toilet training

One of the major tasks of toddlerhood is toilet training. The child must be able to recognize the urge to let go and hold on and be able to communicate this sensation to the parent. Five markers signal a child's readiness to toilet train: bladder readiness, bowel readiness, cognitive readiness, motor readiness, and psychological readiness. According to some experts, physiologic and psychological readiness is not complete until ages 22 to 30 months.

A 6-month-old infant attempts to pick up a toy using his entire hand. This action would be documented as using a:

Palmer grasp. Rationale: At 6 months of age, one would expect an infant to be able to pick up and transfer objects with his/her whole hand. This is noted as a palmer grasp. Prehension is when the infant uses both fingers and hands to grab objects and is typically seen between 2 and 3 months. Pincer grasp is when the infant uses both the thumb and middle finger is seen after 6 months of age. The behavior described is an example of fine motor development as opposed to gross motor development.

Health Problems of Toddlers and Preschoolers: Maltreatment

Parental, child, and environmental characteristics may predispose children to maltreatment.

Health Promotion of the infant and family: Concerns

Parents are faced with many concerns, including infant fears, daycare, limit setting and discipline, thumb sucking and pacifier use, and teething. Providing the parents information regarding infant behavior and appropriate child-rearing practices helps parents cope with the task of child rearing.

When preparing parents to teach their preschool child about human sexuality, what should the nurse emphasize?

Parents should determine exactly what the child wants to know before answering a question about sexuality. Rationale: It is important that the parent answer the question that the child is asking. Actions may have a greater influence because language is not fully developed in the preschool years. Using correct terminology lays the foundation for later discussion of human sexuality. Parents should encourage children to ask questions to provide accurate information at their cognitive level.

A 9-month-old infant is seen in the emergency department after developing urticaric rash with cough and wheezing. When collecting the history of events prior to the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant?

Peanut butter Rationale: Nuts of any type, including peanuts, have a high allergy index in children and infants. The infant has demonstrated the cutaneous and respiratory type of reaction after possible ingestion of peanut butter. Potatoes are not a highly allergenic food. Green beans are not a highly allergenic food. Spinach is not a highly allergenic food.

Health Promotion of the infant and family: Physical growth

Physical growth occurs at a rapid rate during the first year of life. Infant birth weight should double by 6 months of age and triple by 12 months of age. Head growth is also rapid and an important determinant of brain growth. Expanding head size reflects the growth and differentiation of the nervous system. By the end of the first year the brain has increased in weight approximately two and one half times. By 1 year of age, head size has increased by almost 33%.

Health Promotion of the infant and family: Piaget

Piaget's theory of cognitive development, as it applies to the infant, focuses on the sensorimotor phase, which includes the use of reflexes, primary circular reactions, secondary circular reactions, and coordination or secondary schemata and their application to new situations. A major accomplishment is achieving the concept of object permanence, or the realization that objects that leave the visual field still exist.

Which intervention lowers the risk of sudden infant death syndrome (SIDS)?

Placing the infant in the supine position for sleeping. The Back to Sleep Campaign is credited with reducing the rate of SIDS in the United States. Smoking increases the risk of SIDS by exposing the infant to pulmonary irritants. Having the infant sleep with the parents (co-sleeping) increases the risk of SIDS. Overheating increases the risk of SIDS.

Health Promotion of the Preschooler and Family: Play

Play activities for physical growth and the refinement of motor skills include jumping, running, and climbing. Tricycles, wagons, gym and sports equipment, sandboxes, wading pools, and winter sleds can help develop muscles and coordination. Sports such as swimming, skating, and skiing teach safety and help develop muscles and coordination.

Health Problems of Infants: Acquired cranial molding

Positional plagiocephaly, or nonsynostotic plagiocephaly, describes an acquired cranial molding during infancy that occurs as a result of prolonged supine positioning to prevent SIDS. This condition may easily be prevented by allowing the infant tummy time during awake periods and by periodically alternating the side of the head on which the infant sleeps.

Health Promotion of the Preschooler and Family: Moral enforcement

Preschoolers are generally unable to understand why something is acceptable or unacceptable. They are aware of appropriate behavior primarily through punishment or reward and rely almost completely on parental principles for developing their own moral judgment. Verbal enforcement of limits is more effective in preschoolers than with toddlers.

Health Promotion of the Preschooler and Family: Magical thinking

Preschoolers' thinking is often described as magical thinking. Because of their egocentrism and transductive reasoning, they believe that thoughts are all powerful. Such thinking places them in the vulnerable position of feeling guilty and responsible for bad thoughts that may coincide with the occurrence of a wished event.

Which is descriptive of the nutritional requirements of preschool children?

The quality of the food consumed is more important than the quantity. Rationale: It is essential that the child eat a balanced diet with essential nutrients; the amount of food is less important than the quality of the food. Requirements are similar for both toddlers and preschoolers. The caloric requirement decreases slightly for preschoolers. The average intake is about 1800 calories each day for preschoolers.

Health Problems of Toddlers and Preschoolers: Sexual abuse

The reported incidence of sexual abuse has increased in the past decade. Common forms are incest, molestation, rape, exhibitionism, child pornography, child prostitution, and pedophilia. Most sexual abuse is committed by men and by persons known to the child, with family members constituting up to two thirds of the perpetrators.

Health Promotion of the Preschooler and Family: Moral development

The seeds of moral development are planted during the preschool period. According to Kohlberg, these children are in the stage of naive instrumental orientation, in which they are concerned with satisfying their own needs and, less frequently, the needs of others.

Health Promotion of the Toddler and Family: play

The solitary play of infancy progresses to parallel play—the toddler plays alongside, not with, other children.

The nurse is providing education to parents of an infant diagnosed with colic. What would the nurse include in the discharge teaching?

The symptoms of colic typically disappear by 3 months of age. Rationale: The symptoms of colic typically disappear by 3 months of age. The child will not have to be watched for gastrointestinal issues in the future, because colic is not related to long-term gastrointestinal problems. Providing juice at the start of the fussy period will help decrease the length of the crying episodes. There is no evidence that juice will decrease the length of crying in colicky babies. Changing the feeding method to a hypoallergenic formula is not typically recommended for the infant with colic.

Health Promotion of the Preschooler and Family: Agression

The term aggression refers to behavior that attempts to hurt a person or destroy property. Preschool aggression may result from frustration, modeling behavior, and reinforcement.

Health Problems of Infants: SIDS

The third leading cause of infant death (birth to 12 months) in the United States is sudden infant death syndrome (SIDS), defined as the sudden death of an infant younger than 1 year of age that remains unexplained after a complete postmortem examination, including an investigation of the death scene and a review of the case history. SIDS is the leading cause of postneonatal deaths (1 month to 12 months). Factors that place the infant at high risk for SIDS include prone sleeping position, soft bedding, sleeping in a noninfant bed with an adult or older child, and maternal prenatal smoking. Protective factors for SIDS prevention include breastfeeding for the first 6 months of life, pacifier use at bedtime and naptime, updated childhood immunizations, and supine sleep position. Maternal co-sleeping with the infant is not a protective factor for SIDS.

Health Promotion of the Toddler and Family

The toddler stage, extending from 12 to 36 months, is a period of intense exploration of the environment.

Which statement is most characteristic of the motor skills of a 24-month-old child?

The toddler's activities begin to produce purposeful results. Rationale: Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new toy. By 2 years of age, children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is a task of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

Health Promotion of the Toddler and Family: Individuation/Separation

The two phases of differentiation of self from significant others are separation and individuation.

According to evidenced based practice in a recent Cochrane database, which statement is most accurate with regard to the relationship between vitamin A and measles?

There was no correlation between blindness in children who had measles and who also had vitamin A deficiency. Rationale: Current research in Cochrane database reveals there is no relationship between ocular morbidities (blindness) and vitamin A deficiency in children who have measles. Research indicates that vitamin A supplementation can be given to children who have measles with no adverse outcomes.

Which statement by a student nurse indicates that additional instruction is needed regarding topical agents being used to treat burns?

They are associated with electrolyte derangement of surrounding tissues Rationale: Topical agents used in the treatment of burns should provide minimal electrolyte derangement. The other options stated are all consistent with the expected actions of topical agents used in the treatment of burns.

Which statement characterizes toddlers' eating behavior?

They become fussy eaters. Rationale: Toddlers have physiologic anorexia, which contributes to picky, fussy eating. This usually begins at about 18 months of age. They have a decrease in appetite known as physiologic anorexia at this age. They have strong taste preferences at this age. Use of finger foods contributes to the unpredictable table manners of toddlers.

Which statement is correct about young children who report sexual abuse by one of their parents?

They may exhibit various behavioral manifestations. Rationale: There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.

Which infant is at risk for developing vitamin D-deficient rickets?

Those using yogurt as a primary source of milk Rationale: Yogurt may not be supplemented with vitamin D; therefore, the infant may be at risk for the development of rickets. Individuals who follow this diet include milk and its products and therefore receive vitamin D. Breast milk provides sufficient vitamin D to the infant if the mother is not deficient in this vitamin. Lack of sunlight contributes to vitamin D-deficient rickets.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb sucking. What should the nurse's reply be based on?

Thumb sucking should be discouraged when permanent teeth begin to erupt. Rationale: Thumb sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Evidence is inconclusive over whether a pacifier or a thumb better satisfies sucking needs and what the impact of either is on tooth eruption. Thumb sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Nonnutritive sucking reaches its peak at about 18 to 20 months of age. Most toddlers give up nonnutritive sucking on their own.

Health Promotion of the Toddler and Family: Oral care

Toddlers require parental supervision and assistance with toothbrushing and flossing.

Health Promotion of the Toddler and Family: Sleep

Total sleep decreases only slightly during the second year and averages about 11 to 12 hours a day. Most children take one nap a day but may relinquish this habit by the end of the second or third year.

Health Promotion of the Toddler and Family: Transitional

Transitional objects, such as a favorite blanket or toy, provide security for toddlers, especially when they are separated from parents, dealing with a new stress, or just fatigued.

Health Promotion of the Preschooler and Family: Sensitive questions

Two rules that govern answering questions about sex and other sensitive issues are to find out what the child knows and thinks, and to be honest. Regardless of whether children are given sex education, they will engage in games of sexual curiosity and exploration.

Health Promotion of the Preschooler and Family: Play

Various types of play are typical of this period, but preschoolers especially enjoy associative play, group play in similar or identical activities but without rigid organization or rules. Play should provide for physical, social, and mental development.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant?

Vitamin D Rationale: The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 400 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency. Vitamins B, C, and K are not needed.

A parent calls the health clinic stating that her child was just exposed to poison ivy and asks what she should do to prevent further complications?

Wash the exposed area of contact with cold water to neutralize effects of oil exposure. Rationale: Best practice if this is a recent exposure is to wash the affected area with cold running water to minimize the effects by neutralizing the oil and possible bonding to skin areas. The Health Deparment does not have to be contacted as this is not considredd to be a public health issues. The child does not have to be quarentined as posion ivy can only be spread by direct contact of oils assocaited with the plant. Tetanus booster is not required as this is associated with contact and not puncture.

Which assessment finding would the nurse expect to see with regard to weight status in an infant who is 1 year of age?

Weight is tripled that of birth weight. Rationale: Typically at 1 year of age, infant's birth rate is tripled that of initial birth weight. It is doubled at 6 months of age and quadrupled at 2 years of age. Average weight is based on recognition of growth and development tables based on birth weight. Breastfed infants typically have a larger head circumference as compared to bottle fed infants.

Infants most at risk for sudden infant death syndrome (SIDS) are those (Select all that apply.)

Who sleep prone Who were preterm With prenatal drug exposure Ratoinale: Infants at increased risk for SIDS are low birth weight, have low Apgar scores, sleep prone, cosleep, were preterm, and have a mother who smokes. It is recommended that infants sleep supine to reduce the risk of SIESTA cousin dying of SIDS does not present an increased risk for the infant.

A parent is concerned that her toddler may become obese if high fat or sugary foods are included in the diet. Which food selection should still be included in a child's dietary plan during this stage of life?

Whole milk Rationale: Whole milk should be given to infants and toddlers during this critical growth period. Low fat milk should only be given if medically indicated. All of the other food selections should be limited or avoided in the toddler's diet pattern.

A mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. She plays "house" in it with her toddler brother. Based on the nurse's knowledge of growth and development, the nurse recognizes that this is:

creative play that should be encouraged. Rationale: This type of play should be encouraged. After children create something new, they can then transfer it to other situations. There should be some supervision to prevent injury or accidents. As long as the play is supervised, it should be encouraged. This is not considered unsafe play. There is no indication of limited resources. There is no indication of limited adult supervision.

The parents of a 5-month-old child complain to the nurse that they are exhausted because the infant still wakes up as often as every 1 to 2 hours during the night. When the child awakens, they change the diaper and the mother nurses the child back to sleep. Which should the nurse suggest to help the parents deal with this problem?

Start putting the infant to bed while still awake. Rationale: Parents need to develop bedtime rituals that involve putting the child in bed when awake. This will allow the infant to become accustomed to falling asleep somewhere besides the parent's arms or in the parent's presence. Having the infant in bed with them may still interfere with their sleep and increases the risk of injury to an infant of this age. The extinction of crying episodes should be done progressively, beginning with checking on the infant every 5 minutes during the first night and extending this interval by 5 minutes on subsequent nights. This will allow the infant to learn to self-soothe. Providing formula in a bottle at night will contribute to bottle-mouth caries. Additionally, 5-month-old infants generally do not wake up during the night to feed but rather to be soothed. Using feeding as a mechanism to soothe begins a pattern that may lead to eating problems later in childhood.

A parent of a 10-month-old infant tells the nurse that the baby cries and screams whenever the infant is left with the grandparents. Based on the nurse's knowledge of growth and development, the nurse's response is:

Stranger anxiety is common for an infant of this age. Rationale: The infant is experiencing stranger anxiety, which is expected for an infant of this age. Stranger anxiety usually develops by between 6 and 8 months of age and begins to disappear at about 1 year of age. The behavior the infant is exhibiting is normal and not indicative of a spoiled child. Separation anxiety is common between 6 and 8 months of age. There are no data to support the conclusion that the grandparents are not responsive to the infant.

Health Problems of Toddlers and Preschoolers: Ipecac

Syrup of ipecac, an emetic that exerts its action through irritation of the gastric mucosa and by stimulation of the vomiting center, is no longer recommended for immediate treatment of poison ingestion.

The infant's mother reports that her 6-month-old daughter seems to be afraid of strangers now. Based on this reported finding the nurse would advise the mother that:

Tell the mother that fear of strangers is normal during this time period and typically will be self-limiting. Rationale: Fear of strangers is a normal behavior seen between 6 and 8 months of age. Typically, it is self-limiting in nature and is not associated with feeding patterns or abuse. It typically does not require referral for psychological counseling.

A hospitalized toddler clings to a worn, tattered blanket. The toddler screams when anyone tries to take it away. Which is the best explanation for the toddler's attachment to the blanket?

The blanket is an important transitional object. Rationale: The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are important to help toddlers separate, and attachment to them does not indicate immature behavior. Transitional objects are helpful when a toddler experiences increased stress such as hospitalization. The attachment to the blanket does not reflect inadequate bonding with the mother.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that:

bowel control is accomplished before bladder control, so the parent should focus on bowel training first. Rationale: Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. There is no universal right age to begin toilet training or an absolute deadline to complete training. One of the nurse's most important responsibilities is to help parents identify the readiness signs in their child.

During the rehabilitative phase of care, pressure dressings are primarily applied to burned areas to:

decrease blood supply to scar. Rationale: Uniform pressure to the scar decreases the blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. The goal of the pressure dressing is to improve the appearance of scars by decreasing the blood supply to the area. Motion is encouraged because it prevents contractures. Movement should take place to the point of pain, but no further. The goal of the pressure dressing is to minimize the development of scar tissue.

A 2-year-old child has recently started having temper tantrums where breath holding occurs and occasionally fainting. The most appropriate action by the nurse is to:

explain to the parent that this is not harmful. Rationale: The rising carbon dioxide levels restart the breathing process when a child holds his or her breath; therefore, the process is self-limiting and not harmful. A respiratory evaluation is not indicated for this toddler. Temper tantrums are part of this developmental stage as the toddler asserts his or her independence. A psychological evaluation is not warranted. Temper tantrums are part of this developmental stage as the toddler asserts independence. There are no data to indicate that the child is spoiled.

A parent states that she takes her child to a person's home for care while she is at work. There are no other children being care for in the person's home. Based on this finding, the nurse would document child care as being:

family daycare. Rationale: As the parent takes the child outside of the home without any other children being present, this is an example of family daycare. In-home care would be if the child was taken care of in their own home. Center-based care and licensed daycare would include more children being taken care of in the environment.

The preschooler's body image has developed to include:

fear of intrusive procedures. Rationale: Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. The fear of looking different is a concept that occurs in later school-aged children and adolescents.

The two rules used to provide sensitive information to a preschooler focus on:

find out what they know and think and then be honest. Rationale: It is important to find out what they know and think before providing any information and then equally important is to be honest in your communication. The method of providing information may vary based on the type of information being provided and the level of understanding of the child.

The parents of a 4½-year-old girl are worried because she has an imaginary playmate. Based on the nurse's knowledge of the preschooler, the most appropriate response is:

having imaginary playmates is normal and useful at this age. Rationale: Imaginary playmates are a part of normal development at this age and serve many purposes, including being a friend in times of loneliness, accomplishing what the preschooler is still attempting, and experiencing what the preschooler wants to forget or remember. Because an imaginary playmate is part of normal development, a psychosocial evaluation is not warranted. Because an imaginary playmate is part of normal development, an evaluation of the parent-child relationship is not warranted. Imaginary playmates are commonly present during the preschool years; therefore, they are not abnormal after the age of 2 years.

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of:

initiative. Rationale: Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity versus role confusion is associated with adolescence. Intimacy versus isolation is associated with young adulthood. Industry versus inferiority is associated with the school-aged child.

A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for:

kwashiorkor Rationale: Kwashiorkor is defined as primarily a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.

A parent is concerned because her 18-month-old daughter who was previously a "good eater" by her accounts is now being very picky during meal times. Meal time patterns of intake vary from one day to the next with eating large amounts then hardly eating at all. Based on this information, the nurse would suspect that the toddler

may be exhibiting physiological anorexia which is a common finding during this time period. Rationale: These findings are indicative of physiological anorexia as during this time period, many toddlers demonstrate variation in food intake, strong food preferences and picky eating behaviors. There is no correlation with ear infections causing this type of eating behavior. A diagnostic work up is not warranted and this behavior does not demonstrate regression.

A 1-month-old infant is admitted to the hospital for failure to thrive (FTT) secondary to a cardiac condition. Based on the nurse's knowledge of the different types of FTT, this type of FTT is categorized as:

organic Rationale: Organic FTT is the result of a physical cause, such as a cardiac condition, neurologic condition, renal failure, endocrine system disorder, or other possible chronic or acute disease process. Nonorganic FTT is most often the result of psychosocial factors, such as inadequate nutritional information by the parent. Idiopathic FTT is unexplained by the usual organic and environmental etiologies. Generalized FTT is not a recognized term.

Enteral feedings are ordered for a young child with burns covering 40% of the total body surface area. The nurse should know that:

paralytic ileus precludes use of enteral feedings. Rationale: Enteral feedings can begin when the paralytic ileus resolves. Oral feedings are not contraindicated. Oral feedings are encouraged. Most children with burns are unable to consume sufficient calories by mouth, but every possible effort is made to encourage oral feeding. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended to compensate for the increased basal metabolic rate that occurs after a burn injury.

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include

placing the car seat in the back seat of the car facing forward. Rationale: Car seats are required for toddlers to prevent injury in case of a motor vehicle accident. The car seat should be placed in the back seat, forward facing. Safety belts can cause injuries if they are placed over a toddler's abdomen. Car seats should be in rear of the car because air bags can injure the toddler. Three-year-olds should be restrained in car seats.

The best approach for effective communication with a preschooler is through:

play. Rationale: Preschoolers' most effective means of communication is through play. Play allows preschoolers to understand, adjust to, and work out life's experiences through their imagination and ability to invent and imitate. Speech is not effective, because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meaning of words and often take statements literally. Drawing is still being developed as a fine motor skill; therefore, it is not the most effective means of communication. Actions are not an appropriate means of communication for a preschooler.

A toddler is exploring the environment but returns to his mother within a few minutes of exploration. This finding would be noted as an example of:

rapprochement. Rationale: Rapprochement occurs when the child returns to the mother for reassurance following exploration of the environment. Separation anxiety is when the child experiences anxiety based on separation from the parent or significant figure. Separation refers to the emergence of the child as a separate figure from the mother or parent. Individuation refers to the emergence of the child by expressing their own individual characteristic.

A 4½-year-old boy has been having increasingly frequent angry outbursts in preschool for approximately 8 to 10 weeks. In addition, he is aggressive toward the other children and teachers. His parents ask the nurse for advice. The most appropriate nursing intervention is to

refer the child for counseling. Rationale: This is not expected behavior. The child should be referred to a competent professional to deal with his aggression so that an accurate assessment can be made and a care plan determined. Outward aggression to others is not normal behavior and should be evaluated. The validation will be helpful for the referral, but the referral is the priority action. This may be recommended by the professional once an accurate assessment is made.

During a well-child visit, the father of a 4-year-old child tells the nurse that he is not certain if his child is ready for kindergarten. The child's birthday is close to the cutoff date, and the child has not attended preschool. The most appropriate recommendation by the nurse is to:

refer the child for developmental screening and make a recommendation based on the results. Rationale: A developmental screening will provide the necessary information to help the family determine readiness. Encouraging the father to have the child start kindergarten does not address the father's concern about readiness and suggests that his concerns are not warranted. Recommending to the father that he postpone kindergarten and send the child to preschool assumes that the child is not ready for kindergarten, but the recommendation is not based on any data or facts. Recommending to the father that he simply place his child in preschool may lead to the child's boredom with school. Having the father observe a kindergarten class and then decide if the child would enjoy the experience will provide information about kindergarten but not about whether his child is ready to begin and thrive there.

The school nurse is seeing a child who brought poison ivy to school in a leaf collection. The child says that only hands touched it. The most appropriate nursing action is to:

rinse hands in cold, running water. Rationale: Washing the child's hands in cold running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold running water within 15 minutes of exposure to neutralize the effect. Applying Burrow solution is effective for soothing the skin lesions once the dermatitis has begun. Antibacterial soap is not recommended as it removes protective skin oils, and may allow spread of contact.

Kimberly, age 4 years, sometimes wakes her parents up at night, screaming, thrashing, sweating, and apparently frightened. Yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This most likely scenario is

sleep terrors. Rationale: In sleep terrors, the child is only partially aroused; therefore, she does not remember her parents' presence. A nightmare is a frightening dream followed by full awakening; therefore, the child would realize that her parents are present. The description of the child's experience does not indicate the presence of seizure activity. Sleep apnea is a cessation of breathing during sleep.

Parents have brought their 6 months old daughter in for a 1 week follow up for treatment of diaper dermatitis. The parents state that they have followed all directions but that it just doesn't seem to be getting any better. The nurse examines the infant and finds no resolve of the condition. Based on this finding, the nurse suspects that:

the infant may also have a Candida infection Rationale: Unresolved treatment for diaper dermatitis is likely due to a Candida infection. There is no reason to suspect that the parents are not implementing the directions that were previously given. Use of a heat lamp can cause damage to the perineal area and buttocks. If the situation has not resolved, then the nurse should be alert to the possibility of additional infectious process.

A child is being treated for burns in the emergency room. The parents have provided information relative to the origin of the burn event but the patterns of injury are not consistent with their description. The nurse would suspect that:

there may be a potential for abuse and as such requires follow up. Rationale: Anytime burn pattern injuries do not correlate with the provided information of the event, there is a potential for suspecting abuse. As such the nurse should be cognizant of this fact and follow up accordingly. Being upset would be a reasonable parent response but the physical evidence should coincide with the provided description. Suspecting that the child (victim) is not telling the truth would not be a concern unless additional evidence would be presented that would support that conclusion. Even if the burn injuries are not considered to be life-threatenning, health care providers take the issue of suspected abuse very seriously and it must be reported and followed through as part of professional practice guidelines.

For a toddler with sleep problems, the nurse should suggest that the parents

use a transitional object at bedtime. Rationale: Transitional objects may help ease the toddler's anxiety and facilitate sleep. A consistent set of bedtime rituals will facilitate a toddler's sleep. Toddlers should have stimulating physical activity during the daytime in order for them to sleep at night. Toddlers do not understand verbal explanations, so parents cannot explain away their fears.

In teaching prospective parents about the emergence of gender identity, the nurse should instruct them that this concept emerges at about

24 months of age. Rationale: The concept of gender identity begins at about 2 years of age (24 months), at which children are able to label their own as well as other's genders. It is not inherent at birth or by 1 year of age.

Health Promotion of the infant and family: Injuries/car seats

A significant number of infants are injured or die from improper restraint within the vehicle, most often from riding on the lap of another occupant. It is now recommended that infants and toddlers ride in a rear-facing car restraint until they reach age 2 years or the height and weight recommended by the car seat manufacturer. Fewer childhood injuries are observed in motor vehicle crashes when children under age 2 ride in a rear-facing car seat.

Health Problems of Toddlers and Preschoolers: acetaminophen

Acetaminophen poisoning is the most common accidental drug poisoning among children and occurs primarily from acute overdose.

Health Problems of Infants: Vitamins

Although true vitamin deficiencies are rare in the United States, subclinical deficiencies are commonly seen in population subgroups in which either maternal or child dietary intake is imbalanced and contains inadequate amounts of vitamins.

Health Promotion of the infant and family: Height

Height increases by 2.5 cm (1 inch) per month during the first 6 months and by half that amount per month during the second 6 months. Increases in length occur in sudden spurts rather than in a slow, gradual pattern. By 1 year, birth length has increased by almost 50%. This increase occurs mainly in the trunk rather than the legs and contributes to the characteristic physique of the older infant.

Health Problems of Infants: Minerals

Minerals that may be inadequate in children's diets, even with supplementation, include iron, calcium, phosphorous, magnesium, and zinc.

Health Problems of Toddlers and Preschoolers: Abuse--parental risk

Parent characteristics that increase the risk for abuse include young parents, single parents, families with little social support, low socioeconomic status, undereducation, low self-esteem, substance abuse, and lack of knowledge of parenting skills. Abuse in single-parent families is often inflicted by an adult friend or companion. Children more prone to abuse include preterm infants, disabled children, and children under the age of 3 years.

Health Promotion of the Toddler and Family: Parental concerns

Parental concerns during the toddler years include toilet training, coping with sibling rivalry, limit setting and discipline, dealing with temper tantrums, negativism, and regression.

Health Problems of Infants: Nutritional disorders

Reports of severe nutritional disorders in childhood in most developed countries are uncommon, yet there often exist small numbers of children who may experience a nutritional deficiency of some kind.

Health Promotion of the Preschooler and Family: Stressors

Stressors include fears, such as beginning school. Although minimal amounts of stress are beneficial during the early years to help children develop effective coping skills, excessive stress is harmful. Young children are especially vulnerable because of their limited capacity to cope. Expression of frustration, fear, or anxiety is hampered by inadequate expressive language.

Health Promotion of the Toddler and Family: Temper

Temper tantrums are nearly universal during toddlerhood as independence is established and more complex tasks are attempted that may overwhelm the child emotionally. Toddlers may assert their independence by violently objecting to discipline.

Health Promotion of the infant and family: Temperament

Temperament influences the type of interaction that occurs between the child and parents and siblings. With knowledge of the infant's temperament, nurses are better able to (1) provide parents with background information that will help them see their child in a better perspective, (2) offer a more organized picture of the child's behavior and possibly reveal distortions in the parents' perceptions of the behavior, and (3) guide parents regarding appropriate child-rearing techniques.

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to:

store poisonous substances in a locked cabinet. Rationale: This is an appropriate action to prevent the curious toddler from getting into poisonous substances and products. Not all poisonous substances have safety caps, and safety caps are not always foolproof. Ipecac does not prevent poisoning and is not recommended as a treatment for poisoning. Toddlers can climb and are curious; therefore, storing substances out of reach only does not eliminate the potential for poisoning.

In providing nutritional counseling for a family with children, which statement would indicate that the parents need additional teaching with regard to mineral balance?

"I don't have to worry about mineral balance since my child will be following a vegetarian diet." Ratoinale: Vegetarian diets are high in soy and plant foods and as such contain phytates which can form insoluble complexes leading to mineral imbalance. Fortified milk products are recommended along with avoidance of cow's milk. Mineral supplementation should be avoided in order to prevent megadose toxicity which can affect absorption of other minerals. Spinach while a source of iron has a high oxalate content which can affect absorption of minerals.

Health Promotion of the infant and family: Oral hygiene

Cleaning the teeth regularly and appropriate dietary intake promote good dental health. Fluoride, an essential mineral for building caries-resistant teeth, is needed beginning at 6 months of age if the infant does not receive water with adequate fluoride content.

Health Promotion of the infant and family: Cranial sutures

Closure of the cranial sutures occurs, with the posterior fontanel fusing by 6 to 8 weeks of age and the anterior fontanel closing by 12 to 18 months of age (the average age being 14 months).

Health Promotion of the Preschooler and Family: Language

The most critical period for speech development occurs between 2 and 4 years of age. During this period, children are using their rapidly growing vocabulary faster than they can produce the words. Hesitancy or dysfluency in speech patterns is a normal characteristic of language development. Speech problems can occur when parents express excessive concern over this pattern.

Health Problems of Toddlers and Preschoolers: Lead

The most important factor contributing to lead poisoning is its availability in the child's environment. Lead-based paint is the most toxic source of lead. A child does not need to eat loose paint chips to be exposed to the toxin; normal hand-to-mouth behavior, coupled with the presence of lead dust in the environment that has settled over the decades, is the usual method of poisoning.

Health Problems of Toddlers and Preschoolers: Lead

The neurologic system is of most concern when young children are exposed to lead. Mild and moderate lead poisoning can cause a number of cognitive and behavioral problems in young children, including aggression, hyperactivity, impulsivity, delinquency, disinterest, and withdrawal. Long-term neurocognitive signs of lead poisoning include developmental delays, lowered intelligence quotient (IQ), reading skill deficits, visual-spatial problems, visual-motor problems, learning disabilities, and lower academic success.

Health Promotion of the infant and family: Nutrition

The order of introduction of other solid foods is arbitrary. A common sequence is strained fruits followed by vegetables and, finally, meats. Some clinicians prefer to add vegetables before fruit. Only one solid is introduced every 5 to 7 days so that a reaction to a particular food can be distinguished.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which instruction should be included?

The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. Rationale: Some toddlers do not like the flavor of toothpaste, so water can be used for teeth brushing at this age. Flossing should be done after brushing to establish it as part of dental care for the toddler. Two-year-olds cannot effectively brush their own teeth; parental assistance is necessary. Soft multitufted bristled toothbrushes are recommended to avoid damaging a toddler's teeth or gums.

Health Promotion of the Preschooler and Family: More independence

The pervasive ritualism and negativism of toddlerhood gradually diminish during the preschool years. Although self-assertion is still a major theme, preschoolers demonstrate their sense of autonomy differently. They are able to verbalize their request for independence and perform independently because of their much-refined physical and cognitive development.

Health Problems of Toddlers and Preschoolers: Sleep

The preschool years are a prime time for sleep disturbances. Children may have trouble going to sleep, wake during the night, have difficulty resuming sleep after waking during the night, have nightmares or sleep terrors, or prolong the inevitable bedtime through elaborate rituals. Such sleep disturbances are typically related to increasing autonomy, negative sleep associations, nighttime fears, inconsistent bedtime routines, and lack of limit setting.

Health Promotion of the Preschooler and Family: Body image

The preschool years play a significant role in the development of body image. With increasing comprehension of language, preschoolers recognize that individuals have undesirable and desirable appearances. They recognize differences in skin color and racial identity and are vulnerable to learning prejudices and biases.

Health Problems of Infants: Nursing responsibility SIDS

The primary nursing responsibility in care associated with sudden infant death is educating the family of newborns about the risks for SIDS, modeling appropriate behaviors in the hospital such as placing the infant in a supine sleep position, and providing emotional support to the family who has experienced a SIDS loss.

In working with a group of parents related to providing information relative to car seat restraints. Which statement by a member of the parent group would indicate that additional teaching was necessary?

"The LATCH system should be used for a child who is below 35 pounds." The LATCH system should be used if the combined weight of the child and car seat is over 65 pounds. All of other options are considered to apply safe principles of car seat restraints ("I will place the car seat facing backwards in the car." "The car seat should be anchored to the vehicle's seat belt." "The child should be in a rear facing position up to 24 months of age.")

The primary goals in the nutritional management of children with failure to thrive (FTT) are (Select all that apply.)

-Allow for catch-up growth. -Correct nutritional deficiencies. -Achieve ideal weight for height. -Restore optimum body composition. -Educate the parents or primary caregivers on child's nutritional requirements. Rationale: The goal is to provide sufficient calories to support "catch-up" growth, which is a rate of growth greater than the expected rate for age. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating any coexisting medical problems. Accurate assessment of the child's initial weight and height are important as well as the daily recording of weight, food intake, and feeding behavior. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating coexisting medical problems to optimize body composition.

Which herbal therapies are associated with increased milk production? (Select all that apply.)

-Blessed thistle -Fennel -Fenugreek These herbal preparations are known as galactgogoues and are thought to increase milk production. St. John's Wort and echinacea are not reported to increase milk production.

In terms of cognitive development, the 5-year-old child would be expected to do which of the following?

A. A. Use magical thinking. B. Think abstractly. C. Understand conservation of matter. D. Comprehend another person's perspective

Health Promotion of the Toddler and Family: physiologic systems

Although most of the physiologic systems are mature by the end of toddlerhood, development of certain areas of the brain is still occurring, allowing for greater intellectual capacity. By the end of the first year, all the brain cells are present but continue to increase in size.

Health Promotion of the Preschooler and Family: Erikson

According to Erikson, acquiring a sense of initiative is the chief psychosocial task of the preschooler. Development of the superego occurs during this period, and conscience begins to emerge.

Health Promotion of the Toddler and Family: Erikson

According to Erikson, the major developmental task of toddlerhood is acquiring a sense of autonomy while overcoming a sense of doubt and shame. Several characteristics, especially negativism and ritualism, are typical of toddlers in their quest for autonomy.

Health Promotion of the Preschooler and Family: Piaget

According to Piaget, the preschool age is characterized by intuitive thinking and a move toward logical thought processes through advanced, complex learning, language, and understanding of causality.

Health Problems of Toddlers and Preschoolers: Poisoning

Although the incidence of poisoning has decreased in the last 30 years as a result of more stringent packaging regulations, childhood poisoning remains a serious health concern. The most frequently ingested poisons include cosmetics and personal care products, such as perfume, cologne, or aftershave; medications (acetaminophen, acetylsalicyclic acid, ibuprofen, opioids); household cleaning products (bleaches, laundry pods, disinfectants); and foreign bodies, toys, and miscellaneous substances (dessicants, thermometers, bubble-blowing solutions). Many poisonings reflect the easy accessibility of the product in the home, where more than 90% of poisonings occur.

A 3-month-old bottle-fed infant is allergic to cow's milk. Which is the best substitute to teach the parents to use?

Casein hydrolysate milk formula Rationale: The milk protein is broken down in casein hydrolysate milk formulas, making them a safe alternative for the infant who has an allergy to cow's milk. The milk protein in goat's milk cross-reacts with cow's milk protein, and goat's milk is therefore not a safe alternative. Soy-based formulas are avoided due to the cross-reaction with cow's milk protein; they are not a safe alternative. Cow's milk protein is contained in skim milk, making it an unsafe alternative.

Health Problems of Toddlers and Preschoolers: Chelation

Chelation is the term used for removing lead from circulating blood and, theoretically, some lead from organs and tissues.

Health Problems of Toddlers and Preschoolers: Maltreatment forms

Child maltreatment may take the form of physical abuse or neglect, emotional abuse or neglect, or sexual abuse.

Health Problems of Toddlers and Preschoolers: Neglect

Child neglect is the most common form of maltreatment. Physical neglect involves the deprivation of necessities, such as food, clothing, shelter, supervision, medical care, and education. Emotional neglect generally refers to failure to meet the child's needs for affection, attention, and emotional nurturance.

Health Promotion of the Preschooler and Family: Spirituality

Children generally learn about faith and religion from significant others in their environment, usually from parents and their religious beliefs and practices. However, young children's understanding of spirituality is influenced by their cognitive level.

Health Promotion of the infant and family: Separation anxiety

Separation anxiety develops between ages 4 and 8 months and is manifested through a predictable sequence of behaviors. Infants protest the physical separation from the mother through crying. Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to infants' ability to discriminate between familiar and unfamiliar people. Behaviors such as clinging to the parent, crying, and turning away from the stranger are common.

The nurse is caring for a 12-year-old who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action related to this?

Request a psychological consultation. Rationale: A psychological consultation will assist the child in verbalizing fears. This age group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying his or her fears and pain. If the child is feeling pain, the nurse should not praise the child for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.

Which recommendation would a nurse make to new parents who are planning to introduce solid foods to their 6-month-old son?

Rice cereal Rationale: Rice cereal is recommended as it is easily digestible. The other options may contain additional ingredients such as iron as well as complex grains making it harder to digest.

Infants: Renal

Risk for dehydration and e- imbalances. Filtration capacity of glomeruli reduced Frequent voiding, low specific gravity 15-60ml/kg/24 hours=UOP WNL

Health Promotion of the Preschooler and Family: School readiness

Schools and parents play integral roles in a child's school readiness. Schools must be able to assist children with varying learning and physical abilities and should be able to provide diverse learning situations that serve as a foundation for continued growth and maturation.

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which of the following suggestions should the nurse include?

Select an area that is safe and nonstimulating, such as a hallway. Rationale: The area must be nonstimulating and safe. The child becomes bored in this environment and then changes his or her behavior to rejoin activities. The child's room may have toys and other forms of amusement that may negate the effect of being separated from family activities. When the child engages in this type of behavior, the timeout begins when the child quiets. The general rule is 1 minute per year. An hour per year is excessive.

A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse's knowledge of breastfed infants, what type of stool is expected?

Semiformed, seedy, yellow Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow. Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant. Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant. Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant.

Health Promotion of the Preschooler and Family

The combined biologic, psychosocial, cognitive, spiritual, and social achievements during the preschool period (3 to 5 years of age) prepare preschoolers for their most significant change in lifestyle: entrance into school.

Health Problems of Toddlers and Preschoolers: Physical abuse

The deliberate infliction of physical injury on a child, usually by the child's caregiver, is termed physical abuse.

Health Problems of Toddlers and Preschoolers: Burn extent

The extent of a burn is expressed as a percentage of the TBSA. Superficial (first degree) burns typically involve the epidermal layer only. Partial-thickness (second-degree) burns involve the epidermis and varying degrees of the dermal layer. Full-thickness (third-degree) burns are serious injuries that involve the entire epidermis and dermis and extend into subcutaneous tissue. Fourth-degree burns are full-thickness burns that involve underlying structures, such as muscle, fascia, and bone.

Health Problems of Toddlers and Preschoolers: Poisoning

The first and most important principle in dealing with a poisoning is to treat the child first, not the poison. This requires an immediate concern for life support. The major principles are assessment (including vital signs), airway and cardiovascular supportive measures, minimization of poison absorption, prevention of complications, family support, and prevention of recurrence.

Health Promotion of the Toddler and Family: CAM

The misuse or overuse of vitamins as a part of complementary and alternative medicine (CAM) places some children at risk for health problems. Herbs known to have adverse effects in children include ephedra, comfrey, and pennyroyal; some herbs may not be harmful taken alone but may counteract or potentiate prescription medications when taken concurrently. Health care workers need to be knowledgeable about the benefits or potential harm in herbs so that they can appropriately counsel parents and address their concerns.

The primary reason for universal screening of young children for lead poisoning is that:

children with lead poisoning rarely have symptoms. Rationale: In the early stages of lead poisoning, children are asymptomatic. Water and food in the United States are not highly contaminated. Risks are homes painted before 1978, when painting products still had high lead levels. Universal screening will identify children who may receive lead via herbal supplements, if applicable. Universal screening will identify children who may receive lead via environmental exposure, if applicable.