Pediatrics Test 1

10. What foods does the nurse recommend the child with acute glomerulonephritis avoid to prevent hyperkalemia? a. Dairy products b. Whole-grain cereals c. Organ meats d. Bananas

ANS: D Bananas are very high in potassium and should be avoided

34. Put the stages of separation anxiety in order from first to last. Put a comma and space between each answer choice (a, b, c, d, etc.) a. Detachment b. Regression c. Despair d. Protest

ANS: D, C, A, B The preschool child may feel abandoned by the parents and continues to be subject to separation anxiety. Separation anxiety is manifested by the stages of protest, despair, detachment, and regression.

12. What is the treatment of choice for a child with intussusception? a. A barium enema b. Immediate surgery c. IV fluids until the spasms subside d. Gastric lavage

ANS: A A barium enema is the treatment of choice for intussusception because the passage of the barium frequently "un-telescopes" the bowel. Surgery is scheduled only if reduction is not achieved

28. An infant is admitted to the hospital with severe dehydration. Laboratory results show pH 7.32, PaCO2 40, HCO3- 21. How does the nurse interpret these values? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

ANS: A A pH lower than 7.35 indicates acidosis. If the child's pH falls in the same line as the HCO3-, the problem is metabolic (see Table 27-4).

22. The nurse is documenting the pediatrician's assessment of a female patient. When assessing Tanner's stages of breast development there is elevation of papilla only. What stage of development will the nurse document? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

ANS: A According to Tanner's Stages of Sexual Maturity, Stage 1 (Preadolescent) is elevation of papilla only.

5. Which is the most appropriate intervention for a 3-month-old infant who has gastroesophageal reflux? a. Position the infant in the crib on his or her abdomen, with the head elevated. b. Administer medication as ordered to stimulate the pyloric sphincter. c. Give thin rice cereal with formula before feeding solid foods. d. Place the infant in an infant seat after feedings

ANS: A After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure

6. A 7-year-old child with acute glomerulonephritis has gross hematuria and has been confined to bed. What is the most appropriate nursing intervention for this child? a. Providing activities for the child on restricted activity b. Feeding the child a protein-restricted diet c. Carefully handling edematous extremities d. Observing the child for evidence of hypotension

ANS: A Although children may feel well, activity is limited until hematuria resolves

12. Parents are speaking with the urologist about their son's undescended testicle. Which statement by the child's father causes the nurse to determine he understands the information presented? a. "An undescended testicle can reduce fertility." b. "The testicle usually descends spontaneously during the first month of life." c. "Surgical correction reduces the risk for testicular tumors." d. "The optimal time to surgically correct the condition is at diagnosis."

ANS: A Although orchiopexy improves the condition, the fertility rate among patients may be reduced even when only one testis is undescended.

2. A 13-year-old boy states, "The girls in my class tower over me." What would be the nurse's most informative response? a. "It may seem that way because girls have a growth spurt 2 years earlier than boys." b. "Perhaps your parents are not exceptionally tall." c. "Boys usually experience a growth spurt 1 year earlier than girls." d. "You may feel short, but you are actually average height for your age

ANS: A Although the age for growth spurts during puberty varies, growth spurts occur 2 years earlier for girls than for boys

21. Which is an example of associative play? a. Two children playing house, one playing the role of the dad and the other playing the mom b. Two children playing in a sand box, one building a wall and the other digging a hole c. Two children playing with sports-associated items, one with a football and the other with a bat d. Two children playing with a coloring book, one coloring pictures and the other looking at pictures

ANS: A Associative play allows the preschoolers to use their enlarged vocabulary in play with other children to carry on conversations and describe scenarios for each to play.

8. The school nurse is planning a program for girls about the physical changes of puberty. Toward what age girl should this program be directed? a. 10 years b. 12 years c. 14 years d. 16 years

ANS: A Because puberty can occur in girls as early as age 10 years, instruction must be given by that age

11. What description of a child's stool characteristic leads the nurse to suspect intussusception? a. Currant jelly b. Black and tarry c. Green liquid d. Greasy and foul-smelling

ANS: A Bowel movements of blood and mucus that contain no feces ("currant jelly" stools) are common about 12 hours after the onset of the obstruction.

16. The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. What does this behavior indicate the infant has developed? a. The pincer grasp b. A grasp reflex c. Prehension ability d. The parachute reflex

ANS: A By 1 year, the pincer-grasp coordination of index finger and thumb is well established

20. What will the nurse caution the parents of a child who has had a nephrectomy that he will have to avoid? a. Contact sports b. Horseback riding c. Alcohol d. Diuretic medications

ANS: A Children who have only one kidney should avoid contact sports to prevent injury to that remaining organ.

14. A girl tells the nurse that she and her best friend belong to the popular clique. She states, "I love Katy Perry, and I want to be a singer." The nurse recognizes the girl's statement as characteristic of what time period? a. Early adolescence b. Middle adolescence c. Late adolescence d. The entire adolescent period

ANS: A Cliques of unisex friends, having a best friend, and hero worship are characteristics of the early adolescent

18. A school-age child becomes frustrated with a school assignment and says, "I can't do this!" What is the most developmentally supportive response from the parent? a. Ask, "What is it that is so difficult?" b. Allow the child to quit the effort. c. Call in older siblings to help. d. Finish the project for them.

ANS: A Helping the child focus on the problem that is keeping him from mastery can limit frustration. Quitting or having someone else finish is detrimental to the development of industry

9. What statement made by a parent indicates an understanding about helping a 13-year-old manage his allowance? a. "I set amounts he can earn for particular chores." b. "I give him a certain amount of money for each day." c. "I put money into his bank account each month." d. "I told him to ask me when he needs money

ANS: A If money is simply handed out as requested, it is difficult to develop responsibility for finances and money management. The older adolescent is able to get a job. The younger adolescent can earn money by doing particular chores.

13. A mother reports that she has a new job and her 12-year-old child is home alone for a time after school. Which statement made by the parent alerts the nurse to a potentially unsafe situation for this child? a. "I told him that he could invite a few friends after school." b. "I put a list of emergency numbers next to the telephone." c. "Last week we made a first aid kit together." d. "There is a neighbor available in case of an emergency."

ANS: A Latchkey children are subject to a higher rate of accidents. Permitting school-age children and their friends to be home alone in an unsupervised environment is an unsafe situation

9. What instruction will the nurse give to parents about preventing the spread and reinfection of pinworms? a. Keep children's nails short. b. Dress child in loose-fitting underwear. c. Clean the bathroom with bleach solution. d. Wash bed linens in cold water.

ANS: A One intervention to prevent the further spread of pinworms is to keep the child's fingernails short. Pinworms are not spread from person to person.

4. What is it important to assess in a child receiving prednisone to treat nephrotic syndrome? a. Infection b. Urinary retention c. Easy bruising d. Hypoglycemia

ANS: A Prednisone depresses the immune response and increases susceptibility to infection. Because steroids mask signs of infection, the child must be assessed for more subtle symptoms of illness

6. What is the best suggestion by the nurse for an appropriate toy for a hospitalized 6-year-old boy? a. Handheld video game b. MP3 player c. Adventure book d. Jigsaw puzzle

ANS: A The 6-year-old child can perform numerous feats that require muscle coordination. At this age, the handheld video game will offer nonaggressive competition

8. A 9-year-old boy is often cranky and irritable, and his school performance has declined. What is the most probable factor causing this behavior? a. He sleeps only 6 to 7 hours a night. b. He eats eggs every day. c. He has a new dog. d. He plays about 1 to 3 hours each evening.

ANS: A The 9-year-old child requires about 10 hours of sleep per night.

5. The parents of an 8-year-old tell the nurse the child wakes the household crying out during his frequent nightmares. What is the nurse's most helpful response to explain nightmares? a. They are a normal extension of the child's fear of mutilation. b. They are an abnormal response to repressed feelings. c. They are a common result of latent sexuality. d. They are a side effect of overactivity and stimulation.

ANS: A The nightmares experienced by an 8-year-old are an extension of their characteristic fear of mutilation.

21. A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. What will be the nurses's priority goal of the infant's care? a. Prevent fluid and electrolyte imbalance. b. Prevent nutritional deficiency. c. Prevent skin breakdown. d. Prevent malabsorption.

ANS: A The priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance

32. Which assessment would the nurse report to the physician immediately? a. 2-month-old with a urine output of 150 mL in 24 hours b. 3-year-old with a urine output of 650 mL in 24 hours c. 8-year-old with a urine output of over 1000 mL in 24 hours d. 14-year-old with a urine output of 800 mL in 24 hourse

ANS: A The urine output of a 2-month-old should be between 400 and 500 mL/24 hours

20. The nurse suggests the use of "I" messages to communicate a parent's feeling to an adolescent. What is the most appropriate example of an "I" message? a. "I feel frightened when you stay out past your curfew." b. "I am your mother, and I insist that you observe your curfew." c. "I am sick and tired of your staying out late." d. "I expect you to show me proper respect

ANS: A This is the only statement that associates the parent's feelings about the adolescent behavior that is not aggressive or accusatory

14. A 6-year-old child with daytime enuresis complains of dysuria and urgency. What does the nurse recognize these signs and symptoms indicate? a. Urinary tract infection b. Nephrotic syndrome c. Acute glomerulonephritis d. Vesicoureteral reflux

ANS: A Urinary frequency and pain during micturition are symptoms of acute urinary tract infection

21. The school nurse is planning sex education classes for school-age children. What should the nurse be sure to do? a. Use simple terms. b. Avoid slang or "street" words and concepts. c. Keep topics on biological aspects of sexual development. d. Limit questions to keep content clear

ANS: A Using simple terms is essential but slang and street terms need to be clarified. Apply age-specific information across broad aspects of biological, social, and current attitudes

25. Which statement by a mother may indicate a cause of her son's vitamin C deficiency? a. "We get our fruits from homemade preserves." b. "We use milk from our own goats." c. "We grow all our own vegetables." d. "We're not big meat eaters."

ANS: A Vitamin C is destroyed by heat

3. On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment? a. Weight loss of 4 ounces b. Dry mucous membranes c. Decreased skin turgor d. Depressed fontanelle

ANS: A Weight loss is the most significant indicator of dehydration because an infant's weight comprises 77% water.

7. A mother reports that her child has been scratching the anal area and complaining of itching. What does the nurse suspect based on this information? a. Pinworms b. Giardiasis c. Ringworm d. Roundworm

ANS: A With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of itchiness. The other choices do not cause this reaction

24. A 7-year-old child has a BUN of 25 mg/dL. What is the nurse aware this lab value might indicate? (Select all that apply.) a. Dehydration b. Renal disease c. Need for steroid therapy d. Diabetes e. Pituitary malfunction

ANS: A, B, C Increased BUN can indicate dehydration, renal disease, and/or need for steroid therapy

35. What sign(s) indicate(s) moderate dehydration? (Select all that apply.) a. 10% weight loss b. Dry mucous membranes c. Normal anterior fontanel d. Increased urinary output e. Lethargy

ANS: A, B, C The child that is moderately dehydrated will have lost 10% of his body weight, will have dry mucous membranes, normal (nonsunken) anterior fontanelle, decreased urine output, and will be irritable.

26. Which bedtime preparation rituals are the most appropriate for the nurse to suggest? (Select all that apply.) a. Telling a story b. Placing a favorite toy in bed c. Placing a glass of water at the bedside d. Turning on a night light e. Playing energetically

ANS: A, B, C, D All options are soothing bedtime rituals except energetic playing, which would be stimulating and counterproductive to sleep.

27. The nurse is aware that genitourinary surgery is especially stressful for preschool children. What factor(s) lend to this stress? (Select all that apply.) a. They may perceive the treatment as punishment. b. They are especially prone to separation anxiety. c. They are sexually curious and developmentally fixated on their genitals. d. They have a fear of castration. e. They fear death.

ANS: A, B, C, D All options, except fear of death, are especially stressful for preschool children undergoing genitourinary surgery. Children in this age group do not have an understanding of the concept of death.

24. To what is the restlessness seen in the adolescent considered to be attributed? (Select all that apply.) a. Drive to be accepted by society as an individual b. Urge for independence c. Establishment of a personal identity d. Intense libido e. Slowing of body changes

ANS: A, B, C, D All the options listed are sources of stress to the adolescent and are stimulants to restlessness except option E: body changes are rapid

23. What basic "feeling" words should the nurse use in attempting to help a 7-year-old girl express her feelings about being in a new school? (Select all that apply.) a. Mad b. Glad c. Sad d. Scared e. Jealous

ANS: A, B, C, D The words "mad," "glad," "sad," and "scared" are basic feeling words that can prompt a young child to better express his or her feelings

34. What assessment(s) would lead a nurse to suspect Hirschsprung's disease in a 1-month-old infant? (Select all that apply.) a. Ribbon-like stools b. Fever c. Failure to thrive d. Vomiting e. Diminished peristalsis

ANS: A, B, C, D, E All options are significant indicators of Hirschsprung's disease

24. What does including play in the plan of care for a 5-year-old allow the child to do? (Select all that apply.) a. Exercise his imagination b. Assume a role and act it out c. Offers an emotional outlet d. Avoid magical thinking e. Interact with other children

ANS: A, B, C, E Benefits of play for the preschooler include exercising imagination, assuming a role and acting it out, offering an emotional outlet, and interaction with other children. Play employs the use of magical thinking.

27. The nurse points out what advantage(s) of a nursery school or preschool experience? (Select all that apply.) a. Increasing self-confidence b. Fostering group cooperation c. Detecting adjustment problems d. Attainment of toilet training skills e. Playing experiences with other children

ANS: A, B, C, E Nursery school increases self-confidence, group cooperation, social skills, and cooperative play. Objective observations by a nursery school instructor can detect early adjustment problems. The child is usually toilet trained prior to the start of preschool

26. The nurse caring for a child with nephrotic syndrome is alert to which classic symptoms of this disorder? (Select all that apply.) a. Proteinuria b. Grossly bloody urine c. Hyperalbuminemia d. Fatigue e. Generalized edema

ANS: A, B, D, E All options listed are those of nephrotic syndrome with the exception of hyperalbuminemia. The nephrotic child has hypoalbuminemia, as most of the protein has been spilled in the urine.

27. A mother confides in the school nurse that she witnessed her son kissing another boy. Which concepts should guide the nurse to base a reply? (Select all that apply.) a. Homosexual behavior in adolescents is not uncommon. b. Homosexuality is a mental disorder. c. Adolescents often desire to explore alternative lifestyles. d. Homosexual tendencies should be addressed with counseling. e. Parents should seek a support group for parents of gays

ANS: A, C Adolescents may experiment with an alternate sexual expression as part of their self-discovery. Homosexual activities are not uncommon in adolescence

28. The school nurse is discussing challenges of the adolescent years with a group of high school students in health class. What challenges toward adolescent development will the nurse include? a. Developing intimacy b. Maintaining dependence on parents c. Searching for identity d. Adjusting to body changes e. Establishing future goals

ANS: A, C, D, E Adolescents face the challenges of developing intimacy, searching for identity, adjusting to body changes and establishing goals for the future. Adolescents are striving for independence from parents.

24. The school nurse is preparing an educational program for new teachers regarding school-age children. What information is accurate for the nurse to include? (Select all that apply.) a. Participation in group activity increases b. Egocentricity prevails c. Thinking is logical d. Preference is toward family interaction e. Understand cause and effect

ANS: A, C, E Piaget refers to the thought processes of the school age period as concrete operations. Concrete operations involve logical thinking and an understanding of cause and effect. The egocentric view of the preschool child is replaced by the ability to understand the point of view of another person. Between 6 and 12 years of age, children prefer friends of their own sex and usually prefer the company of their friends to that of their brothers and sisters.

25. What developmental milestone(s) assist the 5-year-old boy toward developing his sexual identity? (Select all that apply.) a. Begins to be less focused on his mother b. Ignores both parents totally c. Regresses to a more infantile level d. Forms a romantic attachment to the mother e. Identifies with the parent of the same sex

ANS: A, D, E Children of this age become less focused on the mother as the central person and begin to identify with the parent of the same sex, forming a romantic attachment to the parent of the opposite sex. This little boy might say, "I'm going to marry my mother." A little girl might say, "I'm going to marry my daddy."

26. The nurse considers what "rites of passage" valued by the adolescent in American society? (Select all that apply.) a. Attaining legal drinking age b. Selection of a career c. Religious affiliation d. Obtaining a driver's license e. High school graduation

ANS: A, D, E Rites of passage are socially recognized milestones that signify adulthood. Legal drinking age, driver's license, and matriculation through high school are such signals. Religious affiliation and selection of a career path do not necessarily signal adulthood.

28. What special considerations are related to long-term prednisone therapy in preschoolers? (Select all that apply.) a. Delayed immunization b. Hypertension c. Enlargement of the sex organs d. Alteration in nutrition e. Increased risk for infection

ANS: A, E Delayed immunization and greater risk for infection are concerns relative to long-term prednisone therapy.

5. A mother reports that she and her husband have had one child together, but both have children from previous marriages living in their home. The nurse will base the care planning on what type of family? a. Nuclear b. Blended c. Alternate d. Extended

ANS: B A blended family involves the remarriage of persons with children

17. A parent is concerned because her infant has a diaper rash. What is the best action the nurse would advise the parent to implement? a. Use commercial diaper wipes to clean the area. b. Apply a protective ointment on the area. c. Change the infant's diaper less frequently. d. Keep the diaper area covered all of the time.

ANS: B A protective ointment can be applied when the skin in the diaper area appears pink and irritated

19. What does adolescent acne result from? a. Ineffective sweat glands b. Oily skin c. Inadequate hygiene d. A poor diet

ANS: B Adolescent acne is the result of overactive sweat glands and oily skin.

1. Which finding in a newborn is suggestive of tracheoesophageal fistula? a. Failure to pass meconium in 24 hours b. Choking on the first feeding c. Palpable mass in the sternal area d. Visible peristalsis across abdomen

ANS: B After birth, a newborn with tracheoesophageal fistula will vomit and choke when the first feeding is introduced.

15. The parent of a 3 -year-old child tells the nurse, "My daughter points instead of speaking whenever she wants me to get something for her, but she understands me when I ask her to do something." Based on the parent's comment, what does the nurse suspect? a. Age-appropriate language development b. An expressive language delay c. A receptive language delay d. A potential hearing deficit

ANS: B An expressive language delay is suspected when the child understands spoken language but is not talking.

1. The nurse is assessing a school-age child. What will the nurse expect in regard to physical development of this child? a. Growth of 3 to 6 inches per year b. Gain of 5 to 7 pounds per year c. Increase of head circumference by 1 inch per year d. A visual acuity of 20/20 by 9 years of age

ANS: B During the school-age period, the average weight gain per year is generally 5.5 to 7 pounds

23. The school nurse is educating high school students about guidelines to be followed when participating in sports. Which statement by a student alerts the nurse of the need for further information? a. "I will eat carbohydrates before practice." b. "I drink large amounts of fluid when working out." c. "I wear protective gear every time I play sports." d. "I avoid caffeine when participating in sports.

ANS: B Fluids lost by sweat must be replaced by drinking small amounts of fluid during a workout. Thirst is one guide for intake. Caffeine and alcohol deplete body water and are to be avoided. Carbohydrates that provide both energy and other nutrients are best for athletes. Protective gear should be worn by all team players in any contact sport.

5. What is the earliest age at which the infant should be able to walk independently? a. 8 to 10 months b. 12 to 15 months c. 15 to 18 months d. 18 to 21 months

ANS: B For the majority of children, the milestone of walking alone is achieved between 12 and 15 months

17. At what stage is the adolescent considered to be,according to Freud's theory? a. Conceptual b. Genital c. Glandular d. Pubertal

ANS: B Freud describes the adolescent period as genital

15. A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). What does the nurse expect this child to receive following gastric lavage? a. Activated charcoal b. N-acetylcysteine c. Vitamin K d. Syrup of ipecac

ANS: B Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen

12. What is the nurse's best advice to a parent about a preschooler's "imaginary friend"? a. Having imaginary friends is a sign that the child has low self-esteem. b. It is common for preschoolers to have imaginary friends. c. Preschoolers invent an imaginary friend when they feel overwhelmed. d. The best approach to dealing with an imaginary friend is to ignore them

ANS: B Imaginary friends are common and normal during the preschool period and serve many purposes, such as relief from loneliness, mastery of fears, and acting as a scapegoat.

17. A frightened mother calls the pediatrician's office because her child swallowed dishwashing detergent. What is the most appropriate action? a. Induce vomiting by giving the child syrup of ipecac. b. Take the child to the local emergency department. c. Give the child activated charcoal mixed with juice. d. Give the child milk to soothe affected mucous membranes

ANS: B Inducing vomiting is no longer recommended because it may pose additional problems. The child should be taken immediately to the nearest emergency department along with the packaging of the ingested substance.

11. Which physical assessment technique will the nurse omit when caring for a 2-year-old diagnosed with Wilms' tumor? a. Performing range-of-motion exercises on lower extremities b. Palpating the abdomen c. Assessing for bowel sounds d. Percussing ankle and knee reflexes

ANS: B Palpation of the abdomen could disturb the tumor and cause the malignancy to spread

11. An adolescent's parent comments, "My son seems so preoccupied with his appearance these days. Is this normal?" What is the nurse's best response? a. "It is his attempt to express his individualism." b. "His preoccupation with his looks is quite normal." c. "He is probably troubled with his physical changes." d. "This shows that he has a positive self-image

ANS: B Preoccupation with self-image is normal and accounts for the constant primping of adolescents

23. What would the nurse expect to find in a child admitted to the hospital for nonorganic failure to thrive? a. Cry to be picked up b. Be limp like a rag doll c. Be responsive to cuddling d. Weigh in the 10th percentile for age

ANS: B Some children with failure to thrive have rag-doll limpness (hypotonia) and appear wary of their caregivers

4. The nurse is planning a safety program for high school students. To what will the nurse relay that most accidental deaths in adolescence are related? a. Firearms b. Automobiles c. Drowning d. Diving injuries

ANS: B The chief safety hazard for the adolescent is automobiles

18. A child has been diagnosed with ascariasis (roundworm). Which statement made by her mother that may suggest a cause for her condition? a. "I've been airing out the house on these nice breezy days." b. "My child often goes out to the garden and pulls up a carrot to eat." c. "She runs barefoot so much I have to wash her feet at least twice a day." d. "We just remodeled our bathroom at home

ANS: B The child can ingest roundworm eggs from contaminated soil

15. What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome? a. Reach the child to minimize body movements. b. Change the child's position frequently. c. Keep the head of the child's bed flat. d. Keep edematous areas moist and covered.

ANS: B The child should be turned frequently to prevent respiratory tract infection and to prevent pressure on delicate skin

4. The nurse is advising parents of a 10-year-old boy about the most developmentally supportive experiences for their son. What is the best experience for this child according to Erikson's theory? a. Constant variety of activities b. Successful performance in Little League c. Feeling healthy and strong d. Having a girlfriend

ANS: B The child who is successful in activities will feel positively about himself or herself

3. What is an initial sign of nephrosis that the nurse might note in a child? a. Raspberry-like rash b. Periorbital edema c. Temperature elevation d. Abdominal pain

ANS: B The edema of nephrotic syndrome is generalized and not readily noticed, even by the parents, but an early sign that can be assessed is periorbital edema.

23. What does the nurse calculate the basal metabolic index (BMI) of an 8-year-old child who is 48 inches tall (1.2 meters) and weighs 100 pounds (45.4 kg) to be? a. 28.9 b. 32.4 c. 34.8 d. 37.6

ANS: B The formula for BMI calculation is weight in kg divided by height in meters (squared): 45.4 (weight in kg) divided by 1.4 (1.2 squared) = 32.4. A BMI of over 30 is classified as obese

7. Which urinary diversion procedure is the least damaging to the body image of the adolescent? a. Urostomy b. Ileal conduit c. Nephrostomy d. Suprapubic placement

ANS: B The ileal conduit diverts urine to the colon, and the urine is excreted with the feces. There is no external appliance, as is needed with the other diversion methods

3. At what age does an infant's birth weight triple? a. 9 months b. 1 year c. 18 months d. 2 years

ANS: B The infant usually triples his or her birth weight by about 12 months of age

12. When asked about her activities, a 10-year-old girl responded, "I like school. I play the flute in the school band, and I take tennis lessons." What does the nurse know these activities will help this child develop? a. Initiative b. Industry c. Identity d. Intimacy

ANS: B The school-age period is referred to by Erikson as the stage of industry. Successful participation in activities facilitates the child's sense of industry

2. When asked about correcting the hypospadias of a newborn, what does the nurse explain about this condition? a. No intervention is necessary as the defect will correct itself over time. b. Surgical repair of the hypospadias is done before 18 months of age. c. Corrective surgery is usually delayed until the preschool age. d. Repairing the defect will increase the risk of testicular cancer.

ANS: B Treatment of hypospadias consists of surgical repair and is usually performed before 18 months of age.

6. The nurse is interviewing parents of an infant with pyloric stenosis. What would the nurse expect the parents to report? a. Diarrhea b. Projectile vomiting c. Poor appetite d. Constipation

ANS: B Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting

33. What interventions will the nurse perform when feeding a child with pyloric stenosis? (Select all that apply.) a. Give a formula thinned with water. b. Burp the infant before and during feeding. c. Give the feeding slowly. d. Refeed if the infant vomits. e. Position infant on left side after feeding

ANS: B, C, D Children with pyloric stenosis are given formula thickened with cereal; the infant is burped before and during feeding to get rid of any gas in the stomach; the infant is fed slowly and refed if vomiting occurs. The infant is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve.

37. Parents have adopted a child with the diagnosis of kwashiorkor. What is most likely to be observed when assessing this child? (Select all that apply.) a. Hyperactivity b. White streak in hair c. Edematous abdomen d. Slowed growth e. Thick, oily hair

ANS: B, C, D Kwashiorkor means, in native dialect, "the disease of the deposed baby when the next one is born," indicating that the child no longer breastfeeds because a sibling is born and takes over the breast of the mother. Oral intake then is deficient in protein. The child fails to grow normally. The muscles become weak and wasted. There is edema of the abdomen that may become generalized. Diarrhea, skin infections, irritability, anorexia, and vomiting may be present. The hair becomes thin and dry. Because protein is the basis of melanin, a substance that provides color to hair, melanin becomes deficient. This is the reason the earliest sign of this protein malnutrition is a white streak in the hair of the child (depigmentation). The child looks apathetic and weak.

25. The pediatric nurse is presenting school-age children with information on safety issues to follow when going home alone. What guidelines should they be educated to follow? (Select all that apply.) a. Ask for identification before letting someone in the house. b. Never accept rides with strangers. c. Keep doors locked. d. Do not enter house if door is ajar. e. Walk to and from school with friends.

ANS: B, C, D, E Strangers should never be allowed in the house. Children should be instructed never to accept rides with strangers, to keep doors locked, not to enter the house if the door is ajar, and to walk to and from school with friends

26. A 10-year-old child with disabilities is begging her parents for a dog. When at the pediatric clinic, the parents inquire about possible benefits pet ownership may provide to their child. What benefits of pet ownership should the nurse indicate? (Select all that apply.) a. Decrease the need for physical therapy b. Lower blood pressure c. Improve communication d. Foster trust e. Ease path to socialization

ANS: B, C, D, E Studies have documented the positive influence of pet ownership on improving the medical and psychological outcome after illness or surgery. Disabled children especially benefit from interacting with pets. The interaction with animals can lower blood pressure and heart rate, reduce loneliness and feelings of isolation, improve communication, foster trust, and motivate participation in physical therapy. Pets allow the ill child who feels separated from other people to feel companionship and acceptance. Shy children often find pet ownership eases the path to socialization with others who initiate contact because of the pet.

25. What will the nurse caring for a newborn with exstrophy of the bladder include in the care? (Select all that apply.) a. Diaper infant tightly. b. Protect skin around bladder. c. Position infant on back. d. Prepare for surgical closure. e. Cover exposed bladder with shield

ANS: B, C, D, E The infant is kept on his back or side with special attention to the skin around the exposed bladder, which is constantly bathed with urine. These infants are diapered loosely, if at all. Surgical closure is done as quickly as possible

28. Which major developmental tasks will the nurse expect a child to accomplish by the end of the preschool years? (Select all that apply.) a. Development of parallel play b. Acceptance of separation c. Increased communication skills d. Consistent appetite e. Control of bodily functions

ANS: B, C, E The major tasks of the preschool child include preparation to enter school, development of a cooperative type of play, control of body functions, acceptance of separation, and increase in communication skills, memory, and attention span. Appetite remains inconsistent.

36. A child is brought into the ED with suspected appendicitis. What signs and symptoms does the nurse expect to assess? (Select all that apply.) a. Left lower quandrant pain b. Guarding c. Rebound tenderness d. Decreased C-reactive protein e. Pain on lifting thigh when supine

ANS: B, C, E With appendicitis on examination, characteristic tenderness in the right lower quadrant known as McBurney's point will occur. Other diagnostic signs include guarding (tightening of the abdominal muscles or rigidity of the abdomen on palpation); rebound tenderness (pressing the RLQ with rapid release of pressure causes severe pain); pain on lifting the thigh while in the supine position is caused by muscle irritation. C-reactive protein levels will be increased after 12 hours if any infection is present.

27. Why are infants more vulnerable to fluid and electrolyte imbalances than adults? a. They have a smaller surface area than adults in proportion to body weight. b. Water needs and losses per kilogram are lower than those for adults. c. A greater percentage of body water in infants is extracellular. d. Infants have a lower metabolic turnover of water

ANS: C A greater percentage of body water is contained in the extracellular compartment of children under 2 years of age.

22. The nurse is speaking to the parent of a 3-year-old child who has mild diarrhea. What dietary modification would the nurse advise? a. Soft foods with rice, bananas, toast, and applesauce b. Small amounts of clear fluids such as gelatin c. An oral rehydrating solution, such as Pedialyte d. Chicken soup because it is high in sodium

ANS: C An oral rehydrating solution is recommended to replace fluids and electrolytes lost from frequent bowel movements

13. A parent tells the nurse that her child is scheduled for an x-ray of the bladder and urethra that is done while the child is urinating. What is this test known as? a. Cystometrogram b. Cystoscopy c. Voiding cystourethrogram d. Intravenous pyelogram

ANS: C An x-ray examination of the bladder and urethra before and during micturition is called a voiding cystourethrogram.

19. What does the nurse expect the appearance of the stools of a child with celiac disease to be? a. Ribbon like b. Hard, constipated c. Bulky, frothy d. Loose, foul-smelling

ANS: C Celiac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption

22. The nurse is educating a group of preschool parents about the importance of safety. Which statement by a parent indicates the need for further education? a. "I continue to provide a great deal of indirect supervision for my child." b. "My stairway is always free of clutter." c. "I only leave my child in the car for brief moments." d. "Medications are kept in a locked cabinet."

ANS: C Children must not play in or around the car or be left alone, even for a brief moment, in the car. Preschool children still require a good deal of indirect supervision to protect them from dangers that arise from their immature judgment or social environment. Stairways should be free of clutter and medications kept out of reach.

10. A mother reports that her 2-year-old child experiences constipation frequently. Which food would the nurse recommend to include in the child's diet? a. Cooked vegetables b. Pretzels c. Whole-grain cereal d. Yogurt

ANS: C Dietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals

19. The 6-year-old scheduled for an orchiopexy shyly asks the nurse, "What are they going to do to me 'down there'?" What is the nurse's best response? a. "They are going to fix you up 'down there'." b. "They will move your testicle from your abdomen to your scrotum." c. "What do you think your doctor is going to do?" d. "You shouldn't worry. Your doctor knows exactly what to do

ANS: C Encourage the patient to talk about what he knows and what feelings he has about the surgery. School-age children have a fear of bodily harm.

13. What intervention might the nurse suggest as helpful for the child with enuresis? a. Applying an electric pad that gently shocks the child b. Waking the child several times during the night to urinate c. Decreasing fluid intake after the evening meal d. Increasing dietary fiber intake

ANS: C If a child is experiencing enuresis, liquids after dinner should be limited and the child should routinely void before going to bed.

13. Parents ask the nurse how their infant developed a Meckel's diverticulum. What condition, will the nurse explain, is present causing this diagnosis? a. The yolk sac remains connected to the intestine. b. There is inflammation of the ileocecal valve. c. A pouch forms when the vitelline duct fails to disappear. d. There is a weakness in the abdominal wall

ANS: C If the vitelline duct fails to disappear completely after birth, a blind pouch may form

1. The nurse is assessing a 13-year-old boy. With what do physical changes in the pubertal male begin? a. Development of axillary and facial hair b. Enlargement of penis c. Enlargement of testicles d. Pigmentation of the scrotum

ANS: C In boys, pubertal changes begin with enlargement of the testicles and internal structures

13. Which finding would concern the nurse assessing vital signs on a 2-year-old? a. Temperature of 37.1° C (98.8° F) b. Pulse at 100 beats/min c. Respirations of 36 breaths/min d. Blood pressure of 90/60 mm Hg

ANS: C In the toddler period, the respiratory rate decreases to 25 breaths/min.

18. The nurse is explaining to a 17-year-old female the actions to prevent urinary tract infection. Which is the best beverage for the nurse to recommend to keep urine acidic? a. Milk b. Grape juice c. Apple juice d. Orange juice

ANS: C Juices such as apple or cranberry help maintain acidity of urine

14. What should the nurse suggest as the most appropriate toy choice for a 3-year-old? a. A board game b. A small pet, such as a goldfish c. A large construction set d. Push-pull toys

ANS: C Large construction sets are suitable toys for the preschool-age child

5. During a physical assessment of a hospitalized 5-year-old, the nurse notes that the foreskin has been retracted and is very tight on the shaft of the penis; the nurse is unable to return it over the head of the penis. What action should the nurse implement? a. Forcibly push the foreskin down over the head of the penis. b. Place a warm compress on the penis. c. Notify the charge nurse. d. Wait a few hours and try again.

ANS: C Notify the charge nurse of this occurrence of paraphimosis. The tight foreskin can impede blood flow to the penis; this should be remedied immediately

1. The nurse discussed strategies with a parent to prevent a recurrence of urinary tract infection in the child. Which statement made by the parent indicates a need for further teaching? a. "My daughter should wash and wipe the perineal area from front to back." b. "I am only going to have my daughter wear cotton underwear." c. "It is acceptable to take frequent bubble baths." d. "She needs to drink lots of fluids and void frequently."

ANS: C Oils in bubble bath and similar products are known to irritate the urethra.

15. The nurse is leading a discussion group with parents of adolescents. One parent comments, "My son can't do anything without checking with his friends first. My opinion doesn't count anymore." What knowledge in regard to this behavior would the nurse formulate as a response? a. It is unusual for adolescent boys. b. It is often more apparent in boys than girls. c. It is a normal phenomenon during adolescence. d. It is suggestive of feelings of low self-worth.

ANS: C Parents may need help understanding that the adolescent's exaggerated conformity is necessary for moving away from dependence and obtaining approval from persons outside the nuclear family.

16. The parent of a 4 -year-old child tells the nurse, "Bedtime is difficult. I can't get my son to go to bed at night." The nurse and the child's mother discuss options. What intervention is the most appropriate choice? a. Allow the child to put himself to bed when he is tired. b. Let the child read in his room until he falls asleep. c. Establish a bedtime routine and use it consistently. d. Tire him out with physical activity before bedtime.

ANS: C Parents should engage the child in quiet activities before bedtime and establish a ritual that signals readiness for bedtime.

10. The nurse is discussing preschoolers' sexual curiosity with the parent. What statement by the mother leads the nurse to determine that the mother understands the information? a. "Make up funny words for body parts." b. "Distract the child with a toy if they ask about sex." c. "Answer their questions when they ask." d. "Tell them to ask you again when they are 6 year old.

ANS: C Parents should provide sex education at the time the child asks about sex

22. Parents ask the pediatric nurse how school life might influence their growing child. What area of development will the nurse indicate that school affects the least? a. Moral development b. Social development c. Physical development d. Cognitive development

ANS: C Physical development is the least affected by school life. Moral development occurs as they have experience with, and understand, rules and fairness in the school setting. Schools have a profound influence on the socialization of children, who bring to school what they have learned and experienced in the home. Success in school requires an integration of cognitive, receptive, and expressive (language) skills.

6. The nurse is planning care of an adolescent. What psychosocial task does the nurse understand is important for the adolescent to develop? a. A sense of initiative b. A sense of industry c. A sense of identity d. A sense of involvement

ANS: C Psychosocial milestones that must be accomplished during adolescence include the five Is—image of self, identity, independence, interpersonal relationships, and intellectual maturity

21. A 13-year-old girl tells the nurse she is concerned because she has not had her first menstrual period. What is the best initial response from the nurse? a. "Your hormone levels may be irregular." b. "Could you be pregnant?" c. "Age of first menstrual cycle varies." d. "Do not worry about it."

ANS: C Puberty is easily recognized in girls by the onset of menstruation. The first menstrual period is called the menarche. It commonly occurs about age 12 or 13 years, but this varies. It may occur as early as age 10 years or as late as age 15 years.

19. What is the most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old? a. Ride a tricycle. b. Spend time in an infant swing. c. Play with push-pull toys. d. Read large picture books.

ANS: C Push-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old child

4. Why are rapid respirations a possible cause of dehydration? a. They prevent the child from drinking. b. They increase circulation, thus increasing urine production. c. They cause evaporation of fluid on the mucous membranes. d. They often lead to vomiting.

ANS: C Rapid respirations cause increased insensible fluid loss

19. What is best for the nurse to suggest to the parents of an overweight 9-year-old to help prevent obesity? a. Use whole milk as a between-meal snack because it is more filling than skim milk. b. Feed the child before family meal times to monitor intake more closely. c. Encourage the child to engage in physical activity for at least an hour a day. d. Remove all sweets and junk food from the house.

ANS: C Regular physical activity reduces weight

16. Which stage of cognitive development is a 9-year-old child in according to Piaget? a. Formal operations b. Preoperational c. Concrete operations d. Sensorimotor

ANS: C School-age children are in the concrete operations stage of cognitive development

7. A 13-year-old girl tells the school nurse that she is getting fat, especially in her hips and legs. What understanding by the nurse would best guide the response? a. Many adolescents are unaware of proper nutrition. b. Adolescents of this age become less active and should eat fewer calories. c. Puberty is often preceded by fat deposits in these areas. d. As soon as menarche occurs, she will lose this excess weight.

ANS: C Secondary sexual characteristics become apparent before menarche. Fat is deposited in the hips, thighs, and breasts, causing them to enlarge

9. A parent asked the nurse, "At what age are children capable of assuming more responsibility for personal belongings?" What is the nurse's best response based on knowledge of growth and development? a. 6 years b. 7 years c. 9 years d. 12 years

ANS: C The 9-year-old is dependable and assumes more responsibility for personal belongings

17. What fear is unique to the preschool period? a. Water b. Animals c. Bodily harm d. Death

ANS: C The fear of bodily harm, particularly the loss of body parts, is unique to this stage.

11. What type of play is most appropriate when planning care for a child with moderate intellectual deficiency? a. Exercise leg and arm muscles. b. Be educationally oriented to make up for lost time. c. Be adjusted to mental age rather than chronological age. d. Involve contact sports and aggressive physical activity with other children

ANS: C The nurse must consider the child's mental age rather than her chronological age when selecting toys for play.

8. The nurse is teaching a parent about pyrvinium (Povan). What would be included in regard to potential side effects? a. Diarrhea b. Skin rash c. Red stool d. Metallic taste

ANS: C The nurse should advise parents that pyrvinium stains clothing and turns stools red

16. Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching? a. "I will make sure he gets his measles vaccine as soon as he gets home." b. "He can stop taking his medication next week." c. "I should check his urine for protein when he goes to the bathroom." d. "He should eat a low-protein diet for the next few weeks."

ANS: C The parents should be instructed to keep a daily record of the child's urinary proteins

16. The nurse is planning a parent education program about lead poisoning prevention. What will be included regarding primary sources of lead in the community? a. Increased lead content of air b. Use of aluminum cookware c. Deteriorating paint in older buildings d. Inhaling smog

ANS: C The primary source of lead is paint from old, deteriorating buildings.

21. The parents of a newborn are concerned that their son's scrotum is enlarged and swollen on one side. What is the nurse's best response? a. "It is very common in the newborn that one gonad is larger than the other." b. "Birth trauma caused bruising to the scrotum. It will reduce in size in a few days." c. "It is a collection of fluid that will most likely correct itself in a year." d. "The doctor will drain this collection of blood before your baby is discharged."

ANS: C These signs are indicative of a hydrocele, a collection of fluid in the scrotum that usually corrects itself in a year.

31. Which statement made by a parent alerts the nurse to the need for additional education about poison prevention? a. "I keep the poison control center phone number easily accessible." b. "All medication is kept out of reach in a locked cabinet." c. "I keep a bottle of syrup of ipecac handy." d. "Our garden is free from marigolds

ANS: C Traditionally, syrup of ipecac was the treatment of choice to remove some types of poisons from a child's system and parents were advised to keep a supply on hand in the home. However, the American Academy of Pediatrics (AAP) revised this policy in 2003. Parents are now advised to call the poison control center and bring the container of the substance ingested to the hospital emergency department as quickly as possible because stomach lavage is rarely effective 1 hour or more after ingestion. Ipecac syrup should not be kept in the home. Uncontrolled vomiting can cause serious complications

10. The school nurse is preserving a tooth that was knocked out on the school playground. What will the nurse be especially careful to do? a. Wrap the tooth loosely in a clean cloth. b. Rinse the tooth with alcohol. c. Handle the tooth only by the crown. d. Place the tooth in a warm environment

ANS: C When a permanent tooth is avulsed, the tooth should be picked up by the crown to prevent any further damage to the root and placed in milk until the child can be examined by a dentist.

23. An adolescent male is admitted to the ED with severe acute scrotal pain. When documenting medical history the nurse notes cryptorchidism at birth. What diagnosis does the nurse expect? a. Urinary tract infection b. Nephrosis c. Torsion d. Phimosis

ANS: C When one or both testes fail to lower into the scrotum, the condition is termed cryptorchidism. Acute scrotal pain may indicate a testicular torsion (twisting), which necessitates immediate surgery to preserve testicular function.

10. What can the nurse suggests as a good dietary source of zinc for an adolescent who is a vegetarian? a. Green, leafy vegetables b. Citrus fruits c. Nuts d. Enriched breads

ANS: C Zinc is essential for growth and sexual maturation in adolescence. Good vegetable sources include nuts, legumes, and wheat germ.

12. What foods would be a healthy choice for an adolescent who just finished playing in a strenuous sports game? a. A cheeseburger and soda b. A hot fudge sundae c. Two sausage and egg breakfast sandwiches and orange juice d. A bagel and skim milk

ANS: D A bagel provides a rapid supply of carbohydrates to the muscles, and skim milk provides a slow release of carbohydrates to the muscles.

9. Diuresis has not occurred on a child with nephrotic syndrome after a month on corticosteroids. What protocol can the nurse encourage to bring about diuresis? a. Ibuprofen, an anti-inflammatory agent b. Furosemide (Lasix), a diuretic c. Ciprofloxacin (Cipro), an antibiotic d. Cyclophosphamide (Cytoxan), an antisuppressant

ANS: D A potent antisuppressant such as Cytoxan can bring about diuresis when corticosteroids have proven ineffective

13. When planning to answer a 16-year-old girl's questions about menstruation, the nurse must consider cognitive development. What is developed during adolescence according to Piaget? a. The ability to view a situation from multiple perspectives b. The ability to focus more on the past than present situations c. The ability to exercise concrete reasoning d. The ability to consider hypothetical situations

ANS: D According to Piaget, in the formal operations stage adolescents have the ability to think abstractly.

17. A 5-year-old boy is admitted to the hospital with acute glomerulonephritis. In taking the child's history, what does the nurse recognize as the probable cause? a. Recovery from German measles 2 months ago b. Dysuria since the previous night c. A history of allergy d. A sore throat 2 weeks ago

ANS: D Acute glomerulonephritis develops from 1 to 3 weeks after a streptococcal infection, which causes an allergic-type response that alters the effectiveness of the glomeruli

26. The nurse is instructing a mother how to administer oral nystatin suspension prescribed to treat thrush. What will the nurse include? a. Pour the prescribed amount into a nipple and have the infant suck the medication. b. Squirt the prescribed dose into the back of the mouth and have the infant swallow. c. Give the medication mixed with a small amount of juice in a bottle. d. Use a sterile applicator to swab the medication on the oral mucosa.

ANS: D An appropriate way to administer nystatin is to moisten a sterile applicator with the medication and then swab it on the inside of the mouth.

5. A 16-year-old excitedly tells his parents that he was offered a part-time job. Which response represents an effective problem-solving approach for his parents? a. "Your studies are too important for you to have a part-time job." b. "When we went to high school, academics were the adolescent's priority." c. "We want you to put your earnings in a savings account." d. "How do you think you will manage your school work and a job?"

ANS: D An effective approach to help adolescents learn to solve problems is for parents to guide them in exploring alternatives

20. A parent confides in the school nurse that her 8-year-old twins argue and bicker constantly. What is the best response by the nurse? a. Express alarm at the constant aggression. b. Voice concern and investigate referral for counseling. c. Inquire about what punitive action the parents have taken to stop it. d. Offer reassurance that such behavior is normal for 8-year-olds.

ANS: D Argumentative and competitive behavior is normal in 8-year-olds

16. What does an adolescent's peer group serve as related to development? a. Social outlet b. Association to blur personal identity c. Platform for "group think" d. Initial separation from family

ANS: D Being a member of a peer group and communicating with and seeking approval from this group are hallmarks of the first separation from the family

20. What will children who are unable to express themselves with words often do? a. Become reclusive and introspective b. Develop other methods of verbal communication c. Engage in more creative play d. Have tantrums and act out

ANS: D Children with delayed communication skills will frequently have tantrums and act out when they are unable to make their needs known.

3. A parent comments that her adolescent daughter seems to be daydreaming a lot. What does the nurse understand this behavior to indicate regarding their daughter? a. She is bored. b. She is not getting enough rest. c. She is trying to block out stress and anxiety. d. She is mentally preparing for real situations.

ANS: D Daydreaming allows adolescents to act out in their imaginations what will be said or done in certain situations. This helps them to prepare for and cope with interactions with others.

2. A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. What acid-base imbalance would the nurse expect to occur from this persistent vomiting? a. Hyperkalemia b. Hypernatremia c. Acidosis d. Alkalosis

ANS: D Hydrochloric acid and sodium chloride from the stomach are lost from persistent vomiting. This results in alkalosis

8. The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone? a. Can interfere with the treatment for nephrosis b. Require that the child have antibiotic coverage c. Can be given in smaller, divided doses d. Should be delayed

ANS: D No vaccinations or immunizations should be administered while the disease is active and during immunosuppressive therapy

10. What will the nurse advise a parent to do when introducing solid foods? a. Begin with one tablespoon of food. b. Mix foods together. c. Eliminate a refused food from the diet. d. Introduce each new food 4 to 7 days apart.

ANS: D Only one new food is offered in a 4- to 7-day period to determine tolerance

2. What should the nurse keep in mind when planning to teach a class on nutrition to fourth-grade students? a. School-age children can concentrate on only one aspect of a situation. b. School-age children can think abstractly. c. School-age children are egocentric in their thinking. d. School-age children think logically and concretely.

ANS: D Piaget refers to the thought process of this period as concrete operations, which involves logical thinking and an understanding of cause and effect

20. The nurse has reviewed dietary restrictions for celiac disease with concerned parents. Which grain will the nurse explain can be eaten with celiac disease? a. Wheat b. Oats c. Barley d. Rice

ANS: D Rice is a gluten-free grain that can be eaten by children afflicted with celiac disease. These children will have a lifelong restriction of wheat, oats, barley, and rye

15. A seventh-grade girl tells the school nurse that her art teacher, a woman, is her hero. What is the most appropriate interpretation of the girl's comment? a. The student may be exploring her career options. b. The comment is cause for concern about sexual abuse. c. The child may have difficulty interacting with her peers. d. Hero worship is a normal phenomenon.

ANS: D School-age children tend to admire their teachers and adult companions. For the 11- to 12-year-old, hero worship is a normal phenomenon.

14. An infant is admitted to the hospital with severe isotonic dehydration. For what is this child at the highest risk? a. Metabolic alkalosis b. Hypocalcemia c. Sepsis d. Shock

ANS: D Shock is the greatest threat to life in isotonic dehydration

29. Following surgery for pyloric stenosis, an infant awoke from anesthesia hungry and crying. What is the most appropriate nursing action? a. Delay feeding the child for 6 hours. b. Offer regular formula thinned with water. c. Give small amounts of regular formula thickened with cereal. d. Allow 1 ounce of glucose water at frequent intervals.

ANS: D Small oral feedings of glucose water are given after recovery from anesthesia. Feedings are gradually increased to larger amounts of regular formula

18. The nurse using the PACE interview guide for persons at risk for substance abuse arrives at a score of 2 for an adolescent patient. How would the nurse interpret this score? a. Nonindicative of potential substance abuse b. Normal experimentation of the adolescent c. Need to schedule another PACE interview in 3 months d. Indication for referral for counseling

ANS: D The PACE guide recommends that a score of 2 or higher would suggest the need for a referral for counseling about substance abuse.

17. What statement by an 11-year-old leads the nurse to determine he has moved from the mind set of egocentrism? a. "I am a member of the best Cub Scout group in the world." b. "I must do my homework before I can play." c. "My dad can do anything!" d. "I'm sorry. I bet that hurt your feelings

ANS: D The ability to see another's point of view indicates moving away from egocentrism into a more altruistic mind-set.

14. A mother is concerned because her 9-year-old boy has developed the habit of twitching his eyes and flipping his hair while communicating with anyone. What is the best nursing response to this parent? a. "This may indicate that he needs eyeglasses." b. "Children sometimes do these things for attention." c. "This behavior suggests low self-esteem." d. "Tics appear when a child is under stress

ANS: D The child cannot help such actions and should not be scolded for them because they are mainly a result of tension.

30. The nurse is caring for an 18-pound child who has had one stool of diarrhea. The nurse knows that the child needs to consume how many milliliters of oral fluid to make up for the fluid loss? a. 18 b. 36 c. 64 d. 81

ANS: D The formula for oral fluid replacement is 10 mL/kg. 18 pounds = 8.1 kg ´ 10 = 81 mL

19. A 4-year-old child insists he has more money with a nickel than his father has with a dime. What is this perception, as described in Piaget's theory? a. Egocentrism b. Artificialism c. Animism d. Intuition

ANS: D The intuitive stage, as described by Piaget, is prelogical thinking that is based on the outside appearance of objects. A nickel is larger than a dime and therefore more valuable

24. Which nursing interventions will be implemented for the mother of a 10-month-old infant with nonorganic failure to thrive? a. Pointing out errors that the nurse observes when the mother is caring for the infant b. Discussing negative characteristics of the infant with the mother c. Having the nurse provide as much of the infant's care as possible d. Teaching the mother about the developmental milestones to expect in the next few months

ANS: D The nurse can increase parent's knowledge of growth and development by providing anticipatory guidance about normal developmental milestones

11. A parent states, "My 7-year-old really wants a dog. His 10-year-old brother has allergies to animal dander. I don't know what to do." What type of pet should the nurse suggest as the best choice? a. A small breed of dog because the large dogs produce more allergens b. An older unneutered dog that produces fewer allergens than a younger one c. A cat because it requires less care and is less allergenic d. A poodle, which does not shed, making it a good choice for people with allergies

ANS: D The poodle does not have a shed cycle and so it may be the least offensive pet for the allergic child

3. What type of relationships are the preferred social interactions for the school-age child? a. Heterosexual interest groups b. Association with one "best friend" c. Rigidly organized groups with complex rules d. Same-sex peer groups

ANS: D The preferred social interaction of the school-age child is in same-sex peer groups or cliques

18. A 4-year-old child tells the nurse she will not eat peas because they are green. Of what is this an example? a. Egocentrism b. Artificialism c. Animism d. Centering

ANS: D The tendency to concentrate on a single outstanding characteristic of an object while excluding other features is known as centering

7. The nurse discusses preparation for school with the parents of a 6-year-old girl who will soon be starting first grade. What statement by the girl's father leads the nurse to determine that the parents understood the information? a. "We should put a stop to her thumb-sucking." b. "We'll have a talk about what school is like." c. "We will let her walk to the bus stop by herself." d. "We'll have her meet some children who will be in her class."

ANS: D To prepare a child for school, parents can arrange for the child to meet other children who will be entering school with her.

22. The nurse is providing information to parents of a child born with bilateral cryptorchidism. What information is accurate to include? a. This is the most common form. b. Fertility will be unaffected. c. Surgical intervention is not recommended. d. An inguinal hernia may be present

ANS: D When one or both testes fail to lower into the scrotum, the condition is termed cryptorchidism. The unilateral form is more common. Because the testes are warmer in the abdomen than in the scrotum, the sperm cells begin to deteriorate. If both testes are affected, sterility results. Inguinal hernia often accompanies this condition. Occasionally, a testis or the testes spontaneously descend during the first year of life. An operation called an orchiopexy may be performed

23. Parents of a 5-year-old child tell the nurse they are concerned about their child's speech development by stating, "No one can understand him but us." What clinical classification of speech disorder does the nurse suspect? a. Global language delay b. Expressive language delay c. Language loss d. Articulation disorder

ANS: D When parents are the only people to understand their preschool child, an articulation disorder is suspected.

25. What are the best breakfast choices for the nurse to point out prior to a big exam, to provide high levels of alertness and increased memory? (Select all that apply.) a. Pancakes and syrup b. Coffee and chocolate-covered donuts c. Bacon and fried eggs d. Whole grain cereal and yogurt e. Oatmeal and sliced apples

ANS: D, E Meals high in protein will break down into norepinephrine and increase alertness. Meals with a high sugar content result in a soothing sleepy response. Meals high in fats digest slowly and draw blood from the brain during the lengthy digestive process.

26. Parents of a toddler are discussing the emotion of fear with the pediatric nurse. What information can the nurse offer regarding fear and the toddler? (Select all that apply.) a. Stress increases fear. b. Rituals help deal with fear. c. Teasing the child can decrease fear. d. Once fear is learned it is difficult to eliminate. e. Adults should openly share their fears.

ANS: A, B, D Once a fear has been learned, it is more difficult to eliminate. Clinging to favorite possessions and repetitive rituals are self-consoling behaviors for the toddler, particularly at bedtime and during separation from parents. Stress increases fear of separation. Adults should attempt to control their own fears in the presence of young children. Respect and understanding should always be accorded to children who are afraid. Making fun of the fear or shaming the child in front of others is detrimental to self-esteem

26. The nurse is preparing to outline principles of discipline for parents of an infant. What information should the nurse include? (Select all that apply.) a. Firmly say "No." b. Distract the child to another activity. c. Bribe the child with a sweet treat. d. Remain consistent. e. Ignore the child until behavior improves.

ANS: A, B, D Parental approval is important to the infant, and setting limits early is important (Anderson, 2008). Principles of discipline for an infant include lowering the voice to say "no" firmly, removing the child from the situation, distraction, and consistency.

32. Parents attending a well visit for their 11-year-old son verbalize concern over his computer use. When asked about it, the boy states, "I play games on my computer for 1 hour a day." The nurse knows that computer games can provide what opportunities to childhood development? (Select all that apply.) a. Problem-solving skills b. Gross motor development c. Manipulative skills d. Learning opportunities e. Increased self-worth

ANS: A, C, D Computer programs are popular with all age groups, providing problem-solving skills, manipulative skills, and opportunities for new learning

30. What will the nurse take into consideration when educating parents regarding infant nutrition? (Select all that apply.) a. Cultural practices b. Sex of the infant c. Parental knowledge d. Infant's developmental level e. Parent-child interaction

ANS: A, C, D, E Parents have many concerns about feeding their infant during the first year of life. This is a period when readiness to receive nutrition education is usually high; therefore the nurse looks for opportunities to provide accurate information. Assessment of parental knowledge; infant development, behavior, and readiness; parent-child interaction; and cultural and ethnic practices is important. Sex of the infant does not enter into nutritional education.

28. The nurse is aware that the 7-month-old can signal feeding readiness by which action(s)? (Select all that apply.) a. Pulling spoon toward mouth b. Biting at spoon with upper and lower incisors c. Pointing to food bowl d. Bouncing up and down with excitement at sight of food e. Manipulating finger foods

ANS: A, E The 7-month-old pulls the spoon toward his or her mouth and can manipulate finger foods. The 7-month-old does not have upper incisors and has not developed adequately to recognize the food container or exhibit excitement related to the sight of food.

15. The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. Which statement made by the mother would indicate an unsafe behavior? a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs."

ANS: B A rear-facing infant car seat should be used for infants younger than 1 year of age

11. On a home visit, the nurse notes that the parents require teaching intervention to protect the 15-month-old child who lives there. What observation would lead the nurse to this conclusion? a. The fireplace has a screen. b. The dining room table has a tablecloth on it. c. There are paintings on the wall. d. The kitchen floor is clean but not shiny.

ANS: B A tablecloth presents a safety hazard because the curious toddler will reach up and pull on it. The toddler could be injured if items on the table are moved when the tablecloth is pulled

6. A parent is concerned about her children's reaction should their grandmother die. What understanding will guide the nurse's response? a. Children are unlikely to notice their grandmother's absence if no one reminds them. b. Young children often understand that other people die, but do not equate it with themselves. c. The children's response will depend entirely on whether they have been acquainted with death before this. d. Children can understand the concept of a higher being much like adults can.

ANS: B Between 3 and 4 years of age, the child becomes curious about death and dying. They may realize that others die, but they do not relate death to themselves.

9. A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. What will the nurse weighing the infant today would expect her weight to be? a. At least 12 pounds b. At least 16 pounds c. At least 20 pounds d. At least 24 pounds

ANS: B Birth weight is usually doubled by 6 months of age

12. The nurse observes that a 2-year-old is able to use a spoon steadily at mealtime. What does self-feeding help to develop in the toddler? a. Good nutrition b. A sense of independence c. Adequate height and weight d. Healthy teeth

ANS: B By the end of the second year, toddlers can feed themselves. This helps them to develop a sense of independence.

3. A parent remarks, "My 18-month-old daughter carries her blanket around everywhere. Is this normal?" What is the best explanation a nurse who has an understanding of toddler development might give? a. She carries her blanket because she is ritualistic. b. Carrying her favorite blanket is self-consoling behavior. c. This behavior can be discouraged by offering new toys to the child. d. This could be indicative of emotional distress.

ANS: B Favorite possessions and repetitive rituals are self-consoling behaviors for the toddler

17. How many hours should toddlers be able to stay dry for the nurse to suggest they are ready to begin bladder training? a. 1 b. 2 c. 3 d. 4

ANS: B If the toddler is mature enough to retain urine for 2 hours, bladder training can be effective

18. When a small group of preschool-age children were playing house, each child was pretending to be a particular family member. What type of play does the nurse recognize these children are participating in? a. Parallel b. Cooperative c. Symbolic d. Fantasy

ANS: B In cooperative play, children play with each other, each taking a specific role

5. What instruction would the nurse include when planning anticipatory guidance for parents of a toddler? a. Adhere to a rigid schedule because the toddler is ritualistic. b. Limit-setting should include praise. c. Shoes should fit snugly at the toe and arch. d. Dress the toddler in pants with a zipper so that he or she can learn to zip and unzip clothes

ANS: B Limit-setting should include praise as well as disapproval for undesired behavior.

16. The parent of a toddler tells the nurse, "My daughter's appetite has decreased. Thank goodness she loves to drink milk." What is the most appropriate response by the nurse? a. "Has your daughter been sick recently?" b. "How much milk does she drink in a day?" c. "Has she become a fussy eater, too?" d. "Have you tried offering her finger foods?"

ANS: B Milk should be limited to 24 ounces a day. Too few solid foods can lead to dietary deficiencies of iron.

19. When the nurse asks a 10-year-old Native American if he is ready to go to therapy, he does not answer immediately. How does the nurse interpret this response? a. Indecision b. Considering the answer in silence c. Shyness with strangers d. Fear of medical personnel

ANS: B Native Americans value silence. They need to sit and consider matters before replying to questions

8. The nurse is planning anticipatory guidance for a caregiver of a preschool-age child. The nurse will explain that permanent teeth begin erupting at what age? a. 4 years old b. 6 years old c. 8 years old d. 10 years old

ANS: B Permanent teeth do not erupt through the gums until the sixth year

25. The nurse caring for a 4-year-old postoperative patient instructs him to blow bubbles. What nursing intervention is the nurse most likely implementing by using this form of therapeutic play? a. Providing pain relief b. Encouraging deep breathing c. Decreasing risk of infection d. Maintaining body temperature

ANS: B Play can also be therapeutic and aid in the recovery process. An example of therapeutic play is the game of having the child blow bubbles to promote deep breathing

6. What is the best advice the nurse can offer a parent concerned because her 2-year-old is very active and does not eat much? a. Insist that the child eat one food on the plate. b. Help the child wind down with a quiet activity before mealtime. c. Maintain a consistent eating schedule for the family. d. Serve the meal with a variety of interesting plates, cups, and utensils

ANS: B Quiet time before meals provides an opportunity for the active toddler to wind down

9. What is the most appropriate toy for the nurse to select for a normal 2-year-old child? a. Bicycle with training wheels b. Dump truck c. Wind-up toy d. Building block set

ANS: B The 2-year-old enjoys playing with objects that can be pushed or pulled

14. What would be an expected finding when assessing language development in a 2-year-old? a. A 900-word vocabulary b. Use of two-word sentences c. Use of pronouns and prepositions d. 100% of speech is understandable

ANS: B The 2-year-old should be using two-word sentences

4. The nurse observed three toddlers playing side by side with dolls. Closer observation revealed that the children were not interacting with one another. What type of play is this? a. Solitary b. Parallel c. Associative d. Cooperative

ANS: B Toddlers engage in parallel play. Children play next to, but not with, each other

24. The nurse suggests offering which food(s) to support the toddler's desire to self-feed? (Select all that apply.) a. Pureed foods b. Finger foods c. Foods served cold d. Foods in colorful dishes e. Foods that are varied and colorful

ANS: B, D, E Finger foods that are varied and colorful and served in colorful dishes at a moderate temperature are all attractive. Foods can be chopped into small pieces but not pureed

30. The nurse suggests to the parents of an obese 10-year-old that they use the Portion Plate for Kids placemat. How does this tool help with selection of portion sizes? (Select all that apply.) a. Cartoon characters eating healthy foods b. Tips on healthy food choices c. Portion measurement in tablespoons for common food d. Calorie values for cup-size portions of common foods e. Familiar objects such as a deck of cards to measure servings

ANS: B, E The Portion Plate for Kids is a placemat that uses common objects such as a deck of playing cards or a baseball to measure serving portions

18. The mother of an infant born prematurely tells the nurse, "The baby is irritable. She cries during diaper changes and feedings. Can you make some suggestions about what I should do to soothe her?" What is the most appropriate recommendation to help this parent? a. Play the radio or TV while you feed the infant. b. Put the infant in a room with sunlight. c. Wrap the infant snugly when you hold them. d. Change the infant's position quickly.

ANS: C A strategy that may be helpful is to swaddle the infant snugly in a light blanket with extremities flexed and hands near the face.

7. How would the nurse advise a parent who states, "I never know how much food to feed my child"? a. Serving sizes should not exceed 1 teaspoon of each type of food. b. Food quantities must be carefully measured to avoid overfeeding. c. Use 1 tablespoon of each food for each year of age as a guideline. d. A toddler should eat three balanced meals. Snacks are not necessary

ANS: C A tablespoon of each type of food for each year of age is a good guideline to follow when determining serving sizes.

3. A preschool-age child is asked, "Why do trees have leaves?" Which response would be an example of animism? a. "So I can have shade over my sandbox." b. "Because God made them that way." c. "To hide behind when they are scared." d. "For the squirrels to play in."

ANS: C Animism describes the tendency of preschool children to attribute human characteristics to nonhuman objects

24. What toy is developmentally appropriate for the nurse to suggest to entertain a 5-year-old child? a. Jack-in-the-box b. Book of nursery rhymes c. Model airport with toy planes d. Model car construction kit

ANS: C At this age children are into creative play. The model airport with toy planes is the most developmentally appropriate

7. What would the nurse expect a 4-month-old to be able to accomplish? a. Hold a cup. b. Stand with assistance. c. Lift head and shoulders. d. Sit with back straight

ANS: C Because development is cephalocaudal, of these choices, lifting the head and shoulders is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months.

1. Which behavior reported by a parent of an 18-month-old toddler would the nurse report to the pediatrician as a cause for concern? a. Has temper tantrums b. Feeds self sloppily c. Walks by holding onto furniture d. Speaks in short sentences

ANS: C By 18 months, a toddler should have been walking alone for several months. The toddler who walks holding onto furniture should be evaluated by a developmental specialist.

8. The nurse is discussing toilet training with parents. What behavior by the child would identify toilet training readiness? a. Willing to sit on the potty for 15 to 20 minutes b. Dry in the daytime for 4-hour periods c. Able to communicate that he or she is wet d. Curious about bathroom activities

ANS: C Children are ready for toilet training when they can communicate in some fashion that they are wet or need to urinate or defecate

22. Parents of a 6-month-old infant ask the nurse why it is necessary to offer iron-rich formula to their child. What is the correct response? a. "The infant has limited ability to produce red blood cells." b. "The infant has ineffective digestive enzymes." c. "The infant has exhausted maternal iron stores." d. "The infant has need of the iron to support dentition

ANS: C Many pediatricians recommend iron-fortified formulas because maternal iron stores decrease by 6 months of age

2. What is a unique organization of characteristics that determines an individual's pattern of behavior? a. Environment b. Heredity c. Personality d. Experience

ANS: C One definition of personality states that it is a unique organization of characteristics that determines the individual's typical or recurrent pattern of behavior

26. The mother of a 7-year-old pediatric patient asks the nurse about her child's sleep requirement. What is the most accurate response by the nurse? a. "7 to 10 hours a night" b. "5 to 7 hours a night with one daytime nap" c. "11 to 13 hours a night" d. "4 to 6 hours a night with two daytime naps

ANS: C Sleep patterns vary with age. The neonate sleeps 8 to 9 hours per night and naps an equal amount of time during the day. The 2-year-old may sleep 10 hours during the night and have only one short daytime nap. The 7-year-old usually requires 11 to 13 hours of sleep and rarely has a daytime nap. These patterns may be altered by cultural practices.

6. The mother of a 7-month-old reports that the first lower central incisor has erupted. She asks the nurse, "How many teeth will he have by his first birthday?" The nurse explains that the infant will have how many teeth by 1 year of age? a. 2 b. 4 c. 6 d. 8

ANS: C The 1-year-old infant usually has about 6 teeth, 4 above and 2 below

5. A 3-year-old child, while playing with his favorite toy in the playroom of the pediatric unit, is approached by another child who also wants to play with the same toy. What behavior will the nurse anticipate from this child? a. Will play well with the other child b. Will give the toy up and then not play anymore c. Will become angry and a physical response might ensue d. Will ignore the toy and go on to something else

ANS: C The 3-year-old child is egocentric and likely will become angry when others attempt to take his or her possessions.

9. How does the nurse characterize the play of 5-year-old children? a. Enjoying rough and tumble play b. Playing well-organized games c. Following rules d. Preferring inside activities

ANS: C The 5-year-old wants to play by the rules but cannot accept losing. The rules may be very strict or change as the game progresses.

12. The nurse is assessing development in a 9-month-old infant. What would the nurse expect to observe? a. Speaking in 2-word sentences b. Grasping objects with palmar grasp c. Creeping along the floor d. Beginning to use a spoon rather sloppily

ANS: C The 9-month-old tries to creep, has developed pincer movement, and can grasp a spoon without keeping food on it.

22. What should the nurse avoid when demonstrating a bath procedure to parents of Vietnamese origin? a. Talking directly to the mother b. Exposing the child's genitals c. Touching the child's head d. Using cool water

ANS: C The Vietnamese are very sensitive about anyone touching a child's head because that is where consciousness lies.

4. What is the earliest age at which an infant is able to sit steadily alone? a. 4 months b. 5 months c. 8 months d. 15 months

ANS: C The infant can sit alone without support at about 8 months of age

8. What is an abnormal finding in an evaluation of growth and development for a 6-month-old infant? a. Weight gain of 4 to 7 ounces per week b. Length increase of 1 inch in 2 months c. Head lag present d. Can sit alone for a few seconds

ANS: C The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation

20. Which statement indicates the mother of an 8-month-old understands infant sleep patterns? a. "I put the baby in my bed until she falls asleep, then I put her in her crib." b. "I let the baby skip an afternoon nap so that she will fall asleep earlier." c. "I put the pacifier in the crib so that she can find it when she wakes up." d. "I rock the baby back to sleep if she wakes up at night."

ANS: C The parent should assist the infant to develop self-soothing behaviors so that the infant can get back to sleep on her own

10. What could the nurse recommend to a child's mother to encourage a toddler to practice independence? a. Offer a variety of items to choose from to stimulate his mind. b. Allow the child to determine his own daily routine. c. Offer him a choice between two items. d. Set the routine herself, but discuss with her toddler how he or she would have done it differently.

ANS: C The toddler can be allowed to make choices as the situation warrants, but the number of choices should be limited because too many confuse the toddler.

1. Which statement best describes the 3-year-old child? a. Boisterous, tattles on others b. Aggressive, shows off c. Helpful, wants to assist with chores d. Talkative, inquisitive about the environment

ANS: C Three-year-old children are helpful and can assist in simple household chores

10. An assessment of a child's nutritional status reveals the child is alert, with shiny hair, firm gums, firm mucous membranes, and regular elimination. How would this child's nutritional status be described? a. Overnourished b. Undernourished c. Well nourished d. Borderline

ANS: C Well-nourished children show steady gains in height and weight and have shiny hair, firm gums and mucous membranes, and regular elimination.

29. Which healthy snack foods would the school nurse suggest to a group of adolescents? (Select all that apply.) a. Bubble gum b. Chocolate-covered peanuts c. Raw vegetables d. Cheese e. Dried fruits

ANS: C, D Cheese and raw vegetables are acceptable healthy snacks. Bubble gum, chocolate-covered peanuts, and dried fruits all contain high amounts of sugar.

31. An educational program is being presented to pediatric nurses on the relationship of play to childhood development. What information should be included in this presentation? (Select all that apply.) a. Art play should be used sparingly. b. Use of computer/video games is detrimental. c. Understanding of child/parent relationships can be gained by observing play. d. Play encourages self-expression. e. Play provides a sense of accomplishment.

ANS: C, D, E Art is an appropriate play activity at almost any age and provides an avenue for experimentation as well as for creative expression and a feeling of accomplishment in the child. Observing the child at play can aid in assessing growth and development and understanding the child's relationships with family members. Any plan of care for a hospitalized child of any age should include a play activity that either encourages growth and development or encourages the expression of thoughts and feelings. Computer programs are popular with all age groups, providing problem-solving skills, manipulative skills, and opportunities for new learning

12. What does the nurse consider as an appropriate snack for a 2-year-old child? a. Hot dog sections b. Grapes c. Popcorn d. Applesauce

ANS: D Applesauce is a healthy and safe snack food for the toddler. The toddler is at risk for choking on foods such as grapes, hot dogs, and popcorn.

20. A mother tells the nurse, "My 11-month-old son is not as active as my other children were at this age. He is the youngest of four and the older children love to dote on him." Which factor is influencing this child's language development? a. Heredity b. Sex c. Mother's health during pregnancy d. Ordinal position

ANS: D Motor development of the youngest child may be prolonged if the child is babied by others in the family.

13. What statement made by a parent indicates correct understanding of infant feeding? a. "I've been mixing rice cereal and formula in the baby's bottle." b. "I switched the baby to low-fat milk at 9 months." c. "The baby really likes little pieces of chocolate." d. "I give the baby any new foods before he takes his bottle."

ANS: D New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods.

1. A mother calls the pediatrician's office because her infant is "colicky." What is the most helpful measure the nurse can suggest to the mother? a. Sing songs to the infant in a soft voice. b. Place the infant in a well-lit room. c. Walk around and massage the infant's back. d. Rock the fussy infant slowly and gently.

ANS: D One technique the nurse can offer parents of a fussy infant is to rock the infant gently and slowly while being careful to avoid sudden movements

14. A mother is concerned because her 10-month-old is lethargic. What is the best action the nurse can advise this mother to implement? a. Keep the infant's room well lit. b. Rub the infant's soles vigorously. c. Offer the infant a pacifier. d. Handle the infant slowly and gently

ANS: D Some infants respond to stimulating environments by shutting down. Move and handle infants slowly and gently.

14. What does the nurse recognize as an example of Piaget's concrete operational thinking? a. 2-year-old says, "It's nighttime" when his room is darkened. b. 4-year-old refers to the hospital as "my house." c. 5-year-old coloring a picture of a puppy says, "This is my puppy." d. 7-year-old says, "I am sick because I have germs in my chest."

ANS: D The 7-year-old's remark reflecting the cause and effect of germs and illness is an example of operational thinking. All other options are examples of preoperational thought, which is egocentric and symbolic.

7. At a well-baby visit, parents of a 6-month-old ask when to take the infant for the first dental visit. What is the nurse's best response? a. "If the teeth are brushed regularly, the child should see a dentist by 3 years of age." b. "The first dental visit should be arranged after the first tooth erupts." c. "The child should have a dental examination when all deciduous teeth have erupted." d. "A dental visit by 1 year of age is recommended by the American Academy of Pediatric Dentistry."

ANS: D The Academy of Pediatric Dentistry recommends that the first dental visit occur by 1 year of age

19. The nurse is assessing a 3-year-old. What is the expected weight gain for this age child? a. 2 times the birth weight b. 2.5 times the birth weight c. 3 times the birth weight d. 4 times the birth weight

ANS: D The expected weight of a -year-old toddler is four times the birth weight.

21. How might the nurse demonstrate the parachute reflex with an infant? a. Lifting the infant high in the air above her head b. Holding the infant in a football hold, cradling the head c. Seating the infant in a stroller in an upright position d. Thrusting the infant downward into the crib

ANS: D The infant, when thrust downward in a prone position, will protectively extend the arms

16. What is the best nursing action when an 8-year-old child comes to the school nurse with his central incisor in his hand and reports he knocked his tooth out on the water fountain? a. Give him an ice cube to suck on. b. Have him wash his mouth out with peroxide and water. c. Wrap the tooth in a clean tissue. d. Wash off the tooth and place it in a container of milk

ANS: D The tooth should be washed off and put in a container of milk to preserve it for possible reimplantation.

31. Parents of an infant inform the nurse they are planning home preparation of solid foods. What directions should the nurse provide? (Select all that apply.) a. Boil foods in a large amount of water. b. Do not freeze foods. c. Add 1 teaspoon of salt per cup. d. Puree food in electric blender. e. Add sugar sparingly.

ANS: D, E Home-prepared infant food can be strained and pureed in an electric blender. Sugar should be added sparingly. Food should be boiled in small amounts of water and not over cooked to avoid destroying nutrients. Foods may be frozen in ice cube trays and defrosted for use.

3. An infant's birth weight is 7 pounds, 8 ounces. What can the nurse project the weight to be at 6 months? a. 12 pounds b. 15 pounds c. 18 pounds d. 22 pounds

ANS: B An infant usually doubles his or her birth weight by 5 to 6 months

1. What type of development is the nurse assessing when an infant can lift his or her head before he or she can sit? a. Specific to general b. Proximodistal c. Cephalocaudal d. General to specific

ANS: C Cephalocaudal development proceeds from head to toe.

17. The mother of a 7-month-old states, "The baby is eating food now. Should I give him regular milk, too?" What is the nurse's best response? a. "You should give the baby low-fat milk." b. "Try the milk. See if he has any digestive problems." c. "Continue breast milk or iron-fortified formula until 1 year of age." d. "At this age, infants can tolerate lactose-free or soy-based milk."

ANS: C Whole milk should not be introduced before 1 year of age. Low-fat milk should not be introduced before 2 years of age.

7. What is the most appropriate intervention when dealing with occasional aggression in a 4-year-old child? a. Have the child take a time-out in the corner for 4 minutes. b. Spank the child at the time of the incident. c. Take away television privileges for the day. d. Send the child to his room for 30 minutes.

ANS: A Time-out periods, usually lasting 1 minute per year of age, with the child sitting in a chair or corner, are considered an effective disciplinary technique.

21. Why does day care for the toddler differ from that of the preschooler? a. Toddlers have a shorter attention span. b. Toddlers need more group play. c. Toddlers are less prone to environmental dangers. d. Toddlers require less outdoor space.

ANS: A Toddlers have a shorter attention span than preschoolers and are prone to investigate other opportunities in the environment that may put them in harm's way. Toddlers are more interested in parallel play.

9. A mother asks the nurse how much food should be offered to her 2-year-old. What is a good rule of thumb for serving size (in tablespoons) per year of age? a. 2 b. 3 c. 4 d. 5

ANS: A The rule of thumb for serving sizes is to offer 1 tablespoon of each food group per year of age

15. The nurse is planning to explain the use of time-outs to the parent of a 3-year-old. How many minutes will the nurse indicate is appropriate for a child of this age? a. 3 b. 6 c. 10 d. 15

ANS: A Timing for time-out is usually based on 1 minute per year of age

23. When selecting a potty chair, the parents are encouraged to select one that has which characteristic(s)? (Select all that apply.) a. Small enough for the child's feet to touch floor b. Sturdy and stable c. Supportive of child's back and arms d. Made of plastic or fiberglass e. Capable of being taken apart easily

ANS: A, B, C Potty chairs should be small and sturdy and supportive of the child's back and arms. The composition is not important as long as it is stable.

25. The nurse cautions that children who have unmet hunger needs will likely display which characteristic(s)? (Select all that apply.) a. Irritability b. Ineffective feeding patterns c. No predictable sleep-wake cycle d. Distrust e. Effective parent bonding

ANS: A, B, C, D Children who experience frequent hunger do not have effective parental bonding. All other options are probable outcomes for a child who has unmet hunger needs.

29. The nurse is educating parents of a 2-month-old about immunizations. What immunizations against illness should their child receive? (Select all that apply.) a. Pertussis (whooping cough) b. Influenza c. Diptheria d. Tetanus e. Polio

ANS: A, B, C, D, E The first DPT, polio, and flu immunizations are given at the age of 2 months

27. How do children differ from adults? (Select all that apply.) a. Higher metabolic rate b. Greater surface area in relation to their weight c. Less mature organ systems d. More fluid reserves e. Continuously changing growth and development pattern

ANS: A, B, C, E Children are in a continuous growth and development pattern. Children have a greater surface area and a higher metabolic rate. All of their organ systems are not mature

28. What approaches should the nurse suggest for introducing a toddler to new foods? (Select all that apply.) a. Serve one food at a time. b. Avoid showing personal likes or dislikes. c. Offer foods in small amounts, less than a teaspoon. d. Entice the toddler to eat with sweets. e. Serve food warm.

ANS: A, B, C, E Foods should be introduced in small, warm servings, one food at a time. Sweets and milk should not be offered until after solid food

13. What activity would the nurse choose to meet Erikson's developmental task of industry when caring for a 7-year-old? a. Completing a 50-piece jigsaw puzzle b. Looking at a comic book c. Playing a game of "I Spy" with the nurse d. Coloring a picture in a coloring book

ANS: A In the developmental period of late childhood, children are striving to develop a sense of industry. The completion of a jigsaw puzzle is industrious play.

27. What should the teaching plan include about infant fall precautions? (Select all that apply.) a. Remove all unsteady furniture. b. Keep crib rails up and in locked position. c. Steady infant with hand when on changing table. d. Use tray attachment on high chair as restraint. e. Keep infant seat on the floor.

ANS: A, B, C, E The tray attachment to a high chair is an inadequate restraint. All other options are good precautions to prevent an infant from a fall.

2. The parents of a 4-year-old boy are concerned because they have noticed him frequently touching his penis. What knowledge would act as the basis for the nurse's response? a. This behavior indicates a normal curiosity about sexuality. b. Masturbation suggests the boy has an excessive fear of castration. c. It is usually a result of discomfort from a penile rash or irritation. d. The behavior is abnormal and the child should be referred for counseling.

ANS: A Masturbation at this age is common and indicates that the preschooler has a normal curiosity about sexuality

25. The nurse points out which physiological change(s) in the toddler that serve(s)as protection against disease? (Select all that apply.) a. Toughening of the skin b. Increased capillary response for thermoregulation c. Stabilization of body temperature d. Elevation in white blood cell count e. Enlarged adenoids and tonsils

ANS: A, B, C, E With the exception of an increased white blood cell (WBC) count, which is always pathological, the other options are all maturing changes that equip the toddler to better fight disease

8. A father is concerned about how long his preschool-age child will continue sucking his thumb. What is the most helpful response from the nurse? a. "Most children will stop thumb-sucking naturally by school age." b. "Over-the-counter treatments that give a bad taste can be placed on the thumb to discourage the practice." c. "Consistently touching the child's fingers whenever he sucks his thumb is most effective." d. "Thumb-sucking is detrimental to the eruption of the child's teeth and must be stopped as soon as possible."

ANS: A Most children give up the habit of thumb-sucking by the time they reach school.

4. What tasks would be appropriate to expect of a 5-year-old? a. Setting the table with paper plates b. Washing the dirty knives c. Carrying glasses from the table to the sink d. Scrubbing out the sink with cleanser

ANS: A Parents must consider developmental level and safety when asking the 5-year-old child to help with chores.

23. The nurse is assessing a 1-year-old infant in the pediatric office. What finding should the nurse report to the physician immediately? a. Respiratory rate of 60 breaths per minute b. Pulse rate of 100 beats per minute c. Minimal verbalization d. Fussy behavior

ANS: A Respirations of a 1-year-old should be 20 to 40 breaths per minute. Increased respiratory rate can lead to distress and should be reported immediately. Pulse rate of 100 to 140 beats/minute is normal. Minimal verbalization and fussy behavior are not emergency situations or abnormal for this age.

15. The nurse has discussed with a mother the process of introducing solid foods to her 6-month-old infant. What statement by the mother leads the nurse to determine that learning has taken place? a. "I will give my infant rice cereal first." b. "I will give my infant yellow vegetables first." c. "I will give my infant egg yolks first." d. "I will give my infant fruits first."

ANS: A Solid foods are usually introduced at about 6 months of age, starting with rice cereal, which is the least allergenic.

2. What would the nurse assessing growth and development of a 2-year-old child expect to find? a. The child jumps with both feet. b. Twenty deciduous teeth have erupted. c. The child can hop on one foot. d. The child has a vocabulary of 900 words.

ANS: A The 2-year-old can jump with both feet. The remaining achievements occur after 2 years of age

4. What would the nurse further investigate when assessing patterns of growth in a child? a. Previous weight was in the 75th percentile, and present weight is in the 25th percentile. b. Height is in the 90th percentile, and weight is in the 75th percentile. c. Last weight was in the 5th percentile, and present weight is in the 10th percentile. d. Weight is in the 50th percentile, and sibling's weight at the same age was in the 75th percentile.

ANS: A The child showing a difference of two or more percentile levels from an established growth pattern should undergo further evaluation

11. The nurse is talking with a parent about tooth eruption. What teeth will the nurse explain are the first deciduous teeth to erupt? a. Lower central incisors b. Upper central incisors c. Lower lateral incisors d. Upper lateral incisors

ANS: A The first teeth to erupt, usually at about 7 months, are the lower central incisors

6. The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" What is the nurse's most accurate response? a. 5 months b. 9 months c. 1 year d. 2 years

ANS: A The infant can usually drink from a cup when it is offered at about 5 months

18. Parents tell the nurse they are frustrated with their toddler's recent behavior and refusal to agree with anything they ask of them. What does the nurse explain as the term for when a toddler tests their own power? a. Negativism b. Dawdling c. Tantrums d. Food fads

ANS: A By refusing to eat, dress, sleep, or anything else by saying "No," toddlers test their own power to control. Because toddlers are also egocentric, they come to believe that their negativism is absolute. This is especially true if the adults give into it.

2. When does the posterior fontanelle close? a. 2 to 3 months b. 3 to 6 months c. 6 to 9 months d. 9 to 12 months

ANS: A The posterior fontanelle closes between 2 and 3 months of age

33. Put the developmental milestones in order from first achieved to last achieved. Put a comma and space between each answer choice (a, b, c, d, etc.) a. Jumps with both feet b. Holds a cup by the handle c. Social smile d. Babbles e. Understands "no

ANS: C, D, E, A, B Social smile: 2 months Babbles: 3 months Understands "no": 9 months Jumps with both feet: 24 months Holds a cup by the handle: 36 months

35. The nurse explains that an infant's prehensile development is progressive and logical. Arrange the development in the order from the simplest to the most complex. Put a comma and space between each answer choice (a, b, c, d, etc.) a. Hands held open most of the time b. Grasps with thumb on one side and three fingers on the other c. Picks up toy with squeeze action d. Thumb and forefinger hold object e. Hands held closed most of the time

ANS: E, A, C, B, D The development advances from the newborn's closed hands to the open star hands of the older infant, to the squeeze action, to a grasp with thumb and fingers, to the pincher movement of thumb and forefinger.

22. A 16-month-old child is attending a well-child visit at a pediatric clinic. Which assessment would indicate the biggest cause for concern? a. Does not walk independently b. Prefers finger feeding c. Limited to single words d. Is unable to climb steps

ANS: A A child should be walking independently by 16 months old. It is normal for a child this age to prefer finger feeding and to be limited to single words. Many children do not climb steps until 24 months of age.

11. The nurse encourages a Puerto Rican family to bring food to a child because he is not eating the food served on his hospital tray. What can the nurse expect the child to eat? a. Dried beans mixed with rice b. Crisp vegetables c. Spaghetti and meatballs d. Wild berries, roots, and seeds

ANS: A A common food choice of Americans of Puerto Rican descent is dried beans mixed with rice

21. A mother tells her 4-year-old child that balls should be played with outside and not inside the house. Why is the child likely to obey the rule? a. The child does not want to be punished. b. The child wants to please her mother. c. The child respects authority figures. d. The child believes that following the rules is right.

ANS: A According to Kohlberg, children in the preconventional stage (4 to 7 years) are obedient to their parents for fear of punishment

20. What guideline should an adult follow when speaking to a toddler? a. Be at eye level with the child. b. Hold by the shoulders to keep the child's attention. c. Seat the child to focus on conversation. d. Speak in a firm strong voice

ANS: A Being at eye level is helpful to hold the child's attention and is especially important when the child is frightened.

24. A new mother is voicing concern she is breastfeeding her newborn too frequently. How often does the nurse instruct this mother she should expect her newborn to feed? a. Every 2 to 3 hours b. Every 4 to 6 hours c. Every 6 to 8 hours d. Every 8 to 10 hours

ANS: A Breastfed infants may require feedings at 2- to 3-hour intervals because breast milk is more easily digested. A flexible but regular schedule that provides a rest period between feedings is best for the parent and infant.