Peds Exam 1

The nurse is discussing language development with the parent of a 20-month-old toddler. To accurately assess the toddler's language development, which question would the nurse ask the parent?

"When you say "no" does your toddler seem to understand the meaning?" Explanation: The 20-month-old toddler should understand the word "no." Being able to use plurals, using 3 to 4 word sentences, and stating one's name and age are expectations of a child 36 months of age or older.

The infant weighs 7 lb 4 oz (3,300 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months?

21 lb 12 oz (9.9 kg) Explanation: The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By 1 year of age, the infant has tripled the birth weight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb × 3 = 21.75 lb or 21 lb 12 oz (9.9 kg)

The parents of an infant receiving intravenous therapy via a scalp vein say to the nurse, "We thought our baby would have the IV in the arm." Which response by the nurse would be most appropriate?

"I know it looks scary, but the scalp is just another site and is often more comfortable." Explanation: In infants, the scalp vein is an alternate site (not a last resort) to be used. Seeing IV fluid infusing into a scalp vein can be frightening for parents because it looks like a much more serious procedure than an infusion administered into a hand. The nurse should explain to the parents that the scalp vein infusion is just another site to use to administer fluid or medicine to infants and ultimately might cause the least discomfort for their infant because needles there do not infiltrate readily. This response addresses the parents' concerns and provides them with accurate information. The use of scalp veins is unrelated to the rate of infusion or the level of medication irritation.

A 17-year-old male adolescent on the high school swim team tells the nurse that during swim season he cuts the carbohydrates in his diet to 30% to help his swim times. What responses by the nurse are appropriate? Select all that apply.

"Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?" Explanation: Teenage boys who are moderately active require between 2,200 and 2,800 calories per day and 45% to 65% should come from carbohydrates. Carbohydrates should not be cut, especially during an athletic season when energy use is increased. Asking the student why he or she is cutting carbohydrates is appropriate in order to help the nurse address the issue effectively.

The nurse is educating the parents of a 5-month-old on how to administer an oral antibiotic. Which response indicates a need for further teaching?

"We can mix the antibiotics into his formula or food." Explanation: Never mix a medication with formula or food. The child may associate the bitter taste with the food and later refuse to eat it.

An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse?

"You are feeling sad right now. It's a hard time." Explanation: Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the client's verbalization as real. Support should be real. Telling the adolescent that things will be better in college provides false reassurance. Telling the adolescent to "look on the bright side of things" or that "being a teen is hard work" offer platitudes and interrupt the client's interactions.

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond?

"Your child is not expected to be able to perform those activities at 3 years of age." Explanation: Skipping and standing on one foot for up to 10 seconds are motor skills that are expected from a 5-year-old, not a 3-year-old; therefore, the best response is letting the mother know that her child is not behind in motor development.

A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time, even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?

"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." Explanation: Sleep needs for children change according to their ages. A 6- to 8-year-old child needs 12 hours of sleep per night. The 8- to 10-year-old child needs 10 to 12 hours of sleep per night. The 10- to 12-year-old child needs between 9 and 10 hours of sleep per night. Many younger children need a nap or to be provided with quiet time after school to recharge after a busy day in the classroom. Increasing the child's sleeping hours should be attempted before asking for medical intervention.

The parent of 1-week-old infant voices concerns about the infant's weight loss since birth. At birth the infant weighed 7 lb (3.2 kg); the infant currently weighs 6 lb 5 oz (2.9 kg). Which response by the nurse is most appropriate?

"Your infant's weight loss is within the expected range." Explanation: The normal newborn may lose up to 10% of birth weight. This infant has lost 9.1%. This degree of weight loss will likely not require hospitalization. Expressing to the parent that the infant may be hospitalized is rash and will most likely not occur.

Preschool period

3-6 years

The nurse is calculating the urinary output for the infant. The infant's diaper weighed 40 g prior to placing the diaper on the infant. After removal of the wet diaper, the diaper weighed 75 g. How many milliliters of urine can the nurse document as urinary output? Record your answer using a whole number.

35 Explanation: The diaper must be weighed before being placed on the infant and after removal to determine urinary output. For each 1 gram of increased weight, this is the equivalent of 1 milliliter of fluid. 75 grams - 40 grams = 35 grams = 35 ml

School age children

6-12 years

The nurse is performing a physical assessment of a 10-year-old child. The nurse notes that 1 year ago the child weighed 80 lb (36.3 kg). Which weight, if noted during this assessment, would alert the nurse to further assess the child for appropriate growth and development?

82 lb (37.2 kg) Explanation: From 6 to 12 years of age, an increase of 7 lb (3 to 3.5 kg) per year in weight is expected, so would be a target weight of 87 lb (39.5 kg). A child weighing near 87 lb, such as 86 lb (39 kg) or 88 lb (40 kg), would be considered appropriate. If the child weighed only 82 lb (37.2 kg), this would alert the nurse to further assess the child for lagging growth.

A nurse is caring for a hospitalized 7-year-old child whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. Which activity would best be suited for a child in this age group?

A paint-by-numbers activity creating a picture Explanation: Between the ages of 6 and 8 years, children begin to enjoy participating in real-life activities, such as helping with gardening, housework, and other chores. They love making things, such as drawings, paintings, and craft projects. The child would need additional instruction to learn fractions, which may not be considered fun. A card game such as solitaire and a board game of monopoly may be too hard for the 7-year-old. In addition, the game of monopoly would require additional players.

Normal BP by age

Birth - 60-85 SBP Infant (1m-12m) - 80-100 Toddler (1-2y) - 90-105 Preschooler (3-5) - 95-107 School age (6-9) - 95-110 Preadolescent (10-11) - 100-119 Adolescent (12-15) - 110-124

Head circumference

Done for children under 2

3 year old communication and language development

Exhibits telegraphic speech, using short sentences that contain only the essential information.

Holliday-Segar Method for calculating maintenance fluid

First 10 kg - 100 ml per kg in 24 hours Second 10 kg - 50 ml per kg in 24 hours Remaining kg - 20 ml per kg in 24 hours

A nurse is preparing an educational seminar about the moral and spiritual development of preschoolers. When describing this topic, which information would the nurse include?

Tendency to do good out of self-interest Explanation: Preschoolers tend to do good out of self-interest rather than from the development of a conscience. They determine right and wrong based on rules, not the reason or rationale for the rules. They have difficulty with rules that they know apply to a new situation. Preschoolers enjoy religious holidays and rituals based on the fact that these offer them reassurance and security.

Which gross motor skill would the 4-year-old child have most recently attained?

The child can hop on one foot. Explanation: Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.

The nurse is administering a gavage feeding through a nasogastric feeding tube. Which nursing intervention is the highest priority?

The nurse verifies the position of the feeding tube. Explanation: Verifying the position of the tube to ensure that the tube is in the stomach by aspirating stomach contents is the highest priority. This is a top priority because of the danger of aspiration if the tube is not in the stomach but rather in the esophagus or the lung.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?

The teen is uncertain and frequently unable to make decisions. Explanation: According to Erikson's stages of development, the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self confidence and an inability to see one's self as in independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.

What is the psychosocial task of the toddler years?

To attain a sense of autonomy and to experience separation and individuation.

The nurse is determining a pediatric dosage of medication using the West nomogram for estimating body surface area (BSA). Which two known factors are on the left and the right scales?

Use the client's height and weight. Explanation: The West nomogram for estimating body surface area uses the dimensions of the client to form a line that passes through a point determined as the body surface area. Following that determination, the particulars of the medication prescribed are used.

If a medication is being administered by the otic route, it will be administered in which way?

Warmed to room temperature and dropped into the ear Explanation: Otic means ear. Be sure that the ear drops are at room temperature. If necessary, roll the container between the palms of your hands to help warm the drops. Using cold ear drops can cause pain and possibly vertigo or vomiting when they reach the eardrum. If the medication were to be placed in the rectum the instructions would say "for rectal use only." A ophthalmic drug would be placed in the eye. Medications in a syringe could be for injection or a liquid for oral use.

Average toddler physical growth

Weight gain - average 3 to 5 pounds per year Height gain - average of 3 inches per year Anterior fontanel closes by 18 months.

A nurse is admitting a 5-year-old hospitalized child with normal speech and verbal development. Which pain scale will the nurse use to assess this child?

Wong-Baker Faces Pain Rating Scale Explanation: The FACES pain scale is an appropriate scale for children 3 years and older to rate their pain using a range of cartoon-like faces. The CRIES and COMFORT pain scales are intended for neonates and are not appropriate for a 5-year-old child. The FLACC pain scale measures nonverbal responses when the child cannot provide input and is not the appropriate choice for this child.

The site most often used when administering a medication using the intradermal route is the:

forearm. Explanation: Intradermal injections deposit medications just under the epidermis. They are most often used for tuberculosis screening and allergy testing. The forearm is the site most often used. The anterior thigh, lateral upper arms, and abdomen are the preferred sites for subcutaneous administration. The deltoid, vastus lateralis and the ventrogluteal are the preferred sited for intramuscular injections.

Telegraphic speech

refers to speech that contains only the essential words to get the point across, much like a telegram. Rather than, "I want a cookie and milk", the toddler might say, "Want cookie milk".

A parent calls the health care provider about the 7-year-old child's dental hygiene. The child has had three cavities. The parent does not know what to do and asks the nurse for guidance. How should the nurse respond?

"Are you able to supervise your child's brushing?" Explanation: Dental caries is the leading chronic disease in the United States. Children need help with toothbrushing until they are between 7 and 10 years of age. The parent should monitor the toothbrushing to make sure it is thorough, observe for any abnormal tooth alignment, and schedule cleanings every 6 months. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those teeth are brushed carefully.

The nurse prepares to examine a 4-year-old boy. How would the nurse proceed?

Examine the child's head and work down to the child's toes. Explanation: Preschoolers or young children should be examined starting from their head and working down all the way to their toes for a thorough exam. In infants and young children, the examination starts with the chest and then proceeds from head to toes.

A nurse is caring for a 4-year-old child. The parents indicate that their child often reports that objects in the house are his friends. The parents are concerned because the child says that the grandfather clock in the hallway smiles and sings to him. Which response by the nurse is best?

"Attributing lifelike qualities to inanimate objects is quite normal at this age." Explanation: The nurse should explain to the parents that attributing lifelike qualities to inanimate objects is quite normal for a 4-year-old child. Telling the parents that the child is demonstrating animism is correct information, but it would be better for the nurse to explain what animism is and then remind the parents that it is developmentally appropriate for their child. Asking whether the parents think the child had a recent trauma or whether there is a family history of mental disorders is inappropriate and does not teach.

The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents?

"Is there a family history of hypertension, heart disease, or diabetes?" Explanation: Parents would be more knowledgeable than the child regarding health problems within the family. The other questions are appropriate for the child to answer and may motivate him to think about meal patterns, diet, and exercise habits. The parents will benefit from listening to these questions since their habits influence the child.

The parents of a 7-year-old girl report concerns about her seemingly low self-esteem. The parents question how self-esteem is developed in a young girl. Which response by the nurse is best?

"Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age." Explanation: Self-esteem is developed early in childhood. The feedback a child receives from those perceived in authority such as parents and educators impacts the child's sense of self-worth. As the child ages, the influence of peers and their treatment of the child begin to have an increasing influence on self-esteem.

Toddler period

1-3 years

Physical growth for preschool aged child

2.5-3 inches per year, 4-5 pounds per year

A hospitalized 7-year-old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise?

A feeling of inferiority Explanation: Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.

The mother of a 9-year-old girl calls the physician's office complaining that her daughter continues to vomit soon after being given an oral amoxicillin capsule for her strep throat. The nurse recognizes that the child's vomiting will interfere with which pharmacokinetic process?

Absorption Explanation: Drug absorption (transfer of the drug from its point of entry in the body into the bloodstream) is influenced by the route of administration as well as by the concentration and acidity of the drug. Vomiting and diarrhea, frequent symptoms of childhood illnesses, interfere with absorption because a drug does not remain in the gastrointestinal tract long enough to be absorbed. Distribution refers to the movement of the drug through the bloodstream to a specific site of action. Metabolism involves conversion of the drug into an active form (biotransformation) or an inactive form (inactivation). Excretion is the elimination of raw drug or drug metabolites, a process that largely prevents properly administered drugs from becoming toxic.

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child?

The child demonstrates separation anxiety. Explanation: The child should be past the stage of separation anxiety by age 3 years. Imitating actions, copying a circle on paper, and responding to single requests are developmentally appropriate.

A nurse needs to measure the urine output of a 5-month-old infant. The infant is experiencing loose stools. Which action by the nurse is appropriate to ensure an accurate output measurement?

Apply a urine collection bag to the infant, and then apply a dry diaper. Pour the contents of the collection bag into a graduated container and measure the amount. Explanation: In infants who have liquid stools, it is difficult to separate stool from urine because these blend together in a diaper. The nurse can separate urine from stool by applying a urine collector to the infant. The nurse then checks the collection bag frequently for filling and measuring. If the infant had solid stool, the nurse could use diapers as a method of measuring urine output. The nurse would weigh a diaper before it is placed on an infant and record this weight conspicuously (e.g., mark it on the front of the plastic covering with a ballpoint pen). Then, the nurse would reweigh the diaper after it is wet and subtract the difference to determine the amount of urine present. This difference will be in grams; but because 1 g = 1 ml, the amount can be recorded in milliliters.

The pediatric nurse is bringing the prescribed medication for a child but notes that the identification band is missing. The parents are at the bedside holding the child. What is the best method for identifying the child?

Ask the parents to tell you the child's name and date of birth. Explanation: The parents are the best resource for finding out the child's legal name and date of birth, which can be compared to the medical record. The child may use a nickname or other name, which cannot be verified with the medical record. It is not safe to leave any medication at the bedside. It is appropriate to get another identification band once the child has been properly identified. Refusing to give the medication is not appropriate if the nurse is able to identify the child correctly.

A nurse is explaining to a parent about avoiding the use of aspirin for pain relief for flu-like symptoms. Which rationale does the nurse provide?

Aspirin with the flu can lead to Reye syndrome. Explanation: Children should not receive acetylsalicylic acid (aspirin) for pain relief, especially in the presence of flu-like symptoms, because there is an association between aspirin administration and the development of Reye syndrome, a severe neurologic disorder. Although aspirin is irritating to the stomach, that is not the reason for children avoiding aspirin. Guillain-Barré syndrome is not related to aspirin administration. It is important to explain to parents why aspirin is unsafe.

A child with extensive burns is receiving an intraosseous infusion into the right leg because there is no other site available for IV access. Which action is appropriate for the nurse to implement when caring for the child while receiving fluids and medication by this route?

Assess pulses distal to the site every hour. Explanation: Tubing and dressings must be changed as per protocol (approximately every 48 hours for the tubing and approximately every 24 hours for the dressing), to reduce the possibility of infection. The nurse will assess for a distal pulse and adequate temperature and color of the leg every hour throughout the infusion to ensure there is adequate circulation to the extremity.

The nurse is providing anticipatory guidance for violence prevention to a group of parents with adolescents. Which parental action should the nurse include as the most effective in preventing suicide?

Checking for signs of depression or lack of friends. Explanation: Checking for signs of depression or lack of friends would be most effective for preventing suicide. All other choices are more effective for preventing violence to others.

A toddler requires 1.5 ml of an antibiotic given intramuscularly (IM). How will the nurse administer this medication?

Divide the dose. Administer 0.75 ml IM in each vastus lateralis. Explanation: The recommended amount of solution a toddler should receive in one IM injection should not exceed 1 ml. Dividing the dose is necessary even though two injections will cause additional stress. These could be given simultaneously by two nurses. Seeking an oral route could be explored, but may not be feasible. The manufacturer's directions regarding the amount of diluent should be followed to ensure safety.

The school nurse is meeting with a 10-year-boy who is concerned about his weight. He reports he doesn't eat much candy but loves fruit, pasta, potatoes, and bread. Which suggestion should the nurse prioritize to help him maintain a healthy weight?

Encourage activities that will increase his physical activity. Explanation: Encouraging daily physical activity and following the dietary standards (such as ChooseMyPlate guidelines) will help the child meet necessary nutritional guidelines. Following popular fad diets or using weight-loss supplements must be avoided because they do not supply adequate nutrients for the growing child. The child is aware of the weight problem, but it would not be beneficial to just ignore it because the child may develop harmful eating habits such as bingeing.

Cognitive Development Preschool age

Piaget - Preoperational substage - preconceptual phase (2-4). Exhibits egocentric thinking, which lessens as the child approaches age 4. Short attention span. Learns through observing and imitating. Preoperational substage - intuitive phase (4-7). Knows if something is right or wrong, though cannot state why. Tolerates others differences but does not understand them. Is very curious about facts.

Cognitive development school age children

Piaget- Concrete Operational The child is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action.

Emotional and social development of preschooler

Preschooler needs to develop skills like cooperation, sharing, kindness, generosity, affection display, conversation, expression of feelings, helping others, and making friends. Preschoolers tend to have strong emotions. Developing a sense of identity. They realize they are boys or girls. They know they belong to a particular family, community, or culture.

What behavioral responses to pain would a nurse observe from an infant younger than age 1?

Reflex withdrawal to stimulus and facial grimacing Explanation: Infants younger than age 1 become irritable and exhibit reflex withdrawal to the painful stimulus. Facial grimacing also occurs. Localized withdrawal is experienced by toddlers ages 1 to 3 in response to pain. The nurse would observe passive resistance in school-age children. Preschoolers show a low frustration level and strike out physically.

Included in the nursing care plan for the child receiving total parenteral nutrition (TPN) will be which intervention?

Regularly monitoring the child's blood glucose Explanation: Monitoring the blood glucose is important with TPN since the glucose content of the solution is high and can cause hyperglycemia. The need for a stool softener would be determined on an individual basis. Children receiving TPN may or may not be taking food and fluids orally. The catheter delivering the TPN solutions will be centrally placed to accommodate the concentrated TPN solution (larger vessel with more rapid blood flow).

The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely?

The child has a leaner body mass than a girl at this age. Explanation: The nurse would have found that the child still has a leaner body mass than girls at this age. Both boys and girls increase body fat at this age. Food preferences will be highly influenced by those of her parents. Although caloric intake may diminish, appetite will increase.

A 10 year-old child on the oncology unit has attended mass every Sunday in the hospital chapel during every stay in the facility. What does the nurse suspect is the most likely reason for this attendance?

The child is comforted by participating in the rituals associated with their religion Explanation: While any of these scenarios could be true in some circumstances, the most common reason most children attend services while being hospitalized is that they find comfort in participating in their religious practice rituals.

A six-year-old child is observed sucking the thumb and baby talking while hospitalized for cellulitis. How would the nurse explain this to the parents?

The child may be in pain. Explanation: Some children of school age will regress with pain such as returning to baby talk, thumb sucking, or lying in a fetal position. This child is not seeking attention, acting out, or appearing to be fearful of the nurse.

Physical growth of school age children

height - average growth of 2.5 inches per year Weight - average increase of 7 lb per year

Growth

increase in physical size

The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for?

respiratory depression, constipation, and pruritis Explanation: Nausea and vomiting, pruritis, sedation, respiratory sedation, constipation, and urinary retention are common side effects of opioid medications. Hypotension, hypertension, diarrhea, and disorientation are not common side effects of opioid medication.

Preoperational thought

the beginning of the ability to reconstruct in thought what has been established in behavior

The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of:

transduction. Explanation: The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.

The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content?

whole grain bread Explanation: Whole grain bread contains high amounts of iron and is a type of food the child would not have an aversion to. Milk is a good source of vitamin D. Carrots are high in vitamin A. Orange juice is a good source for vitamin C.

The nurse is talking with the parents of an 8-year-old child who has been cheating at school. Which comment by the nurse would be appropriate as a first step?

"Be sure the adults in the child's life, including you, as parents, demonstrate positive behavior." Explanation: Because they are role models for their children, parents must first realize the importance of their own behaviors. If the academic environment is too difficult, not too easy, the child may be cheating to keep up with the increased rigor. Punishment should be geared toward discussion and helping the child understand the seriousness of cheating, and not be a subtle approach. After a discussion with the child, a review of the child's academic situation (is the work too hard? Is tutoring needed?) and positive role-modeling is assured, then referral to a counselor would be indicated but not as the first step in the resolution.

A high school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client?

"Do you take anabolic steroids?" Explanation: Anabolic steroids are used by adolescents who play sports. They are used to enhance the adolescent's athletic ability. They produce euphoria and lessened fatigue. Unfortunately, steroid use can also lead to early closure of the epiphyseal plate, acne, elevated triglyceride levels, hypertension, aggressiveness, and possibly psychosis. Human growth hormone is also used to enhance athletic performance. The side effects of it are joint pain and swelling and the development of diabetes. Amphetamines provide a sense of well-being, alertness, and self-esteem. They can produce paranoia and extreme restlessness. Cocaine produces increased pulse and respirations, increased temperature, and blood pressure and decreased appetite.

A black adolescent male has been diagnosed with hypertension. Which statement made by the adolescent indicates to the nurse that additional teaching is needed?

"Drinking sodas is not related to my blood pressure." Explanation: Hypertension is present if the blood pressure is above the 95th percentile, or 127/81 mm Hg for 16-year-old girls and 131/81 mm Hg for 16-year-old boys for two consecutive readings. Adolescents who are obese, who are black, who eat a diet high in salt, or who have a family history of hypertension are most susceptible to developing the condition. Drinking soda regularly increases the amount of sodium intake daily, thus having an impact on the blood pressure.

The nurse is presenting information about school-aged children at a community event. Which statement from the group should the nurse prioritize to address with further teaching and more information?

"Food is so expensive, we always make our children eat everything on their plates." Explanation: Obesity can be an issue in the school-aged child, especially if they are urged to clean their plates even if they have more food than they want or need on the plate. The parents should be encouraged to use smaller plates for the children so they will still appear to have a full plate but smaller portions. Firm guidance and direction is important with the school-aged child. Calcium and phosphorus are important to healthy teeth. Exercise each day is important, especially outdoor exercise.

The nurse is teaching a group of school-aged children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?

"Girls typically experience a rapid growth spurt before boys." Explanation: Girls typically experience a rapid growth spurt before boys, and are usually taller by about 2 in (5 cm) or more than preadolescent boys. During the school-age years, the child will grow approximately 1 to 2.5 in (2.5 to 6.25 cm) per year. As puberty approaches, there will be significant differences in development between boys and girls. The first sign of puberty for girls is breast changes, not menarche.

A school nurse has completed an educational program for parents of preschool children. Which statement by a participant indicates a need for further education?

"My 5-year-old son still needs me to dress and undress him." Explanation: Dressing and undressing without assistance is an expected motor skill in a 5-year-old. Four-year-olds should be able to use scissors without assistance. Hopping on one foot is an expected motor skill for a 4-year-old. Learning to skate and swim are normal motor skills for 5-year-olds.

During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents?

"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." Explanation: Typically temper tantrums are few or absent in occurrence by the time the child is of preschool age. Asking if this is typical behavior at home is appropriate in determining if this is just aggressive behavior or if this is a sign of a developmental delay. It is generally not necessary to discipline a child for temper tantrums and disciplining is not in the nurse's scope of practice.

The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child?

"Look! I am a nurse, and I am helping people feel better!" Explanation: Erikson's stage of initiative vs. guilt is prevalent in children between 3 and 6 years of age. This includes activities in which they act out the roles of other people (real or imaginary). Being competitive, learning sports, and comparing skills are important in the industry vs. inferiority stage (6 to 12 years of age) as seen in a child comparing the speed of running a race or playing a game. Staying true to a predefined set of values, such as not cheating in a game, would be typical of a child in the identity vs. role confusion stage (12 to 19 years of age).

The nurse is caring for a child who is experiencing postoperative pain after having undergone surgery several hours ago. The child's parent reports having taken meperidine for postoperative pain and wonders if that medication would be of benefit to the child. What response by the nurse is indicated?

"Meperidine is associated with toxicity issues in children and is usually avoided." Explanation: Meperidine, an opioid agonist, is not recommended as a first-choice agent for pain relief in children due to its toxicity on the central nervous system

The nurse is educating a group of parents about childhood nutrition, specifically caloric needs. Which statement, when made by a parent, indicates teaching was successful?

"My 12-year-old child, who plays soccer, needs to consume no more than 2,000 calories a day to maintain good health." Explanation: Boys and girls 4 to 8 years old who are moderately active will need about 1,400 to 1,600 calories per day. Boys 9 to 13 years old who are moderately active need about 1,800 to 2,000 calories a day and girls 9 to 13 years old who are moderately active need about 1,600 to 2,000 calories a day. Approximately 45% to 65% of calories should come from carbohydrates.

During an examination, an adolescent client tells the nurse about being anxious and frustrated because of the facial acne. Which nursing response is appropriate?

"This is one of the most common physical changes during adolescence." Explanation: It is important for the nurse to inform the client that acne is a normal physical changes that characterizes adolescence as a result of increased glandular activity. The nurse should address the client's concern and not refer the client to the primary health care provider. The client's worries should not be trivialized or ignored as this is a situation that is worrisome for the adolescent. The type of foods consumed do not cause acne.

The father of a 6-week-old infant voices concerns about his son's stooling. He further shares that his son grunts and cries when having a bowel movement. What response by the nurse is most appropriate?

"What does his stool look like?" Explanation: Grunting, crying and straining during bowel movements by infants and newborns is normal. This is due to the immaturity of the gastrointestinal system. The most important thing to do initially is to determine the appearance of the stool. The grunts and cries are not of concern unless the stool is dry and hard, so asking about the characteristics is the initial response. Simply indicating this is normal without having additional information is not the appropriate response. There is no need for a stool specimen based upon the information provided.

The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate?

"Your child can become modest and self-conscious and teasing may cause embarrassment." Explanation: It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.

Moderate sedation is a pain-management technique that is used with children. During moderate sedation for a preschooler, which action would be most important?

Assessing vital signs frequently, because they can become depressed Explanation: Moderate sedation is a medically controlled state of depressed consciousness that allows the protective reflexes to be maintained. The depressed state can be caused by many medications: midazolam, ketamine, propofol, etc. Children often pass through their intended level of consciousness to a deeper level. It is imperative that the child be continuously monitored, the person administering the drugs be skillfully trained in pediatric advanced life support, and there be emergency equipment and drugs available at all times during the procedure.

A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age?

Banding together with other girls and dressing like them Explanation: In early adolescence, girls tend to band together with girls. They dress identically with other members of their group: jeans and sweatshirts, special jackets, or whatever the fashion may be. On the surface, this makes adolescents appear to be losing their identities rather than finding them.

The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation?

Boys grow at a slower, steadier rate than do girls. Explanation: Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.

Parents of an 8-year-old client report the child struggles with the chore of cleaning their bedroom. What advice will the nurse give to assist with this challenge for a child at this stage of development?

Break the chore into smaller tasks that the child can accomplish more easily. Explanation: In the early school-age years, children have the developmental task of achieving a sense of industry. Breaking the job into smaller tasks that they can feel accomplished about provides a "reward" to assist them in completing a larger job. Treats are not required as a reward for children of this age. Providing consequences, such as loss of toys or loss of privileges, does not allow for the development of industry nor support children to learn how to complete the job.

A 5-year-old child is overheard by her parents calling her dog a "fat boo-boo butt" and they are concerned. What advice would the nurse provide for them regarding this behavior?

Calmly correct the child, telling her not to say those words again. Explanation: Children this age often try out naughty words to see what kind of reaction they will get from their parents. Parents are encouraged to express their disapproval with the language and calmly tell the child not to say those words again. Ignoring the behavior will not correct it and punishment is not necessary.

A child has undergone a procedure requiring moderate sedation. The child asks the nurse, "I am thirsty; can I have something to drink?" Before giving the child something to drink, what will the nurse do first?

Check the child's gag reflex. Explanation: Although assessing vital signs and level of consciousness are important, the nurse should check the child's gag reflex to ensure it is intact before offering any fluids to drink to reduce the risk of aspiration. The key is to prevent aspiration. Asking the child's name and birth date would not be effective in preventing aspiration.

The nurse is reviewing the care plan and records of a 14-year-old on the oncology unit who is receiving opioid pain medication. The client normally has a bowel movement on a daily basis, but the client is at tisk for constipation related to opioid analgesic agents. What would be the best goal for this client's risk?

Client will have a soft, formed bowel movement daily. Explanation: Since the client's normal bowel pattern is daily, the most measurable goal describes the characteristics of normal stools on a daily basis. The other options are not measurable, making it impossible to measure during the evaluation phase of the nursing process.

HR and RR by age group

HR Infant - 80-150 Toddler - 70-120 Preschooler - 65-110 School-age - 60-100 Adolescent - 55-95 RR Infant - 25-55 Toddler - 20-30 Preschooler - 20-25 School-age - 14-22 Adolescent - 12-18

A child is receiving continuous tube feedings via a gastrostomy tube. The nurse needs to administer medication via the tube. After preparing the medication, what action should the nurse take next?

Pause or stop the feeding. Explanation: Administering medications via a gastrostomy tube when continuous feedings are running requires the feeding pump to be paused or stopped. If not, the medications will be pushed into the formula tubing and not into the stomach. This means the medication will only be delivered at the rate the feeding is running. The medication could take several hours to completely enter the stomach. Checking for placement with pH paper and checking the amount of residual is important but not the first action. The tubing should be flushed with water prior to the medication administration, but this is not the first action.

The nurse is administering otic medication to a 22-month-old with a diagnosis of otitis media. Which nursing action ensures that the medication is distributed appropriately?

Pull the pinna down and back. Explanation: By making sure that the ear canal is straight for the medication to progress to the tympanic membrane, the medication is distributed appropriately. It is also appropriate to place the child in a side-lying position. Some nurses place a cotton ball in the ear but that does not impact distribution of the medication. A child over 3 years of age needs the pinna pulled up and back.

Maturity of respiratory system

RR slows from average of 30-60 breaths in the newborn to 20-30 in the 12 month old. The newborn breathes irregularly, with periodic pauses. As the infant matures, the respiratory pattern becomes more regular and rhythmic.

The mother of a 9-month-old child reports her child's eyes are often crossed. The nurse confirms this during the examination. What action is indicated?

Report the findings to the physician. Explanation: Persistent strabismus is normal in newborns. If noted after the age of 6 months it should be evaluated by a pediatric ophthalmologist. This will need to be reported to the physician so that the referral can be made.

A parent informs the nurse about having a hard time getting her 6-year-old child to take the liquid medication at home. Which would be the best suggestion for the nurse to offer the parent to help correct this concern?

Tell the parent to state firmly, "It's time for you to drink your medicine." Explanation: The best guideline for the parent to help in getting a child to take the liquid medication is to state firmly, "It's time to take your medication." Asking or pleading with the child does not work. Firmness is required. The child can be, however, allowed to choose what liquid to use to help swallow the medication. This helps with self-esteem and independence. The parent should also be honest about the taste of the medication. Adults also should never refer to medicine as candy. If a child happens to like a particular medicine, he or she may help themselves to it, and consuming too much can be fatal.

A nurse is reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries?

motor vehicle crashes Explanation: Although drowning, violence, and suicide are causes of adolescent injury, the largest number of adolescent injuries are due to motor vehicle crashes.

A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess?

Use of a two-word noun-verb sentence Explanation: A 2-year-old should be able to say a two-word sentence that consists of a noun and verb. A 15-month-old can say 4 to 6 words. A 30-month-old knows his full name and can name one color.

The nurse is preparing to administer a medication via a syringe pump as ordered for a 2-month-old girl. Which is the priority nursing action?

Verify the medication order. Explanation: The priority nursing action is to verify the medication ordered. The first step in the eight rights of pediatric medication administration is to ensure that the child is receiving the right medication. After verifying the order, the nurse would then gather the medication, the necessary equipment and supplies, wash hands, and put on gloves.

The nurse is caring for a breastfed infant hospitalized for gastroenteritis. Which method can be used to most accurately measure intake?

Weigh the infant before and after feeding and subtract weight. Explanation: Intake in breast-fed infants is generally recorded as "breast-fed for X minutes." If it is necessary to estimate the amount more closely than this, an infant can be weighed before and after a feeding. The difference in weight (measured in grams) is calculated to establish the number of milliliters of breast milk ingested (1 g = 1 ml). Weighing the infant before and after feeding is the most accurate method for strict intake. Comparing to a bottle-fed infant is inaccurate and therefore not correct.

When collecting data on a preschool-aged child during a well-child visit, the nurse discovers the child has gained 12 lb (5.4 kg) and grown 2.5 inches (6.3 cm) in the last year. The nurse interprets these findings to indicate which situation?

Weight is above an expected range and height is within an expected range. Explanation: The preschool period is one of slow growth. The child gains about 4 to 5 lb each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm). The child's weight is above the expected gain and the height is what would be expected.

The nurse is conducting a support group for parents of 9- and 10-year-olds. The parents express concern about the amount of time their children want to spend with friends outside the home. What should the nurse teach the parents that peer groups provide?

a sense of security as children gain independence Explanation: Nine-year-olds take their peer group seriously. They are more interested in how other children dress than what their parents want them to wear. This is the age where groups are formed and others are excluded from the club. This age group is imitating their peers as they develop their own identity and separate from their parents. Groups are fluid as they change regularly due to many reasons: each member lives on the same street, each member plays on the same ball team, or one member has fewer material things than the others, etc. Security is gained through these clubs because it helps the school-age child develop independence away from the family. Most of the time in the school-age child, peer group relationships are with same-sex friends. Children do not become self-sufficient through these clubs. They remain dependent on their families for their physical needs.

A nurse is providing anticipatory guidance to the parents of an 8-year-old child, explaining that when the child returns next year for a well check-up, the child will likely undergo which screening?

scoliosis Explanation: Scoliosis may become apparent for the first time in late childhood. All school-age children older than 8 years should be screened for scoliosis at all health assessments. Lead screening is done earlier. Screening for sexually transmitted infections or hepatitis B is not age-dependent and would not be done unless there is an indication of high risk behavior.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia. The child's condition has improved, and the child is much more active and eager to play. Which toy should the nurse offer the child?

large piece puzzle Explanation: An appropriate toy for a 3-year-old child is a large piece puzzle. Board games are more appropriate for preschool and school-aged children; fabric books and squeaky toys are more appropriate for older infants and younger toddlers (10 to 18 month of age).

A child who is being treated for chronic pain comes to the clinic. During the initial assessment, the nurse notes an abnormal body posture. Which further assessment is most important for the nurse to complete?

neurologic assessment Explanation: When children have chronic pain, they can develop an abnormal body posture. This is due to secondary pain in the muscles and fascia. It is important for the nurse to complete a neurologic assessment to determine the presence of muscle spasms, trigger points, and increased sensitivity to touch. Assessing that the correct dosage of medication is being given daily is necessary but, if given correctly, the medications would not be the cause of the abnormal posture. Assessing the pain level is also important in the assessment process, but this only determines the amount of pain and not the cause. All children with chronic pain should be screened for depression, but the physical cause of the pain should be determined before the psychological pain.

A 2-year-old toddler holds his breath until passing out when he wants something the parent does not want him to have. The nurse would decide whether these temper tantrums are a form of seizure based on the fact that:

seizures are not provoked; temper tantrums are. Explanation: Temper tantrums are the natural result of toddler frustration. Toddlers are eager to explore new things but their efforts can be thwarted, especially for safety reasons. Toddlers do not behave badly on purpose. Temper tantrums occur out of anger and frustration. Seizures do not. Seizures can occur at any age. The client may or not be febrile. Depending upon how long a seizure lasts, cyanosis can occur.

magical thinking

the preschooler believes that his or her thoughts are all-powerful

Development

the sequential process by which infants and children gain various skills and functions

The mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a 2-wheel bike. Which response by the nurse is most important?

"Be sure to get the proper size bike." Explanation: It is very important to get a bike of the proper size for the child. Getting a bike that the child can "grow into" is dangerous. Training wheels and grass to fall on are not acceptable substitutes for the proper protective gear. The child should already demonstrate good coordination in other playing skills before attempting to ride a bike.

A first-time father calls the pediatric nurse stating he is concerned that his 4-year-old daughter still wets the bed almost every night. Remembering his own experience of being punished for wetting the bed at 4 years old, he is not sure punishment is the best approach to address this. Which nursing instruction is the most appropriate?

"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration." Explanation: Occasional bedwetting is not uncommon for young preschoolers and is not a concern unless it continues past the age of 7. When the child does have an accident, treating it in a matter-of-fact way and providing the child with clean, dry clothing is best. The child should not be disciplined or made to feel he or she is socially unacceptable when bedwetting occurs.

The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate?

"Both your son's height and rate of growth are within normal limits for his age." Explanation: The average 4-year-old child is 40.5 in (103 cm). The average rate of growth per year is between 2.5 and 3 in (6.35 and 7.62 cm). The child in the scenario demonstrates normal stature and growth patterns.

A school-age child is to receive insulin therapy via a subcutaneous infusion pump. When explaining this method of administration, the nurse would include which site as most likely to be used?

abdomen Explanation: With a subcutaneous infusion pump, the drug is delivered by the pump via a medicine-filled syringe. The site chosen is usually the abdomen because this both protects the pump and allows it to be out of sight. The other sites are used for other intravenous infusions.

During a well-child visit, the parent of a 3-year-old child tells the nurse, "Just recently, my child started sucking the thumb again. I thought we were done with this." Which response by the nurse is appropriate?

"Has anything changed lately in your home or family situation?" Explanation: Some preschool-age children, generally in relation to stress, revert to behavior they previously outgrew, such as thumb-sucking, negativism, loss of bladder control, and inability to separate from their parents. Although the stress that causes this may take many forms, it is usually the result of such things as a new baby in the family, a new school experience, stress in the home from financial or marital difficulties, or separation caused by hospitalization. Therefore the nurse should ask about any recent stressors. Regression in these circumstances is normal and removing the stress is the best way to help a child eliminate this behavior. Unfortunately, the stressor may not be one that is easily controlled.

The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency?

"He loves milk and drinks it every time he is thirsty." Explanation: This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

The school nurse is providing anticipatory guidance to a 13-year-old boy and parent regarding growth and development for this age group. Which statement by the parent demonstrates the need for further teaching?

"My adolescent will start to improve speed and accuracy." Explanation: It is typically during early adolescence (10 to 13 years) that the adolescent begins to develop endurance. The adolescent's concentration has increased so he or she can follow complicated instructions. Coordination can be a problem because of the uneven growth spurts. Because of this period of rapid growth spurts, adolescents may experience times of decreased coordination and have a diminished ability to perform previously learned skills, which can be worrisome for the adolescent. During middle adolescence, speed and accuracy increase while coordination also improves.

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by a caregiver best indicates a common aspect of the diet and nutrition of the preschool child?

"My child is so picky and eats the same thing every day for days on end!" Explanation: The preschooler's appetite is erratic. At one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Food jags, such as eating the same thing for days on end, are common in the toddler, not the preschooler. Preschooler's are picky eaters. They may eat only a limited variety of foods or foods prepared in only one way. Portions for preschoolers are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. Giving the child non-nutritious snacks may cause the child not to eat at mealtimes. The child eating as much as the adolescent sibling is being set up for obesity.

During a health check-up without the parents present, a 17-year-old adolescent tells the nurse about being gay. Which statement from the nurse is best?

"Tell me what makes you think you are gay." Explanation: The nurse needs to get more information from the adolescent (assessment) before making any comment and then proceeding in a sensitive and caring way. Comments about being at risk or needing to know about safe sex are negative and should be replaced with health promotion comments. Denying the statement shows the adolescent that the nurse is not an ally.

A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond?

"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." Explanation: Boys who are unprepared for nocturnal emissions may feel guilty, believing that they have caused these "wet dreams" by sexual fantasies or masturbation. They need to understand that this is a normal occurrence and is simply the body's method of getting rid of surplus semen. The other suggestions do not address the situation in a professional manner.

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. What should the nurse say in response?

"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." Explanation: The markers of readiness are subtle, but as a rule children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers. Because physiologic development is cephalocaudal, the rectal and urethral sphincters are not mature enough for control in most children until at least the end of the first year, when tracts of the spinal cord are myelinated to the anal level. A good way for a parent to know a child's development has reached this point is to wait until the child can walk well independently. Toilet training need not start this early, however, because cognitively and socially, many children do not understand what is being asked of them until they are 2 or even 3 years old.

The nurse is speaking with the parent of a 4-year-old child. Which statement by the parent would suggest a need for further investigation?

"When we go to the park, my child never wants to play with the other children." Explanation: Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period a sensitive and critical time for socialization. Preschoolers who are exposed to other playmates have an easier time learning to relate to people than those raised in an environment where they rarely see other children of the same age

Psychosocial development in preschooler

According to Erikson, the psychosocial task of the preschool years is establishing a sense of initiative versus guilt. Preschoolers feel a sense of accomplishment when succeeding in activities and feeling pride in one's accomplishment helps the child to use initiative. However, when the child extends himself or herself further than current capabilities allow, he or she may feel a sense of guilt. Activities: Likes to please parents, initiates activities with others, develops sexual identity, develops conscience, may take frustrations out on siblings, enjoys sports, shopping, cooking, working, feels remorse when makes wrong choice or behaves badly.

Cognitive Development during toddler stage

According to Piaget, toddlers move through the last two substages of the first stage of cognitive development, the sensorimotor stage, between 12 and 24 months of age. Second stage of cognitive development = preoperational stage (ages 2-7). During this stage, the toddler begins to become more sophisticated with symbolic thought. Plays make believe. Has a sense of ownership (my, mine). Starts to think before acting.

A neonate is to receive a hepatitis B vaccine within a few hours after birth. What is the best approach for the nurse to take when giving this medication?

Administer the medication in the neonate's vastus lateralis with a 25-gauge needle. Explanation: The vastus lateralis site is a safe choice for intramuscular (IM) injections in a neonate. A 22- to 25-gauge needle is recommended for neonates, but the nurse must assess the neonate's size before determining needle size to use. The 25-gauge needle is recommended for neonates. The dorsogluteal site should not be used until school age. Neither the deltoid muscle nor the dorsogluteal muscle are recommended IM sites for neonates. These muscles should not be used until toddler age or older. The volume of the medication should not exceed 0.5 ml per injection until the child is preschool age.

The nurse is about to see a 9-year-old girl for a well-child checkup. Knowing that the child is in Piaget's period of concrete operational thought, which characteristic should the child display?

Consider an action and its consequences. Explanation: The child will be able to consider an action and its consequences in Piaget's period of concrete operational thought. However, she is now able to empathize with others. She is more adept at classifying and dividing things into sets. Defining lying as bad because she gets punished for it is a Kohlberg characteristic.

The nurse is caring for a hospitalized 10-year-old client. Which nursing action is most appropriate?

Consistently reinforce the child's self-worth. Explanation: Helping school-aged clients experience satisfaction in projects, social activities, family life, and school helps them gain a sense of industry. Reinforcing self-worth provides this satisfaction. The child should not be discouraged from participating in his or her care. The child's mistakes may need corrected to learn; however, the child has to be allowed to make mistakes in a safe environment to promote learning. Pointing out these mistakes needs to be done with care. Competition between clients will not facilitate growth and development or psychosocial development.

Psychosocial Development during toddler stage

Erikson defines the toddler period as a time of autonomy vs shame and doubt. It is a time of exerting independence. The toddler is struggling for self-mastery, to learn to do for himself or herself what others have been doing for him or her. Negativism - always saying "no". Is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. Cannot take turns in games until age 3.

The nurse is caring for a pediatric client following an open appendectomy. The client rates the pain an "8" on a 0 to 10 pain scale and the nurse administers morphine sulfate intravenously to the client per the primary health care provider's prescription. Which nursing action is priority following administration of the medication?

Monitor the client's respiratory status. Explanation: It is priority for the nurse to assess the client's respiratory status after administering an opioid medication. The nurse would reassess the client's pain level and document; however, these are not priority over monitoring the respiratory status. Playing a game may help distract the child in pain, but is not priority. After administration of an opioid, the child may prefer to rest.

The nursing instructor is leading a discussion on school-aged children. The instructor determines the session is successful when the students correctly choose which factor as being a priority for the school-aged child?

Needs 10 to 12 hours of sleep per night Explanation: The school-aged child needs 10 to 12 hours of sleep per night. They need to brush their teeth after every meal and at bedtime. A routine physical exam once a year is all that is necessary. Children are screened around the age of 10 or 11 for scoliosis.

The nurse is planning immediate postoperative care for an infant after repair of a cleft lip. What should the plan include?

Pain medication should be given on a routine basis. Explanation: After any surgery on a child, the plan should include pain medication administration on a routine basis. The child's pain should be assessed regularly using the appropriate assessment tool. Providing pain medication will help the infant in the postoperative period. The infant having a cleft lip repaired should not use a pacifier for at least 10 days or upon instructions from the surgeon. Sucking is very limited immediately after surgery. If the infant is breastfed, the infant may begin to feed much sooner than a bottle-fed baby. This is because the breast nipple conforms to the mouth. If bottle fed, the infant will need to use special feeding devices. Crying is not good for the infant, because it irritates the mouth and lips and has the potential to cause bleeding as it produces tension on the suture line.

The nurse is caring for a preschool-age child in the hospital with severe developmental delays. The parents have three other younger children at home and both parents work full-time outside the home. The family has just moved to this area. Which nursing diagnosis would be the highest priority in regard to the parents at this time?

Risk for caregiver role strain Explanation: Given that the parents are trying to care for four children, one of whom is a severely developmentally delayed preschooler in the hospital, and that they are new to the area (making it unlikely that they have a strong support system), the highest priority nursing diagnosis would be caregiver role strain. Family processes are likely altered, but with the hospitalization, strain on the parents is a higher priority nursing diagnosis.

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints. Explanation: Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because the child believes that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Finger painting is a messy activity, so telling the child not to be messy takes the fun and the creative part out of the activity. The adult should provide aprons or clothing to protect the child's clothing and allow the painting in an area that can be cleaned easily.

The nurse is caring for a 12-year-old postoperative spinal rod placement client with scoliosis. Which factor might intensify the child's postoperative pain experience?

The client had a painful experience with an appendectomy at age 10. Explanation: Negative painful past experiences can intensify a child's response to pain. Temperament has not been shown to influence the actual intensity of the pain experience, but it does seem to influence a child's expression of pain behavior. Age does not intensify the pain experience. Discussion of pain control methods can alleviate stress and therefore decrease the pain experience.

The school nurse is assessing a 16-year-old girl who was removed from class because of disruptive behavior. She arrives in the nurse's office with dilated pupils and is talking rapidly. Which drug might she be using?

amphetamines Explanation: Amphetamine use manifests as euphoria with rapid talking and dilated pupils. Signs of opiate use are drowsiness and constricted pupils. Barbiturates typically cause a sense of euphoria followed by depression. Marijuana users are typically relaxed and uninhibited.

A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to:

read the child's armband. Explanation: A child may answer to the wrong name or deny his or her identity to avoid an unpleasant situation or if scared of the unknown. If the child is avoiding the situation he or she may fail to answer. Using the child's nickname is okay in conversation but it is not a legal identification of the child. To verify the correct identity the nurse should verify the child's armband and the correct name with the child's caregiver. Bar code scanning the child's armband would also be a correct method of identification.

Foods to avoid in infancy

• Honey • Egg yolks and meats (until 10 months of age) • Excessive amounts of fruit juice • Foods likely to cause choking: >>Peanuts >>Popcorn >>Other small hard foods (e.g., raw carrot chunks) >>Grapes and hot dog slices (must be cut in smaller pieces) • Foods likely to result in allergic reaction: >>Citrus >>Strawberries >>Wheat >>Cow's milk >>Egg whites >>Peanut butter

After teaching the parents of a 9-year-old child about safety, which statement indicates the need for additional teaching?

"Our child can ride in the front seat of the car once reaching 10 years of age." Explanation: Children younger than 12 years of age must sit in the back seat of the car. Laws in most states require helmets for riding bicycles and scooters. When riding a bike, the child should ride on the side of the road traveling with the traffic. Children should know how to swim. If swimming skills are limited, the child must wear a life preserver at all times.

The parent of a 4-year-old is expressing concern that this child is not talking as much—or as well—as her other children did at that age. Which question should the nurse prioritize when assessing this preschooler for this concern?

"Has your child had their hearing tested?" Explanation: Delays or other difficulties in language development may result from hearing impairment or other physical problems. Although reading to the child, having conversations with family members and other people, and praising and encouraging the child's efforts to communicate help the child develop language skills, most importantly a hearing concern would need to be assessed and treated.

A child is undergoing a painful procedure and is upset. Which statement by the nurse would be the best approach in dealing with the child?

"I know that this hurts some but you are being so strong. It is OK to cry." Explanation: Children should be given the right to cry and be verbally praised for cooperating. Pediatric clients should not routinely be rewarded for acting appropriately during a procedure or for being brave or good, but if they are given a small reward such as a sticker or small toy afterward, the child's memory of the experience is more positive. A nurse never tells a child to be quiet during a painful procedure nor tells the child that he/she is naughty for acting out in pain.

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections?

"I need to eat plenty of fruit each day." Explanation: The sedentary teen needs to consume approximately 1,600 calories each day. A balanced diet includes plenty of fresh fruit and a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.

The nurse is conducting a routine well-child evaluation for a family with five children. The parent seems frazzled, and the two oldest children are engrossed in their hand-held video games. The other three children—all preschoolers—are gathered around a portable DVD player watching a movie while they wait for their appointment. The nurse suspects that the children spend a great deal of time in front of electronic screens and that the nurse's values greatly differ from this family's. How should the nurse approach the issue of television exposure during this evaluation?

"Would you like a pamphlet telling how TV watching affects children's health?" Explanation: It can be difficult to initiate a conversation when the nurse perceives that his or her values are different from those of the client. The nurse should approach the subject in a factual and nonjudgmental way. This gives the parent the opportunity to invite further discussion on the subject. Telling the parent that the children appear to be watching too much TV could cause the parent to become defensive. The other responses are true, but the nurse will likely have more success if the nurse lets the parent initiate further discussion.

The nurse is caring for a 9-year-old male child who is being seen for a well-child care visit. During the visit, the child's parent reports the child is one of the shorter children in his class. The parent asks how much more the child will grow in the next few years. Which response by the nurse is appropriate?

"Your child should grow approximately 10 in (25 cm) over the next 4 years." Explanation: From 6 to 12 years of age, children grow an average of 2.5 in (6 to 7 cm) per year, increasing their height by at least 1 ft (30 cm). Stating that the amount of growth is unknown does not answer the question posed by the child's parent. The child's growth will be more than 1 in (2.5 cm) per year if the child maintains normal growth patterns for the age group.

A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development?

After age 12 children can think in the abstract, including complex problem solving. Explanation: The nurse should explain that there are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn by touching, tasting, and feeling. They learn to control body movement. Preoperational level takes place in children ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level, from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations, after age 12, children can think in the abstract. Complex problem solving is included in this category.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Explanation: Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers.

When performing neurological reflexes on the infant, which primitive reflex will be present longest?

Babinski Explanation: Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the Babinski, which disappears around 1 year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes.

While caring for a 16-year-old client expected to be hospitalized for several months, the nurse will perform which action to assist the client in meeting the current stage of psychosocial development?

Permit peers to visit during open visitation hours. Explanation: In each stage of development, a significant person or group exerts a lasting influence on the ongoing development of the child. An adolescent striving for self-identity and increased independence spends more time with peers than with family. It is important for the hospitalized adolescent to still be able to visit with peers. Video games may be enjoyed by the adolescent and limit boredom; however, this action would not facilitate psychosocial development. Allowing the client to touch equipment and to explain medical concepts/procedures are methods used to teach toddlers and preschoolers. Providing handouts and brochures are not effective methods to explain medical concepts; the nurse would verbally explain using models, pictures, and diagrams. Handouts and brochures can be used as supplements to teaching.

A child is having difficulty swallowing pills. What is the best action for the nurse to take to help this child swallow medications?

Place the pills in a bite of ice cream or applesauce. Explanation: The most useful technique when children cannot swallow pills is to put them into some ice cream or applesauce. This allows the medication to be administered in the original form. The nurse should not use candy for practice, because this may suggest to the child that medicine is the same as candy. The nurse should never crush medications which are enteric coated or time released. The nurse should always strive to administer a prescribed medication, even if doing so may be difficult.

The nurse teaches a preschooler to use a FACES pain rating scale prior to surgery. At that time, the preschooler points to the smiling face. Following surgery when the nurse suspects the child has pain, the preschooler points again to the smiling face. How would the nurse interpret this response?

The child is using the scale to predict what they would like, not what the child has. Explanation: Preschoolers use "magical thinking," or believe that what they wish will come true. They may use pain scales, therefore, to "wish" for a smiling face, rather than for rating their pain. Preschoolers also may not report pain, thinking it is something to be expected. If the child does not report pain then the nurse should also assess the child's features: Is the child grimacing, crying, or being totally still? The nurse can also ask the parent if this is how the parent would describe the child when in pain. Pain is subjective so the nurse would not be reporting the pain falsely.

The school nurse is teaching a class on sports injuries. What information is most important for the nurse to teach?

Vary the sports to prevent use injuries. Explanation: With any organized sport there is the possibility of athletic injuries. Prior to having the child participate in organized activities the parents need to take into consideration the child's maturity and the risk for injury before they decide whether team competition is right for their child. Parents should encourage children to vary the types of sports throughout the year to avoid repetitive-use injuries by using the same muscle groups. Any sport comes with the risk of injury, and children should wear the appropriate protective equipment. Allowing children to play tackle football and playing the same sport regularly will be decisions made by the parents and child. The nurse can only teach the safety aspects to prevent injury.

The nurse in a community clinic is caring for a 6-month-old infant and parent. Which nursing intervention is priority?

monitoring the infant's weight and height Explanation: Monitoring the infant's weight and height is the priority intervention. Ongoing assessments of growth are important so that too-rapid or inadequate growth can be identified early. With early identification, the cause can be diagnosed and the potential for further appropriate growth maximized. Encouraging a more frequent feeding schedule, obtaining the infant's current feeding pattern, and recommending higher-calorie solid foods are interventions that would be used should assessment show that the client's nutrition level does not meet body requirements.

The nurse assesses a 5-year-old client for a well-child visit prior to the start of school (above). What finding from the assessment requires follow-up?

speech and language Explanation: The 5-year-old child's speech should be generally understood by strangers. This child's articulation is delayed, and this issue should be followed up with a speech-language assessment and therapy. The blood pressure is within the normal range. The nutrition is normal for a 5-year-old child; picky eating is a common occurrence. Fine motor development is also normal with writing one's own name, self-dressing, and managing toileting independently.

When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate?

tells a fantasy story about a bear and a car Explanation: The nurse should recognize that by age 4, the preschooler should have a vocabulary of about 1,400 words. Preschool-age children are able to communicate in sentences of five words or more and often like to use their imagination. This is a normal part of growth and development and should be encouraged.

The nurse demonstrates appropriate knowledge when making what statement related to gavage feedings of a child?

"A gastrostomy tube is a tube passed into the stomach through the nose or mouth." Explanation: Gavage feeding, also called enteral tube feeding, provides nourishment directly through a tube passed into the stomach through the nose or mouth. These feedings may be given intermittently as a bolus feeding or may be given continuously at a slower rate over a longer period of time. If feedings will be given continuously, a gastrostomy tube, surgically inserted through the abdominal wall into the stomach, may be considered. For long-term gastrostomy feedings, a gastrostomy button may be inserted. Some advantages of buttons are that they are more desirable cosmetically, are simple to care for, and cause less skin irritation.

The parents of a 4-year-old ask the nurse, "We want to use 'time-out' to help discipline our child. But we're not sure how long we should keep our child in time-out?" Which response by the nurse would be appropriate?

"Keep the time to about 4 minutes." Explanation: A "time-out" is a useful technique for parents to correct behavior throughout the preschool years. Although the technique has some critics, it allows for discipline without using physical punishment and allows a child to learn a new way of behavior without extreme stress. Time-out periods should be as many minutes long as the child is old, so 3 to 5 minutes is appropriate for preschoolers. Since the child is 4 years of age, 4 minutes would be appropriate. Although consistency is key, the length of time spent in time-out should reflect the age of the child, not whether the child calms down.

A parent expresses concern about a child who is reporting shoulder pain following abdominal laparoscopic appendectomy. What is the nurse's best response to this concern?

"This is referred pain and is normal after surgery." Explanation: Referred pain is pain that is perceived at a site distant from its point of origin, such as in shoulder pain following laparoscopy or laparoscopic surgery. Medicating for pain is appropriate after assessing the intensity of pain, location, and most recent medication time, but it does not address the parent's concern about the odd location of the pain. Visceral pain involves sensations that arise from internal organs such as the intestines. The pain of appendicitis is visceral pain and is felt over the abdomen. It is not necessary to contact the health care provider as this is a normal reaction to laparoscopic surgery.

Preventing Preschool Obesity (Evidence Based Practice Box 27.1)

Early childhood obesity is associated with immediate health consequences as well as long term issues such as adult obesity and early-onset metabolic syndrome. Study findings in preventing obesity = Establishing a healthy lifestyle includes developing a preschooler's competency in selecting healthy foods. In addition, increased physical activity is very beneficial. Suggestions: Provide meals seated with the family and in a positive atmosphere. Varied diet with plenty of plant based foods, encouraging water as the beverage of choice, and avoiding high-sugar content foods and beverages. Physical activity - at least 60 mins structured daily, and 60 mins to several hours unstructured daily. Limit media consumption to 30 mins daily and do not permit a tv in child's bedroom.

The nurse is caring for a comatose school-age child receiving gastrostomy tube feedings. The nurse aspirates 15 ml of stomach contents prior to administering a feeding. What is the appropriate action by the nurse?

Replace the stomach contents and continue with the feedings as prescribed. Explanation: The nurse should always aspirate nasogastric or gastrostomy tubes for stomach contents to check for tube placement and assess gastric residual amounts prior to administering feedings. The nurse will return any amount of stomach residue aspirated so the child does not lose large amounts of stomach acid. 15 ml is a very small amount of gastric contents and should not interfere with feedings.

The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent?

The adolescent will likely have the greatest influence on one's own decisions. Explanation: In late adolescence, the client likely has the greatest influence on his or her own decision making. While offering teaching to the parents and healthy cooking classes to the siblings are options, the adolescent will most benefit from being the one to make choices about care. Focusing on more recent concerns rather than the idea of future complications with the adolescent will gain more credibility.

The nurse is caring for a term neonate suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures as related to a neonate?

The newborn's pain pathway components are developed enough at birth to experience pain. Explanation: Neuroanatomical and neuroendocrine components of the pain pathway are sufficiently developed in the neonate to allow the transmission and perception of pain. While infants may not remember painful experiences as distinct actual events, the functional structures for long-term memory—specifically the integrity of the limbic system and diencephalon—are well developed in newborns. These early painful experiences may be stored as procedural memory, not accessible to conscious recall. Ample evidence indicates that both term and preterm neonates have the capacity to experience and remember pain much like older children and adults do. Newborns should receive analgesia for painful procedures.

A 5-year-old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the health care provider diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain?

Visceral Explanation: Visceral pain involves sensations that arise from internal organs, such as the intestines. The pain of appendicitis is visceral pain. Appendicitis would produce acute pain, not chronic. Acute pain arises at the time of injury. Chronic pain lasts beyond the time in which the injury should have healed. Somatic pain is pain that develops within the tissues. Cutaneous pain is a superficial somatic pain that arises in the skin and mucous membranes.

When assessing a preschool-aged child, which activity is most closely associated with the primary psychosocial task of this age group?

attempting to dress oneself Explanation: The primary psychosocial task of the preschool age is demonstration of initiative. Dressing oneself would be an example of displaying independence in action. Trying not to show emotion and making friends are activities associated with older children. Self-soothing is an activity seen in younger children.

The charge nurse is explaining the use of a papoose restraint to a newly hired nurse in the emergency department. Which client would the charge nurse recommend using the papoose board to restrain?

a toddler who is having a nasogastric tube placed Explanation: The papoose board is used for the restraint of toddlers and preschool-age children who need to have procedures performed on their head or neck, such as a venipuncture, passage of a nasogastric tube, or stitches for a scalp laceration. Older children do not need restraining in such a manner and infants receiving rectal medications are never restrained. When a child is having a fracture set, he or she is not restrained.

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

asking the girl to slow down and to think before she talks Explanation: Many preschool-age children stutter as thinking races ahead of their ability to articulate ideas. Most of this stuttering, when not made an issue, will resolve on its own. Calling attention to the dysfluency often exacerbates it. All the other practices are helpful.

A teen is suspected of having anovulatory menstrual cycles. This would be the result of which hormone?

luteinizing hormone Explanation: Luteinizing hormone is responsible for ovulation. Estrogen and progesterone impact the menstrual cycle but do not control ovulation. Prolactin is responsible for preparing the breasts for nursing.

The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond?

"Remind her in simple terms what will happen in the dentist's office." Explanation: Due to the girl's temperament, it is best if the parents talk to the dentist before the first visit to find out exactly what the dentist will be doing and then describe to the child in simple terms what will occur. Reminding the child about the importance of proper oral hygiene is unhelpful. Telling the child that the dental checkup is just like going to see the pediatrician is untrue. It is inappropriate to advise the parents to not prepare the girl in advance.

Parents asks the nurse why their child with gastroenteritis is rubbing the abdomen. What is the nurse's best response?

"Rubbing the stomach helps distract the brain from feeling pain." Explanation: The gate control theory of pain attempts to explain how pain impulses travel from a site of injury to the brain, where the impulse is registered. This theory envisions gating mechanisms in the substantia gelatinosa of the dorsal horn of the spinal cord that, when activated, can halt an impulse at that level of the cord. This prevents the pain impulse from being received at the brain level and interpreted as pain. Rubbing the painful area is cutaneous stimulation, a type of gating mechanism. Although children pull on a painful ear, it is not the same as cutaneous stimulation and does not relieve pain. Telling the parents not to worry is not answering their question. Contacting the health care provider for pain medication is not necessary unless the child is reporting pain because this is an expected response to gastroenteritis.

An overly tired school-aged child enters the school clinic. The nurse asks the child to state the times he/she usually goes to bed at night and wakes up in the morning. The child answers 11:00 PM and 6:00 AM. Which is the best response made by the nurse?

"That is not enough sleep. You should get at least 9 to 12 hours of sleep each night." Explanation: The school-aged child needs 9 to 12 hours of sleep per night. Seven hours of sleep is not enough sleep for this child. It is not appropriate to ask judgmental questions concerning parenting skills nor why the child goes to bed at 11:00 PM.

During a visit to the pediatric clinic the mother of a 2-year-old tells the nurse that her husband is concerned that their son isn't potty trained yet. The mother states, "There is no way he could be potty trained. His bladder is too small." How should the nurse respond?

"The bladder of a 2-year-old is actually the size of an adult's bladder, but there are a lot of variables to when a child is potty-trained." Explanation: Bladder and kidney function reach adult levels by 16 to 24 months of age, but there are many factors that determine when a child is ready to be potty-trained. The other options are misleading the parent regarding potty-training.

The nurse has been caring for a 12-year-old boy during his 5-day hospitalization. The child's IV has infiltrated, and the care provider is getting ready to change the intravenous line site. Which statement made by the nurse would be appropriate in supporting the child?

"The client is left-handed and likes to draw; an IV site in his right arm would be best." Explanation: The staff nurse may serve as the child's advocate when the care provider comes to start an infusion. The staff nurse who has cared for the child has the child's confidence and knows the child's preferences.

A child who is receiving TPN has developed the need to have insulin injections. The child's mother questions this and states that her child does not have diabetes. What is the appropriate response by the nurse?

"The feedings are high in sugar and insulin is needed to manage this." Explanation: Glucose levels may be elevated when TPN is administered. While illness can impact serum glucose levels, this is not an appropriate response. Telling the parent there is no need to worry minimizes concerns and is not a correct response. The child does not have diabetes but warrants insulin coverage.

The nurse is providing discharge education to the parents of a 2-year-old who will be taking amoxicillin orally at home. The nurse would include which statement in the teaching?

"Use a dosing cap to measure the dosage." Explanation: When talking to parents about giving medicine, stress that if a medicine comes supplied with a dosing cap, it is best to use that to measure the correct dose (Pham et al., 2011). If there is no dosing cap, then an oral medicine syringe or dropper are the next best methods to measure liquid medicine because kitchen teaspoons are rarely exactly 5 ml. Antibiotics need to be taken for the full course, not until symptoms subside. Mixing the medication with a drink or in food makes it difficult to determine how much the child has taken if the child refuses to finish it all. Amoxicillin comes in a liquid form, so crushing the pills is not appropriate.

A nurse is caring for a 5-year-old child hospitalized after an open-reduction, internal-fixation (ORIF) of fractures of the ulna and radius. What will the nurse include in the care plan for this child?

Allow the child to make choices such as taking medicine with applesauce or pudding. Explanation: A 5-year-old child can make choices about their care to promote initiative. A child of this age should be involved in explanations of procedures, not just the parents. At 5 years old, a child is not usually future-thinking. Visits from friends can be encouraged if desired.

What would be most effective in helping promote initiative and nutritional health for a preschooler?

Allowing the child to spread soft cheese on crackers Explanation: Allowing a child to do things such as spreading cheese on crackers helps to foster initiative and nutrition. High carbohydrate snacks should be avoided. Cutting an apple into pieces would be a safety issue. Apples are hard and difficult to cut, placing the child at risk for cutting himself. Small servings of food would be more appropriate because preschoolers do not have ravenous appetites. Praising the child for cleaning his plate which contains a small serving of food would be appropriate.

A nurse is assigned to care for a 7-year-old child. The child wants to show the nurse a collection of baseball cards. The nurse understands that the collection of objects is common in this age group and is known as what type of thinking?

Classification Explanation: An important change in thinking during the school-age period is classification. This is the ability to divide things in different sets and identify their relationships to each other. Children in this age group love to collect sports cards, insects, rocks, stamps, coins, etc. These collections may be only a short-term interest, but they are of utmost importance to the child when he or she is collecting them. Decentration occurs in the concrete operational stage from ages 7 to 12 years. It is the ability to consider multiple aspects of a situation. The preoperational stage occurs between ages 2 and 7 years. During this time thinking is at a symbolic level. One part of the preoperational stage is egocentrism. In this stage, the child has the inability to see things from another's point of view.

A health care provider has prescribed hydroxyurea 650 mg for a child diagnosed with sickle cell anemia. The child weighs 65 lb (29.5 kg). The normal recommended dose is 20 mg/kg/day. What action should the nurse take?

Contact the health care provider to lower the dose. Explanation: The nurse should perform the needed calculations to check the dosage is correct for the client. The nurse will use the client's weight in kilograms and multiply by the prescribed milligrams per day. 29.5 kg x 20 mg = 590 mg Therefore, the nurse should contact the health care provider about lowering the dose.

To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care?

Describe a normal serving size. Explanation: Some adolescents may be unaware that their food intake is excessive because they have been told they need excess nutrients for healthy adolescent growth and everyone in their family eats large portions. Health teaching with these adolescents may need to begin with a discussion of "normal" weight and standard food portions. If adolescents eat a diet too low in protein for any length of time, they can develop a negative nitrogen balance, which can lead to impaired growth. Therefore, a diet of fewer than 1,400 to 1,600 calories a day can rarely be tolerated by adolescents. Teenage girls who are moderately active require about 2,000 calories per day and teenage boys who are moderately active require between 2,200 and 2,800 calories per day. Eating in excess can lead to obesity and should be avoided.

The nurse is caring for a school-age child who had an appendectomy the day before. The parents express concern about the use of pain medications. Which is the best nursing response?

Educate the parents about the need for pain relief in proper doses. Explanation: It is important for the nurse to explain the need for pain relief, complication from undertreated pain, proper doses, and taking actions to involve the parents in the assessment and evaluation process. Children may perceive pain differently, and the nurse needs to acknowledge the parents' fears, plus complementary therapies may help lessen pain. However, providing appropriate pain relief is critical for the child's recovery.

The nurse administers an antipyretic rectal suppository. The child has a bowel movement 15 minutes later. What is the appropriate nursing action?

Examine the stool for the presence of the suppository. Explanation: The stool should be examined for the suppository that may have been expelled with the bowel movement. If it is found, the physician or nurse practitioner can be notified to determine if the suppository should be repeated. The nurse should not administer another dose without examining the stool or contacting the physician or nurse practitioner. Rechecking the child's temperature would provide little useful information since only a very limited time has elapsed since the temperature was last checked.

An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step?

Industry Explanation: During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent.

The parents of a 2-year-old boy report to the nurse that their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child?

Offering a variety of foods along with the foods the child likes. Explanation: Toddlers require fewer calories proportionately than infants, and their appetite decreases (physiologic anorexia). Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods. Prolonged preferences for particular foods (food jags) are common. It is also important that mealtime be calm, pleasant, and focused on eating. Toddlers mimic behaviors observed. It is important that parents set a good example with their mealtime behaviors and food choices. All options encourage the development of healthy eating habits, but at this time, variety plus preferred foods will be most helpful.

The pediatric nurse is mentoring a new graduate in the care of children experiencing pain. The nurse knows the teaching was effective when the new graduate makes which statement as the rationale for considering pain assessment?

Pain assessment needs to be done at regular intervals. Explanation: Pain assessment is so important that it should be done at regular intervals. Nurses do not forget to assess pain, but it is important to include it with each assessment. It is not possible to keep children free of pain, but it is important to assess it regularly and help relieve the pain as much as possible.

A preschool-age child tells the nurse about an imaginary friend. The parents are concerned because the child refuses to do anything without the friend's help. Which nursing diagnosis is most applicable for the family?

Parental anxiety related to lack of understanding of childhood development Explanation: The parents need to understand that the child's behavior is not uncommon. Imaginary friends are common in the preschool-age child. The child's behavior is not abnormal. The child does not have a deep-set psychological need. The child is not at risk for social isolation.

What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate?

Talking to another adolescent who has a similar situation Explanation: A sense of identity is developed by "trying on" roles and discussing values and goals with others. A sense of trust develops when an adolescent is able to find out whom (and what ideas) to have faith in. The adolescent period is also a time where past stages of development are revisited. The sense of autonomy is where the adolescent seeks ways to express individuality. The stage of initiative is where the adolescent develops vision of what he or she might become. Talking with another adolescent who also uses a wheelchair to ambulate will help the adolescent see possibilities and reassurances. Making decisions or having assistance from someone else does not allow the adolescent to "try out" roles.

A 6-year-old child is to have an intermittent infusion device inserted for antibiotic administration. The nurse anticipates which site would be used first for insertion?

back of the hand Explanation: If the child does not require continuous IV fluid infusion but may still require IV fluids or medications intermittently, an intermittent infusion device, sometimes referred to as a saline or heparin lock, may be used. This method frees the child from IV tubing between medication administrations. The veins on the back of the hand are often used first for insertion of the intermittent infusion device. The foot may be used, but this site is more likely used for contiguous therapy. The antecubital fossa, which restricts movement, is sometimes used only if other sites are not available. The scalp vein has an abundant supply of superficial veins that may be used if no other site can be accessed in infants and toddlers, but not in school-aged children.

The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result?

following role models Explanation: Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties and stability.

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence?

nocturnal emissions Explanation: Involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in the body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum and emergence of pubic hair.

The nursing instructor is illustrating the various types of play. The instructor determines the class is successful when the students correctly choose which example as best representing onlooker play?

observing without participating Explanation: Onlooker play occurs when there is observation without participation, such as watching television. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Dramatic play allows a child to act out a troubling situation. During cooperative play, children play in an organized group with each other as in team sports.

The nurse is talking with a school-aged child about her interests. In which interest do most school-aged children place the most focus?

school Explanation: The school-age child typically values school attendance and school activities. During school-age, the focus expands from family to teachers, peers, and other outside influences.

An 11-year-old female child is at the pediatrician's office for a well-child check-up. Which health screening would the nurse anticipate that the child would undergo today?

scoliosis screening Explanation: Initial screening for scoliosis begins at age 10 to 11 years; the child is monitored into adolescence for development of scoliosis (or progression if scoliosis is already noted).

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to:

testing and identification of group role. Explanation: Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

A 12-year-old child tells the school nurse, "I do not understand why my parents will not allow me to go to concerts without chaperones like some of my friends' parents. I feel like a baby compared to my friends." How will the nurse respond?

"Have you given any thought to why they do not let you go without a chaperone?" Explanation: Keeping dialogue open with the child and encouraging exploration of feelings is beneficial and therapeutic communication. This will allow the child to identify reasons without being told why the parents have this rule. The nurse would explore reasons and rationales with the client. Peer pressure can be difficult for children to manage. Helping them identify reasons for the parents' actions can help. Telling the child how to feel or that the parents only care does not allow conversation.

Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3-year-old is in what stage as identified by Piaget?

Preoperational thought Explanation: A 3-year-old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 and 15 months.

A 15-year-old adolescent is seen at a health care facility for facial acne. When counseling the teen, the nurse would teach that the basic cause of acne is:

activation of androgen hormones. Explanation: Acne occurs in adolescence as the result of hormone influence. With increased androgen production the sebaceous glands become more active. With increased testosterone production (in both boys and girls) increased sebum is produced. These increased hormone productions lead to the development of acne. Showering will certainly lead to cleaner skin and the removal of oils but the lack of showering does not cause acne. Diet and thyroid hormones do not play a role in the development of acne.

The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse?

"Normal growth and development for this age results in an average weight gain of 7 pounds per year." Explanation: Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation. While activity is important, the nurse must first address the parent's concern.

The nurse is caring for a 3-year-old at a well-child checkup. The parent states that her child still has an afternoon nap but she has a friend whose toddler no longer naps in the afternoon. She is seeking advice on what do to. When providing anticipatory guidance to the parent about sleep patterns, what is the most appropriate response by the nurse?

"Often, the afternoon nap will be no longer needed after 4 years." Explanation: Exact duration of a child's daily sleep patterns varies based on temperament, activity levels, and overall health. Around the age of 4, many children discontinue the afternoon nap.

The nurse is discussing an adolescent's development with the client's parents. Which statement by the parents indicate an understanding of the nurse's teaching?

"Our adolescent is working toward achieving a sense of personal identity." Explanation: According to Erikson's theory of psychosocial development, the major challenge of adolescence is the achievement of identity. Achieving independence from parental domination is another task of adolescence, but not the ultimate one. Helping other adolescents achieve higher goals is not a part of Erikson's theory of psychosocial development. Developing trust occurs in infancy.

The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure?

"Pick your favorite Band-Aid and show me which arm to use." Explanation: Allowing the child options related to the style of the Band-Aid and the extremity to use gives the child some control over the happenings. Offering a pinwheel is a distraction technique. Encouraging the parent to hold the child during the procedure promotes feelings of security. Encouraging the child or parents to ask questions facilitates communication.

During a health history assessment, the mother of a 10-year-old girl tells you that her daughter does not have time to "play" because she is busy going to gymnastics, cheerleading, art class, flute lessons, reading club, and soccer. What should the nurse's response be?

"Play helps children to develop cognitively, socially, physically, and emotionally." Explanation: It is important to recognize that the child is busy with other activities but that this does not replace the need to engage in play. Children need time to play because it helps them to develop cognitively, socially, physically, and emotionally. Play at this age embodies the needs for rules and structures. Engaging in group activities allows children to be part of a social group.

The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents?

"The calories help his body increase muscle mass." Explanation: Adolescents grow rapidly and mature dramatically during the period from ages 13 to 20 years. An adolescent needs an increased number of calories to support the rapid body growth that occurs. Foods must come from a variety of sources to supply the necessary amounts of carbohydrates, vitamins, protein, and minerals. Boys typically gain about 15 to 55 pounds (7 to 25 kg) during their teenage years. The calorie intake will not predispose him to future obesity unless it is continuously excessive. The majority of adolescents eat as part of their development, not as an emotional need.

A 5-year-old child has been admitted to the hospital and is going to have an IV started in the procedure room. Which instructions will be most helpful for the child and the parent?

Have the parent sing softly to the child during the procedure. Explanation: Distraction techniques aim at shifting a child's focus from pain to another activity or interest. Research has demonstrated that having parents present during painful procedures and using distraction works best to decrease the pain. It is not wise to have the parent restrain the child, as this leads to distrust between the child and parent. Having the parent stay in the back of the room or stay in another room does not provide support to the child during the painful procedure.

A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes?

"This is common for this age group and it will get better with time." Explanation: During middle adolescence, the adolescent spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period. They tend to smooth out and the adolescent will become more introspective. By late adolescence emotions become more consistent. Making statements such as "my adolescent will never find anyone to live with" or "we will have to learn to live with [my adolescent's temperament]" does not demonstrate the parent has a good idea of what is happening during the adolescent period.

The mother of a 15-month-old son is returning to work and wants to place her son in the day care close to work; however, they will only accept potty-trained children. Which response from the nurse will best address this situation in answering the mother's questions of how best to potty train her son?

"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." Explanation: To be able to cooperate in toilet training, the child's anal and urethral sphincter muscles must have developed to the stage where the child can control them. Control of the anal sphincter usually develops first. The child also must be able to postpone the urge to defecate or urinate until reaching the toilet or potty and must be able to signal the need before the event. In addition, before toilet training can occur, the child must have a desire to please the caregiver by holding feces and urine rather than satisfying his/her own immediate need for gratification. This level of maturation seldom takes place before the age of 18 to 24 months.

The nurse is caring for an adolescent female who is scheduled for an emergent laparoscopic surgical procedure. What question by the nurse would be appropriate?

"What concerns do you have about scarring from the surgery?" Explanation: Body image is important to the adolescent and scarring following the procedure would be a priority for the client. Offering to have the client read a story about the surgery would be appropriate for an older school-aged child. Immunizations are assessed with each admission, although those specifically within the last 12 months would not be a concern for this surgery. Talking with a peer, and not an adult, would be appropriate for an adolescent.

Which is the best way for parents to aid a toddler in achieving the developmental task?

Allow the toddler to make simple decisions Explanation: The toddler years see a refinement of motor skills, continuous cognitive growth, and the acquisition of language skills. During this time the toddler achieves autonomy and self-control. Allowing the child to make decisions is a good way to help the toddler achieve autonomy and gain independence. Rewarding the child for accomplishing the task after making the decision is a good way to reinforce self-esteem. A younger toddler may not successfully dress alone because he or she may not have mastered such techniques as buttons, zippers, or tying shoes. A toddler can help with household tasks but these are generally limited because the toddler's attention span and motor skills may not be refined enough to complete the task. Helping the child learn to count is improving cognitive development but does not necessarily help the child with gaining autonomy or self-control.

An 8-year-old male child is being seen for a well-child visit. His weight at his visit last year was 50 lb (22.7 kg) and his height was 47 in (119 cm). If he is developing normally, which finding will the nurse expect to note this year?

Height 49.5 in (124 cm) Explanation: Normal physical growth for school-age children is a gain in height of 2.5 inches (6.25 cm) each year. Thus, a height of 49.5 in (124 cm) would be expected growth. The growth in weight is not within normal parameters as this is a 12 lb (5.4 kg) weight gain. A 7-year-old child, not 8-year-old child, should weigh seven times his birth weight. Adult teeth do not normally come in until age 10 to 12.

The nurse is preparing to administer regular insulin to a nonverbal pediatric client. Which action will the nurse perform prior to administering the medication?

Check the full name and birth date on the client's wristband with the medication administration record. Explanation: When administering medications to a child, the nurse needs to use at minimum two client identifiers that are directly associated with the client and the medication to be given, such as full name, client ID number, and birth date. The nurse will take the medication administration record to the room to perform a "double-identifier" check. A client's identity must be verified with two acceptable identifiers, not just one. There is no need to have another nurse verify or have the parent state the client's information. A room number or a bed number is not an acceptable identifier.

A nurse is presenting a class on discipline for a group of parents of toddlers. What information would be important for the nurse to teach this group? Select all that apply.

Consistency in the rules is important so the child understands what is expected. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Even at this young age, children need boundaries. Explanation: Discipline for toddlers must have consistency and correct timing. Parents need to come to a consensus on how to discipline their child and do so consistently and in a unified fashion. Also, the toddler needs to receive negative feedback for negative behavior as soon as the infraction occurs so the child understands what they did wrong. Parents should never label the child as bad, just their behavior. Every child needs boundaries—it is just that every family's boundaries may vary. Discipline begins early in life and toddlers can learn self-control.

The nurse is caring for a 7-year-old postoperative child who is reporting an 8 out of 10 on a pain intensity scale. The child's parent is requesting pain medication. The child received ibuprofen 3 hours ago. What is the correct nursing action?

Contact the health care provider and request an opioid pain medication. Explanation: The nurse must advocate for the child. Advocacy may involve convincing a parent that opioids are appropriate for the situation or consulting with the prescriber regarding an ineffective medication regimen. Explaining to the parent that the child cannot receive any more pain medication is ineffective and does not advocate for the child in pain. Turning on the television is not a bad idea. However, it is not the priority. It is not appropriate to apologize. The nurse can do something. Contacting the health care provider to request more medication is in the nurse's power.

An 8-month old infant has a colostomy placed following abdominal surgery for removal of a section of bowel. The stoma is 2/3 full, draining liquid stool and the bag appears inflated. What actions would the nurse take in caring for this client? Select all that apply.

Empty the bag and record the output. Examine the skin around the stoma site for redness or irritation. Look at the infant's intake to determine if any foods could be causing gas. Explanation: In caring for an infant with a colostomy, the nurse empties the contents of the bag on a regular basis, rinses it out, closes it again, but does not discard it each time it is emptied. The nurse also inspects the skin around the stoma for any redness or skin breakdown. Since the bag was inflated initially, the nurse should review the infant's intake to note if the infant is consuming any gas-causing foods and recommend limiting them. The bag is never left off for any length of time due to the constant stooling pattern of the infant.

The mother of a 4-year-old boy reports her son has voiced curiosity about her breasts. She asks the nurse what she should do. Which information is best for the nurse to give the parent?

Encourage the parent to determine what the child's specific questions are and answer them briefly. Explanation: Sexual curiosity is normal in the preschool-aged child. The parents should be encouraged to provide brief, honest answers to the child. The parents must also determine the type of curiosity the child has. Explanations should be within the level of understanding of the child.

An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health?

Ensure that the child brushes his teeth after each meal and snacks. Explanation: Proper dental hygiene includes a routine inspection and conscientious brushing after meals. A well-balanced diet with plenty of calcium and phosphorus and minimal sugar is important to healthy teeth. Foods containing sugar should be eaten only at mealtimes and should be followed immediately by proper brushing. The school-aged child should visit the dentist at least twice a year for a cleaning and application of fluoride.

When performing a procedure on a child in the health care setting, what should the priority intervention by the nurse be?

Ensuring the child's safety Explanation: Safety is always a priority when performing any procedure on children. The importance of observing a child closely cannot be overemphasized. Vital signs need to be closely monitored. Any restraint procedures must be safe and the least restrictive method should be used. If administering medications, always follow medication rights. The child will not always trust the nurse when he or she is afraid no matter how effective the nurse is at communicating. The parents may or may not be present for the procedure, depending upon the specific procedure and hospital policy.

Psychosocial development school age children

Erikson - Industry vs Inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. The school-age child's satisfaction from achieving success in developing new skills leads him or her to an increased sense of self-worth and level of competence. It is the role of the parents, teachers, coaches, and nurses of the school-age child to identify areas of competency and to build on the child's successful experiences to promote mastery, success, and self-esteem. If the expectations of adults are set too high, the child will develop a sense of inferiority and incompetence that can affect all aspects of his or her life.

The nurse is working with the parents of a school-age child who has juvenile arthritis. What is the most beneficial method for helping this child assess chronic but intermittent pain?

Have child keep a diary of when pain occurs. Explanation: Having children keep logs or diaries in which they note when pain occurs and the intensity of the pain each time it occurs can be useful for assessing children with chronic but intermittent pain. Examining such a diary not only reveals when pain occurs but also provides direction for pain management. A numerical scale is used to assess pain intensity on a regular basis but does not show a pattern over time. The Pain Experience Inventory is a tool consisting of eight questions for children and eight questions for the child's parents. Such a form can be used when a child is admitted to an acute care facility or on an initial home care visit. The Adolescent Pediatric Pain Tool (APPT) combines a visual activity and a numerical scale and is used to assess pain when it occurs.

When educating a parent on how to support the child while experiencing a painful procedure, what is the best information for the nurse to convey?

Explain in detail the role of the parent as a coach and emphasize the coping plan. Explanation: The question asks for the best information, which is having the parent understand his or her role. Parents have a strong influence on the child's ability to cope. For example, if a parent reacts to the child's pain in a positive manner and offers comfort measures, the child may have an easier time coping. If the parent shows anger or disapproval, the pain experience may be intensified for the child. The nurse should break down complex procedures into specific steps and reinforce coping strategies for each distinct task. To do this, the nurse should model, or demonstrate, coping behaviors as well as detail the parent's coaching role and reinforce the need for the parent to emphasize the coping plan, rather than apologizing for the pain. Although parents want to help their children and some are able to act as coaches, the response of the child to pain and stress and to the parents' distraction interventions is highly variable. Some children appear to be soothed by their parents' distraction actions; others appear to become distressed. Thus, the parents should be prepared that they may need to step away from the child. The parents should be focused on the coping plan, not on the procedure itself. Focusing on the procedure attracts the child's attention to the negative experience.

A nurse is preparing to administer a prescribed bolus gavage feeding to an infant with a nasogastric tube in place. Before beginning the feeding, the nurse ensures that the gavage tube is in the proper location based on which assessment?

External tube length measurement matches the length documented on insertion. Explanation: Placement of the tube is confirmed by measuring the length of the external part of the tube (from the marking on the tube at the nose or mouth to the end of tube) and comparing measurement to the documented measurement which should be the same or by aspirating stomach contents and checking the pH of the fluids aspirated. The pH of gastric contents is acidic, rather than alkaline, which would be noted if the fluids were respiratory in nature. The color of the fluid provides no information about placement. Verifying positioning of the feeding tube by inserting air (using an asepto syringe) and listening with a stethoscope for sounds in the stomach is considered an unreliable method of checking for tube placement and is not recommended.

What foods could a parent provide that would be the most beneficial to support healthy dentition for a school-aged child?

Fish, spinach salad and a glass of milk Explanation: A well-balanced diet rich in calcium and phosphorus fosters healthy teeth. Minimal sugar, a diet of whole grain breads, and fish and cheeses are all good sources of calcium and/or phosphorus. Sugary soda drinks and juices, pretzels and bagels, beef and sherbet do not provide substantial amounts of calcium or phosphorus.

A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client?

Formal operational thought Explanation: The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about age 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.

The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to touch the chips and clings to his mother. How should the nurse respond?

Give the mother the FACES pain rating scale to use with her son. Explanation: Different pain rating scales are appropriate for different developmental levels. Children often regress when in pain, so a simpler tool such as the FACES scale may be needed. It is also helpful to enlist the assistance of the parent. Expecting the child to select a chip is developmentally inappropriate when the child shows signs of regression. The child wouldn't understand the phrase "word-graphic scale," and this scale or the visual analog scale is more complex than this 4-year-old can handle.

The nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test?

Help the child to pretend that the CT scan machine is a camera. Explanation: Because preschoolers' imagination is so active, this leads to several fears such as fear of the dark and mutilation. The nurse needs to help the child understand that the CT scanner is like a camera to take pictures of the body parts. Threatening the child to follow directions or becoming hurt plays into the child's fear of mutilation. Telling the child to behave creates a fear of punishment. Telling the child that the CT scan is a picture of the body's dark parts plays into the child's fear of the dark.

The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change?

Include both parents and children in the wellness program. Explanation: Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Although the other actions can accomplish in-school enhancements to health, long-term change tends to be more likely when the programs implemented involve the family. Programs implemented without a family-centered approach often fail when the child's home life and school life are disconnected.

The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication?

Let the child hold the medication cup. Explanation: Droppers and oral syringes can be used to administer medications to infants and young children. Medication cups and spoons can be used to administer liquid medications to the older child. The child can hold the medication cup and drink the liquid medication. Depending upon the age of the child, he or she may still prefer to take liquid medications via the syringe. It makes taking the medication fun when the child can squirt it into the mouth by himself or herself. The child who is lying down when being given medications should have the head of the bed elevated to at least 45 degrees A 5-year-old child does not need to be restrained for medication administration.

As the nurse prepares to administer a medication to a preschooler, the nurse realizes that the child is extremely underweight for age. What action would the nurse take?

Measure the child's height and weight, and check whether the dose is correct for the child. Explanation: Before any medicine is administered, it should be confirmed that the dose is correct for the child's weight and height because of the great variability in these areas. Medication dosages can be prescribed by body weight and by body weight and height. The child's weight is always converted to kilograms. If the medication is prescribed by body weight the nurse would need to weigh the child. This measurement allows for the drugs to be prescribed by a 24 hour period (mg/kg/day) or by the dose (mg/kg/dose). If the weight and height are needed, the drugs are calculated by body surface area (BSA). This is plotted on a nomogram. This is used most often for chemotherapeutic drugs. The nurse should not adjust the dose or call the health care provider until the weight is obtained and the correct dosage needed is verified.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years. Explanation: Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.

A 5-year-old boy is receiving an analgesic intravenously while in the hospital. What should the nurse do to determine whether the drug is being properly excreted from this child?

Monitor the child's fluid intake and output. Explanation: Monitoring intake and output is important in children receiving drugs to be certain urine excretion or an outlet for drug metabolites is adequate. The other interventions listed are not typically used to determine whether drug excretion is occurring.

A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image?

Offer to assist the girl in washing her hair and let her pick the shampoo. Explanation: When caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.

The mother of a 10-year-old daughter is concerned that her child is becoming overweight. Her weight plots in the 95th percentile in the growth chart. Which action would the nurse recommend to the mother to address her concerns?

Offer to go walking every day after school with her for 30 minutes. Explanation: The parent can best assist the child in weight reduction by encouraging physical activity and by offering to participate in the exercise with the daughter. It allows private family time for the two of them. Nagging each day about food intake or placing the child on a strict diet does not help the child lose weight and may encourage rebellion. Fat intake is not to exceed 35% of the total calories each day.

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers?

Placing the child in an approved car seat Explanation: The leading cause of death in the preschool group is automobile accidents, followed by poisonings and falls. Placing the child in an approved car seat is a safety precaution to help prevent serious injury and even death. All safety measures help keep children safe. Putting latches on the lower cabinets and using a baby gate at the top of the stairs are important to prevent poisonings and to prevent falls which could cause head injuries and fractures. Many infectious diseases are preventable as a result of health promotion and illness prevention techniques.

The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level?

Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again. Explanation: Proper medication administration for an infant includes the following: Position the infant upright, present a pleasant- or neutral-tasting substance to ensure that the child is awake and swallowing, give the medication slowly enough to allow the child to swallow and prevent any risk of aspirating, and give a pleasant-tasting "chaser." An infant should not be placed supine since this would increase the risk of aspiration. Medications should not be placed in a client's staple food to avoid an aversion to the food in the future.

When interviewed by the school nurse, a 13-year-old adolescent female states she has a boyfriend and that her parents do not talk about sex with her. She says is confused about the facts and wants to know the truth. Which approach would best address this adolescent's concerns?

Sit down with her and openly discuss her concerns and questions in an honest, straightforward manner. Explanation: Discussions about human sexuality need to be open, honest and straightforward with adolescents. Parents and health care providers must remain nonjudgmental if they want adolescents to come to them with questions. Sitting down with the student and addressing her questions is the best way to establish a trusting relationship with her. Recommending that she talk with her parents will not help her since they are apparently not open to discussing the topic. Brochures cannot answer her specific questions and may result in more confusion on her part. Referring her to the health department is passing the nurse's responsibility to someone else, and there is no indication that any pregnancy prevention is needed.

A 1-year-old child with an abdominal wound is undergoing a dressing change. The child's parent is at the bedside. Which action would the nurse instruct the parent to do?

Talk to the child in a quiet, soothing voice. Explanation: At the time of a procedure, the nurse should advocate for the parents to remain during procedures to offer support. The parental role should be supportive and comforting and not one that causes pain. The parent should be sitting next to the child in the same room, not across from the child. Some parents may ask to hold their child during a procedure that causes pain, but do not ask parents to restrain the child during such a procedure.

The nurse is assessing the psychosocial development of an adolescent. The nurse determines that the client is in the middle post-conventional phase with which observation?

The adolescent tells the nurse, "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." Explanation: According to Kohlberg, the middle post-conventional phase is characterized by the adolescent developing his or her own set of morals by evaluating individual morals in relation to peer, family, and societal morals. This is demonstrated when the adolescent stated. "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." The early post-conventional phase is characterized by asking broad, usually unanswerable questions about life such as the question about God. During the late post-conventional phase, the adolescent internalizes his or her own morals and values, and continues to compare morals and values to those of society. During this phase, the adolescent also evaluates the morals of others. The statements regarding the rich in society and work ethic demonstrate this late phase.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

having the child wear a personal flotation device whenever near or on the water. Explanation: Preschool children are safe around water only when adult supervision is constant. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car. At 5 years old, most preschoolers are mature enough to become swimmers, yet knowing how to swim does not make the preschooler safe without supervision. CPR is a life-saving skill and using sunscreen will protect the skin, but neither will be a factor in preventing drowning.

A first-time mother calls the pediatrician's office to ask the nurse about her baby's tooth eruption. The baby is 8 months old and still does not have any teeth. What information can the nurse share with this mother that would correctly respond to her anxiety about her baby's dentition?

Tooth eruption is often genetically based, with some families having babies with early tooth eruption, while others have late tooth eruption. Explanation: Teeth eruption normally begins around age 6 to 8 months but infants' teething patterns vary greatly between children. Genetics plays a big role in both the timing and the actual pattern of eruption.

The nurse is preparing to administer an IV antibiotic to a child. After calculating the recommended dose with the child's weight, the nurse discovers the prescribed dose exceeds the safe dose range in a pediatric drug book. The medication has been given to the child at this dose for 3 days. What action should the nurse take next?

Verify the dose with the prescribing health care provider. Explanation: Medication calculations should always be checked before giving the dose. When a medication dose is found to be outside of the safe dose range, the dose should be verified with the prescribing health care provider. Doses that exceed the recommended range should always be verified, even if they have been given before. The parents did not prescribe this medication. Even if the medication has been given for 3 days, it does not make the dose correct. Calling the pharmacy can only verify if the dose is out of the safe range. The pharmacy did not prescribe the medication nor does it know the child's medical background.

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiologic effects?

impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression Explanation: Unrelieved acute pain can lead to impaired mobility; anorexia, causing poor nutritional intake; delayed wound healing; anxiety and irritability; somatic symptoms; sleep disturbances; avoidance; developmental regression; and increased parental distress. Constipation, nausea, vomiting, nocturnal enuresis, and migraine headaches are not effects of acute pain.

The nurse is working to gain a preschooler's cooperation to swallow an oral medication. What would be the nurse's best approach?

ask if the child would like to take the medicine in a cup or through an oral syringe Explanation: The preschool age is when the child develops initiative. This is the sense that the child is helping. Thus, the nurse should allow the child to participate in the medication task. The instructions and choices need to be simple. The nurse can ask if the preschooler would like to take the medicine in a cup or through an oral syringe. Medicine never should be compared to candy or any other foods. Doing so can present a safety problem if the child gets into the medication cabinet at home thinking he or she is getting candy. Children cannot be depended on to take medicine without supervision, so leaving the medication on the night stand would not only be ineffective it would also be dangerous. Bribing is ineffective. A preschooler is not going to do a task he or she does not like and the medication is needed to make the child well. The nurse should be gentle but firm in the administration of the medication.

The nurse is caring for a preterm infant who requires a heel stick to obtain a blood sample. Which action by the nurse demonstrates a lack of understanding regarding pain in infants?

attempting the heel stick when the infant is asleep to minimize long-term effects of pain Explanation: Research suggests that preterm infants experience pain at a greater intensity than older children or even adults. The reason for this may be that the inhibitory mechanisms higher in the central nervous system have not had time to develop. In preterm and term newborns, behavioral and physiologic indicators are used for determining pain. Behavioral indicators include facial expression (such as brow contracting and chin quivering) and physiologic signs include changes in oxygen saturation levels. Repeated exposure to painful procedures and events can have long-term consequences and infants feel pain and at a greater intensity regardless if they are sleeping. Sleeping can also be a coping mechanism for the child in pain.

A teenage boy tells the nurse that his parents embarrass him in front of his friends when they kiss him goodbye. The nurse is aware that this teenager is revisiting which stage of development identified by Erikson?

autonomy Explanation: In revisiting the stage of autonomy, the adolescent is seeking out ways to express his or her individuality in an effective manner. The adolescent would avoid behaviors that would "shame" or ridicule him or her in front of peers. The sense of industry is again encountered as the adolescent makes the choice to participate in different activities at school, in the community, at church, and in the workforce. Initiative is revisited as the adolescent develops a vision for what he or she might become. Generativity largely involves establishment of career and work.

The parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating:

centering. Explanation: At age 3 years, cognitive development is still preoperational. Although children during this period do enter a second phase called intuitional thought, they lack insight to view themselves as others see them or put themselves in another's place. This is called centering. Because preschoolers cannot make this kind of mental substitution, they feel they are always right and causes them to argue. Conservation is reflected in the child's ability to distinguish that two items of equal size are the same despite a change in form. Initiative is the developmental task of preschoolers and is reflected in the child attempting to learn as much as possible about the world around them by trying new activities or having new experiences. Guilt occurs if children are punished or criticized for attempts at initiative.

A nurse is discussing ways parents can foster the development of self-confidence in their school-aged child. Which action if stated by the parents would lead the nurse to continue the discussion?

comparing the child to an older sibling regarding academic achievements Explanation: A school-age child needs consistency, clearly defined expectations, and positive attention in order to develop self-confidence. By being accepting of mistakes the child makes, focusing on the child whenever they are talking, and making sure the child understands behavioral expectations, the parents are fostering self-confidence in the child.

While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according to Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned?

does not understand the phrase "slow as molasses" when used by the teacher Explanation: Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete-operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. Abstract thinking, such as understanding the meaning of the phrase "slow as molasses," is expected at this stage of cognitive development.

A mother suspects that her 11-year-old son is experimenting with deliriants with his friends. Which symptoms would the nurse advise the mother to look for that would validate her concerns?

giddiness and coughing Explanation: Inhalation of substances can cause numerous symptoms, including giddiness and coughing. The child will not experience diarrhea, hyperactivity, or develop bad breath from experimenting with inhalants.

A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to:

make her child attend school every day. Explanation: School refusal or phobia may result from both a parent not wanting a child to attend school and a child not wanting to leave a parent. Th nurse's role is to help them work together while keeping the child in school to resolve the issue.

A 10-year-old child is scheduled for open reduction and internal fixation of the tibia following a skateboard accident. The nurse anticipates which pain medication and administration method will best provide postsurgical pain relief for this child immediately after surgery?

morphine given as an intravenous injection Explanation: For managing severe or acute pain, such as postoperative pain, opioids like morphine or fentanyl are preferred. Immediately after surgery, the intravenous route is preferable to the oral route because the child may not be able to tolerate oral medications at that time and intravenous medications begin to work much faster than oral medications. NSAIDs, such as ibuprofen or naproxen, are excellent for reducing pain because they reduce inflammation and pain; however, the child most likely will not be able to take an oral medication immediately following surgery. NSAIDs could be given intravenously as prescribed during the immediate postoperative period. Intramuscular injections should be avoided in children because the number of suitable injection sites in children is limited, injections are associated with pain on administration, and many children are afraid of injections. As a rule, other routes for administration of pain medication are used whenever possible.

The nurse is preparing to use the FLACC behavioral scale to assess the pain level of a child. For which child will the use of this scale be the most appropriate?

postoperative 6-year-old child who is unable to accurately report pain level Explanation: The FLACC behavioral scale is a behavioral assessment tool that is useful in assessing a child's pain when the child is unable to accurately report his or her level of pain or discomfort and is reliable for children from age 2 months to 7 years. A 7-year-old child who is getting ready to undergo a dressing change and a 4-year-old child who just had stitches placed would be able to report pain and could use the Faces, Oucher, poker chip, or visual analog scales. A 10-year-old with a broken femur in traction would be able to self-report pain using the numeric scale. In alert children verbally able to report pain, self-report is the primary source for the measurement of pain.

The nurse is monitoring children playing in the unit's playroom. The nurse notes that some children are involved in associative play by which actions?

pushing toy cars around on a large rug with roads Explanation: Associative play occurs when children play together and are engaged in a similar activity, but without organization, rules, or a leader; each child does what they wish, such as pushing toy cars around on a rug that has roads. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity, such as drawing a picture in the art area. During cooperative play, children play in an organized group with each other as in team sports or a board game. Parallel play occurs when the toddler plays alongside other children but not with them, such as each having their own tool-and-bench set to play with the hammers and other tools.

The parents of a preschooler ask the nurse, "What snacks are appripriate for us to give our child?" Which suggestion would the nurse provide? Select all that apply.

sliced cheese sticks Explanation: Parents should offer the child healthy options that are not choking hazards. Cheese sticks that have been cut are healthy and are not a potential choking hazard. Whole carrots and grapes are healthy but also hold the potential to cause choking. Unhealthy snacks include candy such as jelly beans or sweets such as donut holes.

The nurse is caring for a client who has been diagnosed with a tumor in the small intestine that is pressing on the liver. Which type of pain does the nurse anticipate the client will report?

visceral Explanation: Visceral pain is often produced by disease. It usually is diffuse and poorly localized and is described as a deep ache or sharp stabbing sensation that may be referred to other areas. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones and causes dull, aching, or cramping pain. Neuropathic pain usually results in burning, tingling, shooting, squeezing, or spasm-like pain. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue.

A mother of a 10-month-old states to the nurse, "I brush my child's teeth every day with flavored kids' toothpaste." Which is the most appropriate response by the nurse?

"Toothpaste is not necessary; it is the scrubbing that is required." Explanation: Toothpaste for infants is not required. The important health technique is the removing of plaque, and that is accomplished through scrubbing of the teeth.

The parent of a 2-year-old client states it is the child's naptime. The child is refusing to take a nap and cries, "I have to put my babies to sleep first!" The parent states, "I am so sorry, I do not know what is wrong. My child does not act this way at home. My child has 2 baby dolls we rock to sleep each day at home before nap." Which response by the nurse is most appropriate?

"A 2-year-old child's behavior can be greatly altered if rituals are not maintained." Explanation: Ritualism employed by the young child to help develop security involves following routines that make rituals of even simple tasks. The child's self-esteem is built through familiarity with the daily routine. When these rituals are interrupted, the child's behavior can be negatively impacted, resulting in temper tantrums for 2-year-old children. The nurse can recommend someone bring the dolls to the hospital; however, the nurse first needs to address the parent's concern. Stating the child is "just acting out" does not address the parent's concern or current situation. There is nothing in the scenario indicating inconsistent discipline.

The nursing students are learning how to perform a health assessment on a pediatric client. The nursing instructor identifies a need for further teaching when a student states:

"I should take blood pressure on a child beginning at age 2 years." Explanation: When performing assessments, the nurse does not usually take blood pressure on children younger than 3 years. The recommendations are that blood pressure assessment be done at least once during every health care visit on children aged 3 years and older. Children younger than 3 years should have blood pressure assessed if they have a history of prematurity, have congenital heart defect, have a urinary tract infection, take any medications that influence the blood pressure or have increase intracranial pressure. Blood pressure measurement on hospitalized children is taken according to hospital policy no matter what age. The nurse should always establish good rapport with the child's parents. The nurse would use an electronic thermometer to take a temperature on a child who is 3 years.

The nurse is teaching good sleep habits for toddlers to the parent of a 3-year-old client. Which response indicates the parent understands sleep requirements for the client?

"My child needs 12 hours of sleep per day including a nap." Explanation: The father understands the child needs 12 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. Changing the routine from day to day leads to the child not knowing when it is time to go to bed. Giving the child a glass of milk before bed can cause diaper leakage or, if the child is potty-trained, having to get up during the night to void.

During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy?

"My toddler uses the potty chair and is dry all day long." Explanation: During the toddler years, the toddler separates from his or her parents, recognizes one's own individuality and exerts autonomy. Being toilet trained is an example of the toddler developing autonomy or independence. Having temper tantrums is a normal response of the toddler as it is a way the toddler expresses frustration of being tired or not being able to accomplish a task. Having the parent pick up the child after the child falls is a security and emotional need. All children need this, so it is not indicative of toddlerhood or autonomy. Having the same routine for bedtime each night provides security but it does not demonstrate autonomy.

The nurse comes into an infant's room on the pediatric floor. The nurse wants to try to feed the infant for the first time since her surgery. How does the nurse know what state the infant is in by what the mother says, and that it's fine to try and feed the infant?

"She has been a chatterbox and smiles just like her brother." Explanation: The best time to feed an infant is when the child is in the active alert state. This infant is talking and smiling, which shows she is calm and actively awake. In the active alert state the infant has normal respirations, limited movement, and eyes that are bright and shiny and attentive. The other choices put the infant in a crying state, quiet alert or deep sleep, or drowsing. These stages are not optimal for interacting with the child.

The mother of a 6-week-old infant reports she doesn't know if her child recognizes her face yet. What response by the nurse is most appropriate?

"Since about 4 weeks of age your child has been able to recognize those who are around him often." Explanation: At 1 month of age the infant can recognize by sight the people he or she knows best. Telling the child's mother that this will come with time is not correct as this developmental milestone has already occurred. Telling her not to worry minimizes her questions and concerns.

The parent of a 20-month-old toddler reports the toddler has been becoming distraught when the parent leaves. The parent asks the nurse for advice about what is going on and how to best manage it. What information can be provided? Select all that apply.

"This is a normal happening for a toddler of this age." "As your toddler begins to learn that you will return the toddler will become less upset." "Establishing a routine for saying goodbye to your toddler will be helpful." Explanation: Separation anxiety occurs initially in infancy and then reoccurs again during the toddler stage. Separation anxiety for the toddler is normal. As the toddler begins to develop an understanding of object constancy, separation anxiety will ease. The toddler, while missing the parent, will begin to recognize that the parent will return. Establishing a routine for saying goodbye is helpful for the toddler. There is no indication that the care providers are problematic.

A group of caregivers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is appropriate related to this form of discipline?

"When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." Explanation: A method for a young child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary. The chair should be used for discipline, not because the child will not go take a nap. It can be used for all ages of young children.

A parent asks the nurse if the 2-month-old infant can have bananas yet. The nurse would respond and educate the parent on the nutrition stages of infants by which response?

"You can try bananas 2 or 3 months from now." Explanation: The nurse will educate the parent to wait 2 to 3 months, because solid foods are not recommended for infants at 2 months of age. The age of 4 to 6 months is when it is recommended to introduce solid foods. In 1 month, the infant will be only 3 month of age. The other responses will not help the parent determine the appropriate answer.

The nurse is caring for a parent following the birth of the newborn. The new parent asks the nurse, "When is the best time for me to start bonding with my baby?" Which response by the nurse is appropriate?

"You should interact with your newborn when the eyes are open wide and bright." Explanation: A newborn's neurological development includes 6 states of consciousness. The best time for a family to interact with a newborn is when the newborn is in the quiet or active alert stage. The quiet alert state is when the body is calm and the eyes are wide open. The active alert state is when the eyes are wide open and there are body movements. Examples of this are minimal body activity, regular respirations, face with shiny look, eyes wide and bright, and paying attention to stimuli. When the newborn is crying it is very difficult to get the newborn's attention. The newborn needs immediate needs met at this time such as feeding, repositioning, or a diaper change. When the newborn is in a drowsy state, trying to interact only causes frustration for the newborn as sleep is interrupted.

4-2-1 Rule for calculating maintenance fluids

0-10 kg - 4 ml/kg/hr 10-20 kg - 40 ml/hr + 2 ml/kg/hr >20 kg - 60 ml/hr + 1 ml/kg/hr

The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit?

24 pounds (10.8 kg) and 30 inches (75 cm) Explanation: By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.

The parents of a 30-month-old toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding?

A tantrum preceded the event. Explanation: Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler is old enough to verbalize feelings. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.

A nurse in a busy pediatric clinic is educating a group of parents with toddlers about the nutritional needs of this age group. Which concepts should be addressed in this educational presentation? Select all that apply.

Active, "busy" toddlers may need up to 1,400 cal/day. Try to limit the fat intake to less than 35% of total calories. Milk is still important to incorporate in the diet for bone health. Explanation: Active children in this age group may need up to 1,400 kcal daily. Children over 2 years old should have a total fat intake between 30% and 35% of calories, with most fat coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils, the same as adults. Adequate calcium and phosphorus intake is important for bone mineralization. Milk should be whole milk until age 2 years, after which 2% milk can be introduced. Trans fats should be kept to a minimum. Diets high in sugar (like cookies) should be avoided to help prevent toddler obesity.

What is covered under Safety diagnostic division?

Allergies, immunizations, history of injuries, cognitive/sensory limitations and assistive aids, exposure to illnesses, toxic substances, and recent travel, skin integrity, high risk behaviors like tobacco, alcohol, etc.

An 8-month-old infant in being held by her mother and the nurse needs to obtain the infant's vital signs. Which approach would most likely ensure accurate readings?

Allow the mother to continue to hold the infant, listen to the child's heart rate, count respirations by the abdominal rise, then take an axillary temperature. Explanation: The best method for obtaining vital signs on an infant is to keep the infant calm and begin with listening to heart and breath sounds, followed by temperature. Respiratory rate is easily obtained by watching an infant's abdomen rise and fall since infants are abdominal breathers. Keeping the infant calm is best accomplished by allowing the parent to hold the client.

Newborn weight

Average weight is 3.4 kg (7.5 lb) at birth, with boys being slightly heavier than girls. Newborns may lose 5-10% of their body weight over the first week of lift. The average newborn then gains about 20 to 30 g/day and regains their birth weight by 7 to 10 days of age. Most infants double their birth weight by 4-5 months, and triple their birth weight by 1 year.

Peripheral cyanosis and causes

Bluish discoloration of extremities, caused by anxiety, hypothermia, heart disease

Central cyanosis and causes

Bluish discoloration of lips, tongue, mucosa or trunk. Caused by hypoxia, shock, CV collapse, congenital heart disease

BP Cuff placements

Brachial artery - upper arm Radial artery - lower arm Popliteal artery - thigh DP/PT artery - lower calf

6 states of consciousness for newborn

Deep sleep - sleeping with eyes closed and no movement Light sleep - sleeping with eyes closed; rapid eye movements and irregular movements may be noticed Drowsiness - eyes may close or be half-lidded, the infant may be dozing Quiet alert state - the infant's eyes are wide open, and the body is calm Active alert state - the infant's eyes are open; body movements occur Crying - the infant cries or screams and it is difficult to gain the infant's attention.

The parent of a 2-year-old toddler tells the nurse she needs to constantly scold the toddler for having wet pants. The parent says the toddler was potty trained at 12 months, but since starting to walk, the toddler wets the pants all the time. Which nursing diagnosis would be most applicable?

Deficient parental knowledge related to inappropriate method for toilet training Explanation: Myelination of the spinal cord is achieved around 2 years of age. When this occurs, the toddler can exercise voluntary control over the sphincters. It is probable that a toddler toilet trained at 12 months of age was not truly trained, because the infant would not be developmentally able to complete the task. It is most likely the parent used a training method of reminding the infant or placing the infant on a toilet frequently during the day. When the toddler begins to play independently, the toddler forgets the regimented schedule. This toddler is not toilet trained independently. The toddler does not display total urinary incontinence. The toddler is only incontinent when playing and not reminded to potty. A 2-year-old toddler has limited coping skills. Frequent wetting of the pants does not indicate too much fluid intake. It is a symptom that the toddler does not feel the urge to urinate until the bladder is too full and the toddler cannot get to the toilet on time.

The nurse is providing anticipatory guidance to the parents of an 18-month-old child. Which recommendation should be the most helpful to the parents?

Describe proper behavior when the child misbehaves. Explanation: Stopping the child when misbehaving and describing proper behavior sets limits and models good behavior. This will be the most helpful advice to the parents. At 18 months, the child is too young to use time out or extinction (ignoring the child's behavior) as discipline. Slapping the child's hand, even done carefully with two fingers, is corporal punishment, which has been found to have negative effects on child development.

A mother brings her 2-year-old child to the pediatrician's office, voicing concerns about her toddler's growth over the last year. According to the child's records, the toddler has gained 6 pounds (2.7 kg ) and grown 2.5 in (6.25 cm) since the chld's last visit a year ago. How should the nurse respond to this mother's concerns?

Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Explanation: Normally, a toddler's growth is 5 to 10 pounds per year and about 3 inches in height. This child falls within the recommended parameters of growth and the mother has nothing to be worried about.

A single mother with three young children is reluctant to leave her crying and upset 16-month-old daughter overnight in the hospital but needs to go home to care for the other children. Which suggestion from the nurse will best address the fears and concerns of both the child and mother?

Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." Explanation: When the family caregiver must leave the toddler, it may be helpful for the adult to give the child some personal item to keep until the adult returns. The caregiver can tell the child he or she will return "when the cartoons come on TV" or "when your lunch comes." These are concrete times that the toddler will probably understand. The toddler is too young to understand that staying is important for her recovery. Distracting the child while the mother leaves may increase the child's anxiety when she realizes her mother is gone. Although the child will be watched closely in the hospital setting, toddlers explore their environment wherever they are.

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take?

Explain that children can take their first steps as late as 18 months of age. Explanation: Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.

The nurse is assessing 2-year-old twins. The parent states, "My twins will not play together, only alongside each other." Which action will the nurse take first?

Explain that this is normal behavior for toddlers. Explanation: Playing beside one another is parallel play and typical of toddlerhood. The nurse would explain this is normal behavior for the twins and then document the finding. The nurse would not need to observe the twins at play or ask additional questions as this is an expected finding.

FLACC pain scale

F - Face 0 - No particular expression or smile. 1 - Occasional grimace or frown, withdrawn, disinterested. 2 - Frequent to constant quivering chin, clenched jaw L - Lets 0 - Normal position or relaxed 1 - Uneasy, restless, tense 2 - Kicking or legs drawn up A - Activity 0 - Lying quietly, normal position, moves easily 1 - Squirming, shifting back and forth, tense 2 - Arched, rigid or jerking C - Cry 0 - No cry (awake or asleep) 1 - Moans or whimpers; occasional complaint 2 - Crying steadily, screams or sobs, frequent complaints C- Consolability 0 - Content, relaxed 1 - Reassured by occasional touching, hugging or being talked to distractible

Development of fine motor skills

Fine motor development includes the maturation of hand and finger use. Fine motor skills develop in a proximodistal fashion (from the center to the periphery). In other words, the infant first bats with the whole hand, eventually progressing to gross grasping, before being capable of fine fingertip grasping.

The nurse is teaching a mother of a 1-year old girl about weaning her from the bottle and breast. Which recommendation should be part of the nurse's plan?

Give the child an iron-fortified cereal. Explanation: The nurse would be sure to tell the mother to feed her child iron-fortified cereal and other iron-rich foods when she weans her child off the breast or formula. Weaning from the breast is dependent upon the mother's need and desires with no set time. Weaning from the bottle is recommended at 1 year of age in order to prevent dental caries. Use of a no-spill sippy cup is not recommended because it too is associated with dental caries.

Toddler motor skill development

Gross - walking independently (12-15 months) Fine - By 24 months, will be clear whether they are right or left handed. Will imitate circular and vertical strokes. Scribbles and paints. By 36 months, undresses self. Copies circle. Holds pencil in writing position. Screws and unscrews lids, nuts, and bolts.

Genitourinary system maturity

Infants urinate frequently, and the urine has a relatively low specific gravity. The renal structures are immature and the GFR and renal perfusion are all reduced compared to the adult. The glomeruli reach full maturity by 2 years of age.

The nurse is reviewing the diet of an 8-month-old infant with the mother who reveals she has been using evaporated milk to make the formula. Which additional ingredient should the nurse ensure she is including in the formula?

Iron Explanation: Infants who are fed home-prepared formulas (based on evaporated milk) need supplemental vitamin C and iron. Evaporated milk has adequate amounts of vitamin D, which is unaffected by heat used in the preparation of formula. Calcium and vitamin E would not be a concern in this infant's formula.

The parents of a 2-year-old child born with short-gut syndrome feed their toddler via a feeding tube. Knowing this is a developmental time when children usually feed themselves, the parents are asking the nurses what they can do to help foster the child's independence. Which suggestion would be most appropriate at this time?

Let the child choose what clothing he or she will wear the next day. Explanation: If children are tube fed, they receive no experience at all with finger foods. For these children, parents should try to provide other, comparable experiences in independence, such as letting them choose what toy to take to bed or what clothing to wear. Playing, reading, or pretending a toy is food at feeding time are not appropriate activities since the child's feeding is usually scheduled around normal meal times.

The parent of a 3-month-old infant is concerned because the infant does not yet sit by oneself. Which statement best reflects average sitting ability?

Most infants do not sit steadily until 8 months; this infant is normal. Explanation: At 3 months of age the infant should be able to raise the head about 45 degrees when in the prone position. The infant does yet have the developmental skills for sitting. Most infants are unable to sit steadily until 8 months of age. Gross motor skill development does not correlate with tooth eruption. The nurse should reassure the parent that this infant is on tract developmentally.

Once a temper tantrum has started, which intervention is appropriate?

Move objects out of the way or move the toddler to prevent injury. Explanation: Temper tantrums are a normal part of the toddler years. Toddlers are very inquisitive and do not know boundaries. They need time and maturity to learn the rules. During the tantrum, it is most important to keep the toddler safe. Appropriate interventions include moving objects out of the way or moving the toddler to prevent injury from occurring. The caregiver should not speak to the toddler and should avoid eye contact until the toddler has calmed down. The toddler's behavior should not be engaged. The caregiver should not talk excessively about the tantrum, because this can negatively impact the toddler's self-esteem.

Maturity of digestive system

Newborn stomach can only hold one half to 1 oz. By 1 year, the stomach can hold three full meals and several snacks per day. In the duodenum, three enzymes in particular are important for digestion. Trypsin is available in sufficient quantities for protein digestion after birth. Amylase (needed for complex carb digestion) and lipase (for fat digestion) are both deficient in the infant and do not reach adult levels until about 5 months of age.

Reflexes at birth and for infant

Primitive reflexes are subcortical and involve a whole-body response. Moro - with sudden extension of the head, the arms abduct and move upward and the hands form a 'C'. Root - When infant's cheek is stroked, the infant turns to that side, searching with mouth. Suck - Reflexive sucking when nipple or finger is placed in infant's mouth. Assymetric tonic neck - While lying supine, extremities are extended on the side of the body to which the head is turned and opposite extremities are flexed. Plantar and palmar grasp - Infant reflexively grasps when palm is touched; reflexively grasps with bottom of foot when pressure is applied to the plantar surface. Step - With one foot on a flat surface, the infant puts the other foot down as if to 'step'. Babinski - Stroking along the lateral aspect of the sole and across the plantar surface results in fanning and hyperextension of the toes. Primitive reflexes diminish over the first few months of life, giving way to protective reflexes (aka postural responses). These are gross motor responses r/t maintenance of equilibrium. These responses remain throughout life once they're established. These include the righting and parachute reactions. Neck righting - neck keeps head in upright position when body is tilted Parachute - protective extension with the arms when held up and moved forward. The infant reflexively reaches forward to catch themselves.

Language development in toddlers

Receptive language development (the ability to understand what is being said or asked) is typically far more advanced than expressive language development (the ability to communicate one's desires and feelings). The toddler understands language and is able to follow commands far sooner than he or she can actually use the words themselves. Toddlers should have a vocabulary of about 50 words by 2 years of age. Vocab of 1,000 words at 3 years.

Development of Gross motor skills

Refers to those that use large muscles, like head control, rolling, sitting, walking. Gross motor skills develop in a cephalocaudal fashion (from the head to the tail). In other words, the baby learns to lift the head before learning to roll over and sit. First, the infant achieves head control, then the ability to roll over, sit, crawl, pull to stand, and usually around 1 year of age, walk independently.

Which activity will the nurse encourage new parents to complete in order to assist their infant in accomplishing Erikson's developmental task for the first year of life?

Respond promptly when the infant cries. Explanation: The developmental task of the infant year, according to Erikson, is to gain a sense of trust. This can be accomplished by promptly meeting the infant's needs during the first year of life. If the infant does not learn to trust, mistrust will develop. Praising will help meet the future developmental tasks of the child. Reading books and appropriately enunciating words will aid in the infant's language development.

Piaget's Cognitive developmental theory for birth to 2 years

Sensorimotor stage - Infant uses senses and motor skills to learn about the world. Substage 1 - use of reflexes (birth to 1 month). Reflexive sucking brings the pleasure of ingesting nutrition. Infant begins to gain control over reflexes and recognizes familiar objects, odors, and sounds. Substage 2 - Primary circular reactions (1-4 months). Thumb sucking may occur by chance; then the infant repeats it on purpose to bring pleasure. Imitation begins. Object permanence begins. Infant shows affect. Substage 3 - Secondary circular reactions (4-8 months). Infant repeats actions to achieve wanted results (ex. shakes rattle to hear the noise it makes). The infant's actions are purposeful but the infant does not always have an end goal in mind. Substage 4 - Coordination of secondary schemes (8-12 months). Infants coordinate previously learned schemes with previously learned behaviors. They may grasp and shake a rattle intentionally or crawl across the room to reach a desired toy. Infant can anticipate events. Object permanence is fully present at about 8 months of age. The infant begins to associate symbols with events (ex. waving goodbye means someone is leaving).

The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice?

Serve new foods several times. Explanation: When introducing a new food to an infant, it may take multiple attempts before the child will accept it. Parents must demonstrate patience. Letting the child eat only the foods she prefers, forcing her to eat foods she does not want, or actively urging the child to eat new foods can negatively affect eating patterns.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?

Sitting independently Explanation: Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old.

Which milestone would the nurse expect an infant to accomplish by 8 months of age?

Sitting without support Explanation: Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurs quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk.

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old toddler?

The toddler should speak in two-word sentences ("Me go"). Explanation: A toddler can understand language and is able to follow commands far sooner than he or she can actually use the words. By 2 years of age, a toddler typically speaks in two-word (noun and verb) sentences. Two-year-old toddlers have a vocabulary of about 40 to 50 words, and they start to use descriptive words (hungry, hot). The words "ma-ma" and da-da" occur much earlier than the toddler stage. The toddler is about 36 months of age before using pronouns or plurals in sentences. Children are unable to count to 20 until they are 5 to 6 years old.

During a wellness care visit, the parents of a 2-year-old toddler report that they are struggling to deal with their toddler's daily and increasing number of tantrums. What information should be provided to the parents? Select all that apply.

Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums. Ignoring the behavior is often helpful in reducing the duration of the tantrum. Explanation: Temper tantrums can be a frequent occurrence in toddlerhood. Some toddlers are more prone to displaying these behaviors than others. For the toddler who experiences frequent tantrum outbursts, maintaining a consistent schedule for activities is helpful. Tantrum-prone toddlers benefit from consistent nap, meal and play periods. Ignoring the behavior signals to the toddler that the behavior is futile. Avoiding interaction with the toddler having the tantrum is beneficial. Discipline such as spanking, swatting or yelling at the toddler does not reduce the episode and may escalate it.

The nurse is taking vital signs on a 6-month-old infant. The caregiver reports that over the past 12 hours, the infant has had vomiting, diarrhea, and has been pulling on the ears. Which method(s) would be appropriate for taking this infant's temperature? Select all that apply.

Temporal, axillary Explanation: Temporal and axillary temperatures would be appropriate on this infant. Axillary temperatures are taken on newborns and on infants and children with diarrhea. Taking the temperature using the tympanic method is noninvasive and causes little disturbance to the infant, but it is contraindicated in this infant because of suspected ear pain. Oral temperatures usually are taken only on children older than 4 to 6 years of age who are conscious and cooperative. Rectal temperatures are contraindicated in children who have had rectal surgery, have cancer or, like this infant, who have diarrhea. Rectal temperatures are the most invasive and are used very infrequently.

When obtaining a child's health history, the child's demographic data is assessed first. What should the nurse assess next?

The chief complaint of the child Explanation: The order of the health history is as follows: demographics, chief complaint, history of the present illness, past health history, a review of the systems, the family health history, developmental history, functional history, and family composition, resources, and the home environment. The chief complaint should be obtained from the parent or guardian and from the child if the child is old enough to verbalize. The child's concern could be different than the parent's. The history of the illness would be the third stage the nurse should assess. That could include the medications the child is currently taking or that could be obtained in the past health history, depending on the child's medical problem.

Maturity of cardiovascular system

The heart doubles in size over the first year of life. As CV system matures, pulse rate slows from 120-140 in newborn to about 100 in 1 year old. BP steadily increases over the first 12 months of life, from an average of 60/40 in the newborn to 100/50 in the 12 month old. Over the first year of life, thermoregulation becomes more effective.

The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up? Select all that apply.

The infant does not pay attention to noises behind him. The infant has frequent episodes of crossed eyes. The infant seems disinterested in the surrounding environment. Explanation: Warning signs that may indicate problems with sensory development include the following: young infant does not respond to loud noises; child does not focus on a near object; infant does not start to make sounds or babble by 4 months of age; infant does not turn to locate sound at age 4 months; infant crosses eyes most of the time at age 6 months. Language development at this stage of development does not include stringing together 2-word sentences.

A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child?

The infant says "da-da" when looking at her father Explanation: By 9 months, an infant usually speaks a first word: "da-da" or "ba-ba." The other answers refer to earlier milestones in language development. In response to a nodding, smiling face, or a friendly tone of voice, a 3-month-old infant will squeal with pleasure or laugh out loud. By 4 months, infants are very "talkative," cooing, babbling, and gurgling when spoken to. At 6 months, infants learn the art of imitating. They may imitate a parent's cough, for example, or say "Oh!" as a way of attracting attention.

The nurse is performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments?

The infant will most likely present with developmental skills consistent with a 6-month-old infant. Explanation: When assessing the growth and development of a premature infant, the nurse will use the infant's adjusted age to determine expected outcomes. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronological age. The infant who was born at 32 weeks' gestation was 8 weeks (or 2 months) premature. To determine the adjusted age, the nurse subtracts 2 months from the chronological age of 8 months: 6 months.

The nurse is making a home visit and observes the 7-month-old pulling the family dog's hair and ears. Which parenting skill does the nurse determine is most effective?

The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog Explanation: Providing a safe environment, redirection away from undesirable behaviors, and saying "no" in appropriate instances are effective forms of discipline for an infant's developmental level. Infants are at an increased risk for injury from spanking and do not understand the reason for the spanking. Infants do not understand time-outs or the reason for this type of discipline.

When testing the deep tendon reflexes of a child, a four-point grading scale is used. What would a 1+ result mean for a reflex tested?

The reflex is diminished. Explanation: On the four-point grading scale used in assessing deep tendon reflexes, 1+ indicates a diminished response. With 2+ as average, a grade of 3+ is brisker than average and 4+ is hyperactive. The reflex is absent at a grade of 0. Healthy children should have reflexes 2+. The newborn has reflexes of 3+ and decreases to 2+ by 3 to 4 months of age.

A parent is concerned because the toddler refuses to share. What is the nurse's best response to the parent regarding this concern?

This is normal toddler behavior; sharing is learned later. Explanation: Play is the major socializing medium for the toddler. Toddlers exhibit parallel play instead of cooperative play. Sharing is not usually learned until the preschool period. Because toddlers have such short attention spans, they change toys and activities frequently. This also is not conducive to sharing. Because parallel play is normal for the toddler, the parent should be assured the toddler is developing normally and no restrictions are needed.

Erikson's Developmental Theory for birth to 1 year

Trust vs Mistrust Caregivers respond to the infant's basic needs by feeding, changing diapers, cleaning, touching, holding, and talking to the infant. This creates a sense of trust in the infant. As the nervous system matures, infants realize they are separate beings from their caregivers. Over time, the infant learns to tolerate small amounts of frustration and trusts that although gratification may be delayed, it will eventually be provided.

The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk?

Uses only the left hand to grasp Explanation: Favoring one hand over the other may be a warning sign that proper motor development is not occurring in the other arm or hand. Grasping small objects with the entire hand is common at 8 months and precedes the pincer grasp, which is used about 2 months later. Crawling with stomach down and being unable to pull to standing are abilities that may not occur for another 4 to 8 weeks.

Parents and their nearly 3-year-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay?

Uses two-word sentences or phrases Explanation: A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.

On which client would it be appropriate for the nurse to perform a rectal temperature?

a child who has suffered a head injury and is comatose Explanation: Rectal temperatures are not the preferred method of obtaining a child's temperature but are appropriate if the child is unconscious and the nurse cannot do an oral temperature. They are not desirable in the newborn because of the danger of irritation to the rectal mucosa or in children who have had rectal surgery, are immunosuppressed or who have diarrhea or a bleeding disorder.

Maturation

an increase in functionality of various body systems or developmental skills

The nurse is assessing a 2-year-old boy during a well-child visit. The nurse correctly identifies the child's current stage of Erikson's growth and development as:

autonomy versus shame and doubt Explanation: The Erikson stage of development for the toddler is autonomy versus shame and doubt. During this period of time the child works to establish independence. Trust versus mistrust is the stage of infancy. Initiative versus guilt is the stage for the preschooler. Industry versus inferiority is the stage for school-aged children.

The nurse is assisting with the physical examination on a sleeping 10-month-old infant being held by the parent against the parent's shoulder. In what sequence would the nurse complete the assessment?

back and extremities; head and neck; then the ears, nose, mouth, and eyes Explanation: Data are collected by examination of the body systems. Often the exam for an infant is not done in a head-to-toe manner, as is done with adults, but rather in an order that takes the infant's age and developmental needs into consideration. Because the infant is asleep and held against the parent's shoulder, the nurse would begin by assessing the infant's back and extremities. The infant's eyes would be inspected last to allow the infant to be most comfortable until the end of the assessment. Aspects of the examination that might be more traumatic or uncomfortable for the infant are completed last.

A 6-month-old has fanning of the toes and dorsiflexion of the big toe seen on physical exam. Based on this finding the nurse should:

document as a normal finding. Explanation: The infant should be assessed for a Babinski reflex. To achieve this stroke the sole of the foot. Fanning of the toes will occur in infants younger than 3 months of age. A downward reflex of the toes will occur beyond 3 months of age. Some infants will demonstrate a flaring Babinski sign until 2 years of age. In the absence of other neurologic findings this is a normal response. The nurse would document this normal finding. The child would not need to be referred for further evaluation. The finding does not indicate any particular type shoe the child would require.

All infants should have their head circumference measured at health assessment visits. Where should the nurse place the tape measure to obtain this measurement?

just above the eyebrows through the prominent part of the occiput To measure the circumference of an infant's head, the nurse would measure the largest point across the skull, not including the ears, with a no stretching cloth or paper tape. The tape would be placed at the forehead just above the eyebrows and brought around the head in a taut circle just above the occiput prominence at the back of the head. The measurement is then marked on a growth chart so it can be plotted to assess adequate growth. Each of the other options depicts incorrect placement of the tape for measurement and would not provide a correct measurement of the head.

During the physical examination, the nurse notes a positive Kernig and Brudzinski sign. The nurse interprets these findings to suggest which condition?

meningeal irritation Explanation: A positive Kernig and Brudzinski sign are indicative a meningeal irritation and are not associated with auditory or visual problems or heart murmurs.

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age?

no teeth Explanation: Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.

A first-time parent asks the nurse what toys would be appropriate for her son's second birthday next month. What recommendations would be nurse make?

play lawn mower Explanation: Toys for toddlers should include imitative toys, toys that encourage fine and gross motor development, and toys that involve socialization. A play lawn mower meets these criteria by being something the child can push and imitate the parent's activities. A 2-year-old is too old for a rattle and dress-up clothing and a water gun are too advanced.

The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to:

refer the infant for developmental and/or neurologic evaluation. Explanation: There should be no head lag by 4 months. Head lag in the 5-month-old may indicate motor or neurologic problems and needs immediate follow-up. All other nursing actions indicate failure to recognize the problem.

Echolalia

repetition of words and phrases without understanding. Normally occurs in toddlers younger than 30 months of age.

The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex:

should have disappeared. Explanation: This primitive (not protective) reflex should be present at birth and disappear around age 4 months.

Bottle weaning

should occur by 12-15 months of age

Where is the point of maximal impulse (PMI) found in a 5-year-old child?

the fourth intercostal space Explanation: The area of most intense cardiac pulsation, or point of maximal impulse (PMI), varies with age. Up until the age 4 years it is located between the 3rd and 4th intercostal space (ICS). From ages 4 to 6 years it is found at the 4th ICS medial to the left midclavicular line. From age 7 upward it is located at the 5th ICS lateral to the left midclavicular line. Heart sounds radiate and can be heard either to the right or left of the sternum but never directly over the sternum. The clavicle is located too high to hear heart sounds.