PEDS Exam 1

Define animism and give an example:

Animism is the belief that objects are alive EX the cords or tubes are snakes crawling up to pt.

A mother brings a 2 week old baby into the clinic. The mother is upset because she notices that when her baby is sleeping the baby breaths rapidly and then has pauses in breathing up to 16 seconds. She notices that the baby's abdomen rises and falls. The nurse assesses the baby and finds that this is true. The nurse also notes that the baby has no color or heart rate change when this is happening. The baby's pulse oximetry is 96%. What should the nurse do next? A. Refer the baby to the physician or nurse practitioner for follow up B. Refer the baby to the physician or nurse practitioner for follow up C. Send the baby for a chest X ray to determine the etiology of the problem D. Reassure the mother that this type of breathing is completely normal in a newborn

For respirations, babies are abdominal breathers so you can see the respirations with the rise and fall of the abdomen And periodic breathing is normal, you may see this as well. It looks like they hold there breath and then take a breath Take respiratory rate for 1 full minute. Babies are nose breathers, they have to breath through there nose, that cant breath with their mouth at this time We need to make sure there are not secretions in there and the nares are patient The RR for a newborn will be about 35 bpm For Infant 1 month to 11 month it will be about 30bpm

A 14 month old child is expected to have how many teeth?

Rationale: During the first 2 years of life: age of child in months minus 6 = number of teeth. In this case 14-6=8

You go into your friend's college dorm. She has a worn stuffed bunny named "Bun-Bun" on her bed. She says this toy was special and provided comfort to her as a child. What is the proper term nurses use to describe this special toy that children may be very attached to?

Rationale: Transitional object

The nurse is caring for a adolescent admitted for treatment of acute glomerulonephritis. Which question should the nurse ask when obtaining information about the present illness? A. "Have you had a sore throat recently?" B. "Has anyone in your family had chickenpox recently?" C. "Have you had a bladder infection in the last six weeks?" D. "Does anyone in your family have a history of kidney disease?

✓A. "Have you had a sore throat recently?" Rationale: Acute glomerulonephritis occurs as post infectious in most cases. Usually due to stretococcal, pnuemococcal or viral infection like strep throat which is common in children. If a child comes in with acute glomerulonephritis, they should be asked if they have had strep throat or a soar throat. The most common childhood renal disease is acute post-streptococcal glomerulonephritis and usually peaks around age 6 - 7 years of age.

An infant, age 5 months, is brought to the clinic by his parents for a well-baby checkup. Which of the following is the best advice that the nurse should include at this time about injury prevention? A. "Keep buttons, beads and other small objects out of his reach." B. "Do not permit him to chew paint from window ledges because he might absorb too much lead." C. "When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall." D. "Lock the crib sides securely because he may stand and lean against them and fall out of bed."

✓A. "Keep buttons, beads and other small objects out of his reach." Rationale: Aspiration of foreign objects is a great risk at this age. Parents are instructed to keep small objects out of the infant's reach. At this age, the child is not mobile enough to reach window sills. If window sills have cracked or chipped paint, it needs to be removed before he is a toddler. This child should already be rolling over. This information is reinforced but should have been taught earlier. Pulling to a stand occurs between 8 and 12 months of age.

The mother of a 2-week-old infant tells the nurse that she thinks he is sleeping too much. The most appropriate nursing response to this mother would be: A. "Tell me how many hours per day your baby sleeps." B. "It is normal for newborns to sleep most of the day." C. "Newborns generally sleep 12 to 15 hours per day." D. "You will find as the baby gets older, he sleeps less."

✓A. "Tell me how many hours per day your baby sleeps." Rationale: It is normal for babies to sleep a lot. However, to determine what is "normal" and what is "abnormal" we need to collect more information and ask the mother how much the baby is sleeping before any response should be given.

During the nurse's initial assessment of a school-age child, the child reports a pain level of 7 out of 10. The child is lying quietly in bed watching television. Which action by the nurse is most appropriate? A. Administer the prescribed analgesic B. Reassess the child in 15 minutes to see if the pain level has changed C. Ask the child's parents if they think he is hurting D. Do nothing, the child appears to be resting and comfortable

✓A. Administer the prescribed analgesic Rationale: School-age children are old enough to accurately report their pain level. A pain score of 6 is an indication for prompt administration of pain medication. The child may be trying to be brave or may be lying still because movement is painful.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: A. Bowel control is accomplished before bladder control, so the parent should focus on bowel training. B. Nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. C. The toddler must have the gross motor skill to climb up to the adult toilet before training is begun. D. The universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

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

What explanation provides the rationale for why iron-deficiency anemia is common during infancy? A. Cow's milk is a poor source of iron. B. Iron cannot be stored during fetal development. C. Fetal iron stores are depleted by 1 month of age. D. Dietary iron cannot be started until 12 months of age.

✓A. Cow's milk is a poor source of iron. Rationale: Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet, and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by ages 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

The nurse should suspect a hearing impairment in an infant who demonstrates which of the following behaviors? A. Lack of babbling by age 7 months B. Lack of eye contact when being spoken to C. Lack of the Moro reflex D. Lack of gesturing to indicate wants after age 10 months

✓A. Lack of babbling by age 7 months Rationale: The absence of babbling or inflections in voice by age 7 months is an indication of hearing difficulties. The absence of the Moro reflex and eye contact when being spoken to does not indicate a hearing impairment. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

When talking with a parent about tooth eruption, the nurse explains that the first deciduous teeth to erupt are the: A. Lower central incisors. B. Upper central incisors C. Lower lateral incisors D. Upper lateral incisors

✓A. Lower central incisors. Rationale: Teething usually begins at age 6 months with the eruption of the lower central incisors; 4 months is too early for teething. By age 8 months, the infant has the upper and lower central incisors. At age 12 months, the infant has six to eight deciduous teeth

The nurse is preparing to perform a heel stick on a neonate. Which complementary therapy is appropriate for the nurse to use decrease pain during this quick but painful procedure? A. Offer the infant a sucrose pacifier B. Hold the infant C. Swaddle the infant tightly D. Massage the infant in a counter clockwise pattern

✓A. Offer the infant a sucrose pacifier Rationale: Sucrose provides short-term natural pain relief and is most appropriate for use in neonates to decrease pain associated with a quick procedure. The other measures are more appropriate following the procedure or as an adjunct to pain medication for ongoing pain or distress.

Which of the following is most descriptive of atraumatic care of children? A. Prepare the child before any unfamiliar treatment or procedure B. Prepare the child for separation from the parents during hospitalization C. Help the child accept the pain that is associated with the treatment or

✓A. Prepare the child before any unfamiliar treatment or procedure Rationale: When using atraumatic care, the nurse would avoid or reduce painful procedures, avoid or reduce physical distress, use core primary nursing, maximize parent-child interactions, provide family-centered care, and provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.

The nurse is making a home visit after the death of an infant from SIDS. An appropriate objective for this visit is: A. Provide information on the grief process B. Reassure parents that SIDS is not likely to occur again C. Give contraceptive information D. Thoroughly investigate home situation to verify SIDS as cause of death

✓A. Provide information on the grief process Rationale: A home visit after the death of an infant is an excellent time to help the parents with the grief process. The nurse can clarify misconceptions about SIDS and provide information on support services and coping issues. Giving contraceptive information is inappropriate unless requested by parents. Telling the parents that SIDS is not likely to occur again is a false reassurance to the family. Investigating the home situation to verify SIDS as the cause of death is not the nurses role; this would have been done by legal and social services if there were a question about the infants death.

A mother verbalizes concern that her second-born son is reaching his milestones, but not as quickly at her first-born child. The best response from the nurse would be: A. "I will let the physician know right away." B. "It is normal for individual children to vary in reaching their developmental milestones." C. "Milestones should be reached consistently by each child." D. "A psychology consult should be ordered."

✓B. "It is normal for individual children to vary in reaching their developmental milestones." Rationale: "Norms can vary greatly for the individual child."Norms vary greatly for individual children. The most common cause for concern about a child is a sudden slowing, not typical for age, of any aspect of development

When assessing development in a 9-month-old infant, the nurse would expect to observe the infant: (Select all that apply) A. Speaking in 2-word sentences. B. Able to sit steadily unsupported C. Creeping along the floor D. Beginning to use a spoon neatly E. Standing on 1 leg for 3 seconds

✓B. Able to sit steadily unsupported ✓C. Creeping along the floor Rationale: Creeping along the floor and being able to sit steadily unsupported will be seen in a 9 month old. Speaking in 2-word sentences is usually seen around 2 years of age. Children can begin to use a spoon neatly around 18 to 24 months. being able to Standing on 1 leg for 3 seconds is not seen until around 3 years of age.

When teaching an adolescent with a urinary tract infection about taking Pyridium (phenazopyridine hydrochloride) the nurse should tell the patient to expect: A. Incontinence B. Bright orange-red urine C. Constipation D. Slight drowsiness

✓B. Bright orange-red urine Rationale: The client should be told that phenazopyridine hydrochloride (Pyridium) turns the urine a bright orange-red, which may stain underwear. It can be frightening for a client to see orange-red urine without having been forewarned. Other common adverse effects associated with phenazopyridine include headaches, gastrointestinal disturbances, and rash. Phenazopyridine does not cause incontinence, constipation, or drowsiness.

An abnormal finding in an evaluation of growth and development for a 6-month-old infant would be: A. Length increase of 1 inch in 2 months B. Head lag present C. Can sit alone for a few seconds D. Weight gain of 4 to 7 ounces per week

✓B. Head lag present Rationale: Head lag should be gone at 6 months

Whenever the parents of a 10-month-old leave their hospitalized child for short periods, the child begins to cry and scream. The nurse explains that this behavior demonstrates that the child: A. Needs to remain with his parents at all times. B. Is experiencing separation anxiety C. Is traumatized from painful procedures D. Is extremely spoiled

✓B. Is experiencing separation anxiety Rationale: This is experiencing separation anxiety. Infants and toddlers between the ages of 6months and 30 months experience separation anxiety.

The nurse is preparing to assess a toddler patient. Which activity would gain cooperation from the toddler? Selcet all that apply A. Administer the vaccines prior to the assessment B. Let the toddler sit on the parent's lap C. Ask the parents to wait outside D. Handing the client a stethoscope while taking the health history

✓B. Let the toddler sit on the parent's lap ✓D. Handing the client a stethoscope while taking the health history Rationale: Allowing the client to stay on the parents lap and allowing the client to play with instruments that will be used in the assessment process are activities the nurse can implement to gain the toddler's cooperation during the assessment process. Asking the parents to wait outside may cause the toddler to become fearful. Vaccinations should be administered at the end of the visit.

A child is admitted to the hospital unit with a diagnosis of minimal-change nephrotic syndrome (MCNS). Which clinical manifestations does the nurse anticipate when conducting the admission assessment? A. Hypertension, weight loss, proteinuria B. Massive proteinuria, hypoalbuminemia, edema C. Hematuria, bacteremia, weight gain D. Gross hematuria, albuminuria, fever

✓B. Massive proteinuria, hypoalbuminemia, edema Rationale: Nephrotic syndrome is an alteration in kidney function secondary to increased glomerular basement membrane permeability to plasma protein. It is characterized by massive proteinuria, hypoalbuminemia, and edema. While hematuria and hypertension may be present, they are not pronounced. Gross hematuria and hypertension are associated with glomerulonephritis. Bacteriuria and fever are associated with a urinary tract infection. Because of the edema, a weight gain, not a weight loss, would be seen.

While assessing the development of a 9-month-old infant, the nurse asks the mother if the child actively looks for toys when they are placed out of sight. Which developmental task is the nurse assessing this infant for? A. Conservation B. Object permanence C. Transductive reasoning D. Spatial relations

✓B. Object permanence Rationale: A child who has developed object permanence has the ability to understand that even though something is out of sight, it still exists. In centration, a child focuses only on a particular aspect of a situation. Transductive reasoning happens when a child connects two events in a cause-effect relationship because they have occurred at the same time. Conservation describes when a child knows that matter is not changed when its form is altered.

A boy, age 5 years old, has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and hit his teacher. This behavior has been a problem for approximately 8 to 10 weeks. Now he has started repeatedly hurting the family dog even though his parents have intervened. His parents have sent the dog away because they are afraid he will kill the dog. His parent asks the nurse for advice. Which of the following is the most appropriate intervention? A. Talk to the child to assess why he is acting like that B. Refer the child for a professional psychosocial assessment C. Explain that this is normal behavior in preschoolers, especially in boys D. Talk to the preschool teacher to obtain validation for the behavior the parent report. E. Encourage the parent to try more consistent and firm discipline.

✓B. Refer the child for a professional psychosocial assessment Rationale: The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior but the severity, frequency, and duration. Some aggressive behavior is within normal limits, if it is persistent . There is no indication that the parent is using inconsistent discipline. A part of the evaluation is to obtain validation for behavior parent reports.

When introducing hospital equipment to a preschooler who seems afraid, the nurses' approach should be based on which of the following principles? A. Explaining the equipment to the child may only increase the child's fear B. The child may think the equipment is alive C. One brief explanation will be enough to reduce the child's fear D. The child is too young to understand what the equipment does

✓B. The child may think the equipment is alive Rationale: Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the child's fear. The preschooler will need repeated explanations as reassurance.

The senior nursing student in their Capstone rotation is working in a neonatal intensive care unit with a preterm infant. The nursing student asks about the infant experiencing pain from so many procedures. The nurse's response should be which of the following? A. They may react to painful stimuli but are unable to remember the pain experience. B. They perceive and react to pain in much the same manner as children and adults. C. They do not have the cortical and subcortical centers that are needed for pain perception. D. They lack neurochemical systems associated with pain transmission and modulation

✓B. They perceive and react to pain in much the same manner as children and adults. Rationale: Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.

An 18-month old child comes into the pediatric clinic. The nurse notes a protuberant abdomen and spinal lordosis. The child also has a wide stance gait. All other findings of growth and development are appropriate and normal. The nurse appropriately tells the parent: "He may need to see an orthopedist for this curve." B. "I'm bringing in the Nurse Practitioner to further assess his back." C. "His growth and development are all on target for his age." D. "He will outgrow this baby fat by age six."

✓C. "His growth and development are all on target for his age." Rationale: These are normal finding for growth and development in this age group

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The nurse's reply should be based on knowledge of which of the following? A. The antibiotic therapy he is on contributes to labile blood pressure values B. Hypotension leading to sudden shock can develop at any time C. Acute hypertension is a concern that requires monitoring for identification D. Blood pressure fluctuations indicate that the condition has become chronic

✓C. Acute hypertension is a concern that requires monitoring for identification Rationale: Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations do not indicate chronic disease. Most children with glomerulonephritis fully recover. Vital signs, in particular blood pressure, provide information about the severity of the disease and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Hypertension is more likely with glomerulonephritis.

When the nurse notes that an infant can sit well before she can crawl well. The nurse is assessing which of the following? A. Specific to general development B. Proximodistal development C. Cephalocaudal development D. General to specific development

✓C. Cephalocaudal development Rationale: The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant's ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.

Using knowledge of child development, which of the following is the best approach when preparing a toddler for a procedure?A. Avoid asking the child to make choices B. Plan for teaching session to last about 20 minutes C. Demonstrate on a doll how the procedure will be done D. Show the necessary equipment without allowing child to handle it

✓C. Demonstrate on a doll how the procedure will be done Rationale: Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure. In preparing a toddler for a procedure, allow the child to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment, and allow the child to handle it.

The nurse explains that by the age of 6 months iron-rich foods should be offered because the infant has: A. Limited ability to produce red blood cells B. Ineffective digestive enzymes C. Exhausted maternal iron stores D. Need of the iron to support dentition

✓C. Exhausted maternal iron stores Rationale: A child will have exhausted maternal iron stores by 6 moths and therefore iron-rich food should be given

The most important factor that influences the development of urinary tract infections in children is: A. Poor hygiene B. Female gender C. Urinary stasis D. Congenital anomalies

✓C. Urinary stasis Rationale: Urinary stasis is the single most important host factor that influences the development of UTIs. Urine is usually sterile but at body temperature provides an excellent growth medium for bacteria. Poor hygiene can be a contributing cause, especially in females because their short urethras predispose them to UTIs. Urinary stasis then provides a growth medium for the bacteria. Intermittent constipation contributes to urinary stasis. A full rectum displaces the bladder and posterior urethra in the fixed and limited space of the bony pelvis, causing obstruction, incomplete micturition, and urinary stasis. Congenital anomalies can contribute to UTIs, but urinary stasis is the primary factor in many cases.

A toddler diagnosed with nephrotic syndrome has a fluid volume excess related to fluid accumulations in the tissues. Which measure should the nurse anticipate including in the child's plan of care? A. Limiting visitors to 2 to 3 hours per day B. Testing the specific gravity every shift C. Weighing the child at the same time each day D. Vital signs every 2 hours

✓C. Weighing the child at the same time each day Rationale: The best indicator of fluid balance is weight. Therefore, daily weight measurements help determine fluid losses and gains. Although limiting visitors to 2 to 3 hours per day or maintaining strict bed rest would help to ensure that the child gets adequate rest, this is unrelated to the child's fluid balance. In nephrotic syndrome, urine is tested for protein, not specific gravity.

The nanny to a newborn says that her brother, a toddler "is showing resentment toward the new baby and wants to get rid of her. He suggested that we bring her to the dog pound and leave her there." The nurse's best reply is which of the following? A. "Why do you think he resents the new baby?" B. "Did he make any other statements against the baby?" C. "I'll let the nurse practitioner know. He may need counseling to work this resentment out." D. "That is a normal response to a new baby in the house. Let's talk about strategies to help him ."

✓D. "That is a normal response to a new baby in the house. Let's talk about strategies to help him ." Rationale: This behavior is normal. Children at this age are egocentric and believe they are the "center of the universe". When a new baby enters the home the child can be upset as the attention is no longer solely on them and is now shared. This is a form of sibling rivalry. Coping strategies need to be discussed and implemented.

The nurse would place highest priority on which nursing activity in managing a young child diagnosed with a urinary tract infection (UTI)? A. Provide adequate fluids to prevent dehydration B. Restrict fluids to provide kidney rest C. Prevent enuresis D. Administer ordered antibiotics on schedule

✓D. Administer ordered antibiotics on schedule Rationale: Administer ordered antibiotics on schedule is the highest priority out the other options as this will treat the UTI.

Which is the single most important factor to consider when communicating with children? A. Presence of the child's parent B. Child's physical condition C. Child's nonverbal behaviors D. Child's developmental level

✓D. Child's developmental level Rationale: Always know the child development level so you can have a level of communication that will match the needs of the patient and so that patient will be able to understand what it is you are trying to communicate with them.

The parents of a 5-year-old child ask the nurse in the doctor's office what they should do about their child who is still wetting the bed several nights a week. In addition to reporting this to the physician, what suggestion should be included in the nurse's discussion with the parents? A. Have the child wear diapers to bed B. Suggest that they promise the child a sleep over party if the child stays dry for two weeks C. Punish the child each time he wets the bed. D. Do not give the child anything to drink after the evening meal

✓D. Do not give the child anything to drink after the evening meal Rationale: Enuresis is a disorder of elimination that involves the voluntary or involuntary release of urine into bedding, clothing, or other inappropriate times. For treatment we need to do lab tests to rule out primary causes and confirm there is a UTI. Next we will do fluid restriction so there will not have anything to drink after dinner or before bed time. Bladder training and scheduling can also be tried.

The nurse compared the birth weight of a 3-day-old newborn with her current weight and determined the infant had lost 7% of the baby's birth body weight. It is most appropriate for the nurse to A. Report the discrepancy to the pediatrician immediately B. Decrease the interval between the infant's feedings C. Try feeding the infant a different type of formula D. Do nothing because this is a normal occurrence

✓D. Do nothing because this is a normal occurrence Rationale: It is typical for the newborn to lose 5% to 10% of his or her birth weight in the first 3 to 4 days of life. No change in the plan of care is needed.

vesicoureteral reflux (VCR) with infection is the most common cause of pyelonephritis in children. In teaching the parent of a newly diagnosed 2-year-old, the nurse includes: A. Limit fluids to reduce reflux. B. Give cranberry juice twice a day C. Surgery is indicated to reverse scarring D. Have siblings examined for VCR

✓D. Have siblings examined for VCR Rationale: Vesiocouretal reflux is when there will be a retrograde flow of bladder urine into the ureters during voiding. Residual urine from the ureters stays in the bladder. Primary reflux occurs due to congenital anomalies. Secondary reflux occurs from acquired condition such as UTI. It does run in families and siblings are at risk and should be also tested.

A preterm infant has just been admitted to the neonatal intensive care unit. The infant's parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. The nurse's explanation should be based on knowledge that: A. Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli. B. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief. C. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences. D. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

✓D. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Rationale: Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates and there for the neonate can feel pain and should receive medication for pain when needed Respiratory - Mostly anatomic Immunologic system - Changes in IGs Cardiovascular - As they grow Heart rate slows, BP increases Hematopoietic changes - Physiologic anemia Digestive processes - Changes in stools Thermoregulation - Efficiency increases Renal function - Urine concentration builds Sensory - intact

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which of the following is the most appropriate recommendation? A. Punish the child. B. Give the child what they want in order to stop the tantrum. At eye level and in a calm voice explain to the child that the tantrum is wrong D. Remain close by the child but without eye contact

✓D. Remain close by the child but without eye contact Rationale: The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of "time-outs," which of the following instructions should the nurse include? A. Send the child to his room B. If child cries, refuses, or is more disruptive, try another approach C. General rule for length of time is 10 minutes per year of age D. Select an area that is safe and unstimulating, such as a hallway

✓D. Select an area that is safe and unstimulating, such as a hallway Rationale: Areas must be non stimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child's room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets.

A 3-year-old child is admitted with a diagnosis of nephrotic syndrome. Which signs would the nurse expect the parents to report when the child is admitted? A. Jaundiced skin and pale stools B. Blood in the urine and high fever C. Chest pain and shortness of breath D. Swelling around the eyes and weight gain

✓D. Swelling around the eyes and weight gain Rationale: A classic finding in a child with nephrotic syndrome will be facial edema. The other choices would not be a sign or symptom of nephrotic syndrome

A nurse caring for a school-age client notices some swelling in the child's ankles. The nurse presses against the ankle bone for five seconds, then releases the pressure and notices a markedly slow disappearance of the indentation. Which priority nursing assessment is appropriate? A. Skin integrity, especially in the lower extremities B. Range of motion and ankle mobility C. Level of consciousness D. Urine output

✓D. Urine output Rationale: Rationale 1: Dependent, pitting edema, especially in the lower extremities, can be a symptom of both kidney and cardiac disorders. Decreases in urine output can also indicate compromise in both the renal and cardiac systems. Changes in level of consciousness, if present, would more than likely be a later effect in this situation. While ankle edema could lead to both decreased ankle mobility and compromise in skin integrity, diagnosing and treating the underlying cause of the edema is most important.

An infant's birth weight is 7 pounds, 8 ounces. The nurse can project that the infant's weight at 12 months in Kilograms (KG) should be:

10.2 kg Rationale: Birth weight doubles at 6 months, triples at 1 year, quadruples at 2 to 2 ½ years , quintuples at 3 years. For this question, if a baby weighs 7 pounds, 8 ounces at birth it will be triple that at 12 months (1 year). For ounces: Each pound =16oz 8x3=24 24/16 = 1.5 For pounds 7X3=21 21+1.5=22.5 pounds Convert to kg (1kg = 2.2 lbs) 22.5/2.2 = 10.205 Round up = 10.2

A new mother is worried about a "soft spot" on the top of her newborn infant's head. The nurse informs her that this is a normal physical finding called the anterior fontanel. At what age will the nurse educate the mother that the soft spot will close? A. 12-18 months of age B. 2-3 months of age C. 24 months of age D. 6-9 months of age

12-18 months of age Rationale: The anterior fontanel is located at the top of the head and is the opening at the intersection of the suture lines. As the infant grows, the suture lines begin to fuse, and the anterior fontanel closes at 12 to 18 months of age.

At a well-child examination, the mother comments that her toddler eats little at mealtime, will only sit briefly at the table, and wants snacks all the time. Which of the following should the nurse recommend? A. Provide nutritious snacks B. Offer rewards for eating at mealtimes. C. Avoid snacks so she is hungry at mealtime. D. Explain to her firmly why eating at mealtime is important.

A. Provide nutritious snacks Rationale: Mealtime has psychosocial and physical significance. If the parents struggle to control toddlers' dietary intake, problem behavior and conflicts can result. Toddlers often develop "food jags," or the desire to eat one food repeatedly. Rather than becoming disturbed by this behavior, encourage parents to offer a variety of nutritious foods at meals and to provide only nutritious snacks between meals.