Peds: growth and development

21. Which foods would the nurse recommend to the mother of a 2-year-old with anemia? 1. 32 oz of whole cow's milk per day. 2. Meats, eggs, and green vegetables. 3. Fruits, whole grains, and rice. 4. 8 oz of juice, three times per day.

2. Meats, eggs, and green vegetables. rationale: Meat, eggs, and green vegetables are excellent sources of iron.

19. Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. "My child is able to stand but is not yet taking steps independently." 2. "My child has a vocabulary of approximately 15 words." 3. "My child is still sucking his thumb." 4. "My child seems to be quite wary of strangers."

1. "My child is able to stand but is not yet taking steps independently." rationale: The child should be walking indepen- dently by 15 to 18 months. Because this toddler is 18 months and not walk- ing, a referral should be made for a developmental consult.

29. A 3-year-old is hospitalized for an ASD repair. The parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is: 1. "Your mommy and daddy will be back after your nap." 2. "Your mommy and daddy will be back at 6:00 p.m." 3. "Your mommy and daddy will be back later this evening." 4. "Your mommy and daddy will be back in 3 hours."

1. "Your mommy and daddy will be back after your nap." rationale: Preschoolers understand time in relation to events.

32. What can a nurse do to reinforce a 5-year-old's intellectual initative when he asks about his upcoming surgery? 1. Answer the child's questions about his upcoming surgery in simple terms. 2. Provide the child with a book that has vivid illustrations about his sugery. 3. Tell the child he should wait and ask the doctor his questions. 4. Tell the child that she will anser his questions at a later time.

1. Answer the child's questions about his upcoming surgery in simple terms. rationale: The child is taking the initiative to ask questions, as all preschoolers do, and the nurse should always answer those questions as appropriately and accurately as possible.

11. Which finding would the nurse consider abnormal when performing a physical assessment on a 6-month-old? 1. Posterior fontanel is open. 2. Anterior fontanel is open. 3. Beginning signs of tooth eruption. 4. Able to track and follow objects.

1. Posterior fontanel is open. rationale: The posterior fontanel should close between 6 and 8 weeks of age.

37. A 4-year-old hospitalized with FTT has orders for daily weights, strict intake and output, and calorie counts. Which action by the nurse would be a concern? 1. The nurse weighs the child every morning before breakfast. 2. The nurse weighs the child with no clothing except for undergarments. 3. The nurse sits with the child while the child eats her meals. 4. The nurse weighs the child using the same scale every morning.

1. The nurse weighs the child every morning before breakfast. rationale: The child should be weighted every day on the smae scale before eating. Her weight will not be accurate reflection if she is fed prior to being weighed.

49. Which should the nurse recommend to the parents of a 9-year-old hosptialized following a bicycle injury? To prevent future injury, their child should: 1. Wear safety equipment while riding bicycles. 2. Read educational material on bicycle safety 3. watch a video on bicycle safety. 4. Ride his bike in the presence of adults.

1. Wear safety equipment while riding bicycles. rationale: safety equipment is essential for bicycling, skateboarding, and participating in contact sports. Most injuries occur during the school-age years, when children are more active and participate in contact sports.

7. A first-time mother brings in her 5-day-old baby for a well-child visit. The nurse weighs the infant and reports a weight of 7 lb 5 oz to the mother. The mother looks concerned and tells the nurse that her baby weighed 7 lb 10 oz when she was discharged 4 days ago. The nurse's best response to the mother is: 1. "I will let the doctor know, and he will talk with you about possible causes of your infant's weight loss." 2. "Al weight loss of a few ounces is common among newborns, especially for breastfeeding mothers." 3. "I can tell you are a first-time mother. Don't worry; we will find out why she is losing weight." 4. "Maybe she isn't getting enough milk. How often are you breastfeeding her?"

2. "Al weight loss of a few ounces is common among newborns, especially for breastfeeding mothers." rationale: Newborns can lose up to 10% of their birth weight without concern but should regain their birth weight by 2 weeks of age.

39. A 3-year-old boy has been hospitalized because he fell down the stairs. His mother is crying and states, "This is all my fault." Which is the nurse's best response? 1. "Accidents happen. You shouldn't blame yourself." 2. "Falls are one of the most common injuries in this age group." 3. "It may be a good idea to put a baby gate on the stairs." 4. "Your son should be proficient at walking down the stairs by now."

2. "Falls are one of the most common injuries in this age group." rationale: Falls are one of the most common injuries, and it may make the parent feel better to know that this is common.

38. A 3-year-old is attending her grandfather's funeral. Her parents told her that her grandfather is in heaven with God. Which statement describes a 3-year-old child's understanding of spirituality? 1. "The body is here with us on Earth, and the spirit is in heaven." 2. "He is in heaven. Is this heaven?" 3. "The spirit is no longer in his body." 4. "He won't need his body in heaven."

2. "He is in heaven. Is this heaven?" rationale: three-year-old children are literal thinkers. The child's parents told her that Grandpa was in heaven. She sees his body, so she thinks they are all in heaven.

15. The mother of an 11-month-old with iron deficiency anemia tells the nurse that her infant is currently taking iron and a multivitamin. Which statement made by the mother should be of concern to the nurse? 1. "I give the iron and multivitamin at the same time each morning." 2. "I give the iron and multivitamin in the morning 6-oz bottle." 3. "I give the iron and multivitamin 2 hours before I feed the morning bottle." 4. "I give the iron and multivitamin in oral syringes toward the back of the cheek."

2. "I give the iron and multivitamin in the morning 6-oz bottle." rationale: Medications should never be mixed in a large amount of food or formula be- cause the parent cannot be sure that the child will take the entire feeding. Formula decreases the absorption of iron.

4. Which statement by an infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? 1. "I will continue to breastfeed my son and will give him rice cereal three times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 8 ounces of baby juice per day."

2. "I will start my son on fruits and gradually introduce vegetables." rationale: Infants should be started on vegetables prior to fruits. The sweetness of the fruits may inhibit them from taking vegetables.

10. The mother of a newborn asks the nurse when the infant will receive the first hepatitis B immunization. Which is the nurse's best response? 1. "Babies receive the hepatitis B vaccine only if their mother is hepatitis B-positive." 2. "The first dose of the hepatitis B vaccine will be given prior to discharge today." 3. "The first dose of hepatitis B vaccine is given at 1 year of age." 4. "Babies receive their first hepatitis B vaccine at 6 months of age."

2. "The first dose of the hepatitis B vaccine will be given prior to discharge today." rationale: The first dose of hepatitis B vaccine is recommended between birth and 2 months. Most hospitals give the vac- cine prior to discharge home.

3. The nurse is going to give a 6-month-old a dose of Rocephin IM. What must the nurse do when the 1.5-mL dose arrives from the pharmacy? 1. Administer the injection into the deltoid muscle. 2. Divide the dose into two injections. 3. Administer the injection into the dorsogluteal muscle. 4. Give dose as a single injection into the vastus lateralis muscle.

2. Divide the dose into two injections. rationale: A nurse should not deliver more than 1 mL per IM injection to a child of 6 months.

33. A 5-year-old boy has always been one of the shortest children in class. His mother tells the school nurse that her husband is 6 tall and she is 57. What should the nurse tell the child's mother? 1. He is expected to grow about 3 inches every year from ages 6 to 9 years. 2. He is expected to grow about 2 inches every year from ages 6 to 9 years. 3. He should be seen by an endocrinologist for growth-hormone injections. 4. His growth should be re-evaluated when he is 7 years old.

2. He is expected to grow about 2 inches every year from ages 6 to 9 years. rationale: During the school-age years, a child grows approximately 2 inches per year.

A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside her clubhouse that says "No boys allowed." The child's parents are concerned that she is excluding their neighbor's son, and they are upset. What should the school nurse tell the child's parents? 1. Her behavior is cause for concern and should be addressed. 2. Her behavior is common among school-age children. 3. Her feelings about boys will subside within the next year. 4. They should have their daughter speak with the school counselor.

2. Her behavior is common among school-age children. rationale: This is common behavior. Girls of 9 and 10 generally prefer to have friends who are of the same gender.

26. Which stressor is common in hospitalized toddlers? Select all that apply. 1. Social isolation. 2. Interrupted routine. 3. Sleep disturbances. 4. Self-concept disturbances. 5. Fear of being hurt.

2. Interrupted routine. 3. Sleep disturbances. 5. Fear of being hurt. rationales: 2. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 3. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 5. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. The stressors of social iso- lation and self-concept disturbances are stressors of the hospitalized teen.

8. Which toy is the best choice for a 12-month-old? 1. Baby doll. 2. Musical rattle. 3. Board book. 4. Colorful beads.

2. Musical rattle. rationale: A musical rattle is the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation.

44. Which activity can the nurse provide for a 9-year-old to encourage a sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

2. Provide the child with the homework his teacher has sent. rationale: The school-age child is focuses on academic performance; therefore, the cild can achieve a sense of industry by completing his homework and staying on track with his classmates.

31. Which reaction would a nurse expect when giving a preschooler immunizations? 1. The child remains silent and still. 2. The child cries and tells the nurse that it hurts. 3. The child tries to stall the nurse. 4. The child remains still while telling the nurse that she is hurting him.

2. The child cries and tells the nurse that it hurts. rationale: The common response of a 5-year-old is to cry and protest during an immunization.

12. A mother requests that her child receive the varicella vaccine at the 9-month well-child checkup. The nurse tells the mother that: 1. Children who are vaccinated will likely develop a mild case of the disease. 2. The vaccine cannot be given at that visit. 3. The vaccine will be administered after the physician examines the child. 4. A booster vaccination will be needed at 18 months of age.

2. The vaccine cannot be given at that visit. rationale: The nurse should not give the vaccine. The varicella vaccine is not usually ad- ministered prior to 1 year of age.

48. Which technique should the nurse suggest to the mother of an 8-year-old who does not want to complete her chores? 1. Grounding. 2. Time-out. 3. Reward system. 4. Spanking.

3. Reward system. rationale: School-age children respond very well to a reward system and often enjoy the rewards so much that they will continue chores without continual reminders.

1. A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is: 1. "At 6 months his weight should be approximately three times his birth weight." 2. "Each child gains weight at his or her own pace." 3. "At 6 months his weight should be approximately twice his birth weight." 4. "At 6 months a child should weigh about 10 lb more than his or her birth weight."

3. "At 6 months his weight should be approximately twice his birth weight." rationale: Children should double their birth weight by 4 to 6 months of age.

6. The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with an adequate source of iron in her diet. Which statement reflects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby's diet when she is 2 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet."

3. "I will need to add iron supplements to my baby's diet when she is 2 months old." rationale: Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months. Full-term infants have iron stores that last approximately 4 to 6 months.

16. The nurse is using the FLACC scale to rate the pain level in a 9-month-old. Which is the nurse's best response to the father's question of what the FLACC scale is? 1. "It estimates a child's level of pain utilizing vital sign information." 2. "It estimates a child's level of pain based on parents' perception." 3. "It estimates a child's level of pain utilizing behavioral and physical responses." 4. "It estimates a child's level of pain utilizing a numeric scale from 0 to 5."

3. "It estimates a child's level of pain utilizing behavioral and physical responses." rationale: he FLACC scale utilizes behavioral and physical responses of the child to measure the child's level of pain. The scale utilizes facial expression, leg position, activity, intensity of cry, and level of consolability.

45. The mother of 11-year-old fraternal twins tells the nurse at their well-child checkup that she is concerned because her daughter has gained more weight and height than her twin brother. The mother is concerned that there is something wrong with her son. The nurse's best response is: 1. "I understand your concern. I will talk with the physician, and we can draw some lab work." 2. "Let me ask you whether your son has been ill lately." 3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." 4. "It is normal for you to be concerned, but I am sure your son will catch up with your daughter eventually."

3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." rationale: This is the appropriate response. The nurse understands that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood.

34. The nurse realizes that a 5-year-old's mother needs further education about the Denver Developmental Screening Test when she states: 1. "It screens for gross motor skills." 2. "It screens for fine motor skills." 3. "It screens for intelligence level." 4. "It screens for language development."

3. "It screens for intelligence level." rationale: The Denver Developmental Test does not test a child's level of intelligence.

18. The nurse is assessing the pain level in an infant who just had surgery. The infant's parent asks which vital sign changes are expected in a child experiencing pain. The nurse's best response is: 1. "We expect to see a child's heart rate decrease and respiratory rate increase." 2. "We expect to see a child's heart rate and blood pressure decrease." 3. "We expect to see a child's heart rate and blood pressure increase." 4. "We expect to see a child's heart rate increase and blood pressure decrease."

3. "We expect to see a child's heart rate and blood pressure increase." rationale: When a child is experiencing pain, the normal physiological response is for the heart rate, respiratory rate, and blood pressure to increase.

35. A 3-year-old admitted to the hospital with croup has the following vital signs: heart rate 90, respiratory rate 44, blood pressure 100/52, and temperature 98.8°F (37.1°C). The parents ask the nurse if these vital signs are normal. The nurse's best response is: 1. "Your son's blood pressure is elevated, but the other vital signs are within the normal range.." 2. "Your son's temperature is elevated, but the other vital signs are within the normal range.." 3. "Your son's respiratory rate is elevated, but the other vital signs are within the normal range." 4. "Your son's heart rate is elevated, but the other vital signs are within the normal range."

3. "Your son's respiratory rate is elevated, but the other vital signs are within the normal range." rationale: A normal respiratory rate for a child from 3 to 6 years is 20 to 30 breaths per minute.

17. A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental milestones, what should the nurse caring for the child expect the current weight to be? 1. 16 lb 4 oz 2. 20 lb 5 oz 3. 24 lb 6 oz 4. 32 lb 8 oz

3. 24 lb 6 oz Children should triple their birth weight by 12 months of age.

27. Which nursing action would help foster a hospitalized 3-year-old's sense of autonomy? 1. Let the child choose what time to take the oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe. 4. Let the child watch age-appropriate videos.

3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe.

36. Which action is a developmentally appropriate method for eliciting a 4-year-old's cooperation in obtaining the blood pressure? 1. Have the child's parents help put on the blood pressure cuff. 2. Tell the child that if he sits still, the blood pressure machine will go quickly. 3. Ask the child if he feels a squeezing of his arm. 4. Tell the child that measuring the blood pressure will not hurt.

3. Ask the child if he feels a squeezing of his arm. rationale: Preschool children enjoy games, and it is a good way to elicit their assistance and cooperation during a procedure.

13. What should parents understand is one of the most common causes of injury and death for a 7-month-old infant? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

3. Aspiration. rationale: Aspiration is a common cause of injury and death among children of this age. These children often find small objects lying on the floor and place them in their mouths. Older siblings are often responsible for leaving small objects around.

9. The parents of a newborn are asking the nurse how to use the infant car seat and where it should be placed in their vehicle. Which is the next most appropriate action by the nurse? 1. Give the parents a pamphlet explaining how to install the car seat. 2. Accompany the parents to the car, and show them how to install the car seat. 3. Contact the hospital's car-seat safety officer, and ask the officer to accompany the parents to the car for car-seat installation. 4. Show the parents a video on car-seat installation and safety, and ask if they are comfortable with the information.

3. Contact the hospital's car-seat safety officer, and ask the officer to accompany the parents to the car for car-seat installation. rationale: The car-seat safety officer is the best choice, as that individual would have the needed information and certification to help the family.

28. The best method to explain a procedure to a hospitalized preschool-age child is to: 1. Show the child a pamphlet with pictures showing the procedure. 2. Have the 5-year-old next door tell the 4-year-old about the experience. 3. Demonstrate the procedure on a doll. 4. Show the child a video of the procedure

3. Demonstrate the procedure on a doll. rationale: Allowing toddlers to participate in actions of which they are capable is an excellent way to enhance their autonomy.

2. How can the nurse best facilitate the trust relationship between infant and parents while the infant is hospitalized? The nurse should: 1. Encourage the parents to remain at their child's bedside as much as possible. 2. Keep parents informed about all aspects of their child's condition. 3. Encourage the parents to hold their child as much as possible. 4. Advise the parents to participate actively in their child's care.

3. Encourage the parents to hold their child as much as possible. rationale: Having parents hold their child while in the hospital is an excellent means of building the trust relationship. Infants are most secure when they are being held, patted, and spoken to.

23. Which should the nurse do to prevent separation anxiety in a hospitalized toddler? 1. Assume the parental role when parents are not able to be at the bedside. 2. Encourage the parents to always remain at the bedside. 3. Establish a routine similar to that of the child's home. 4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

3. Establish a routine similar to that of the child's home. rationale: It is very important to try to maintain a child's home routine both when par- ents are present and when they have to leave the hospital. This will increase the child's sense of security and de- crease anxiety.

43. Which is the best method of distraction for an 8-year-old who is having surgery later today and is NPO? 1. Use the telephone to call friends. 2. Watch television. 3. Play a board game. 4. Read the central line pamphlet he was given.

3. Play a board game. rationale: A board game is the opinmal choice because school-age children enjoy being engaged in an activity with others that will require some skill and challenge.

20. The mother of a child 2 years 6 months has arranged a play date with the neighbor and her child 2 years 9 months. During the play date the two mothers should expect that the children will do which of the following? 1. Share and trade their toys while playing. 2. Play with one another with little or no conflict. 3. Play alongside one another but not actively with one another. 4. Only play with one or two items, ignoring most of the other toys.

3. Play alongside one another but not actively with one another. rationale: Toddlers engage in parallel play. They often play alongside another child but they rarely engage in activities with the other child.

40. Which nursing action is most appropriate to gain information about how a child is feeling? 1. Actively attempt to make friends with the child before asking about her feelings. 2. Ask the child's parents what feelings she has expressed in regard to her diagnosis. 3. Provide the child with some paper to draw a picture of how she is feeling. 4. Ask the child direct questions about how she is feeling.

3. Provide the child with some paper to draw a picture of how she is feeling. rationale: Often children will include much more detail about their feelings in drawings. They will often express things in pictures that are unable to verbalize.

41. Which statement would indicate to the nurse that a school-age child is not developmentally on track for age? 1. The child is able to follow a four- to five-step command. 2. The child started wetting the bed on admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister.

3. The child has an imaginary friend named Kelly. rationale: Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age.

47. What information should a school nurse include in a discussion on nutrition with a fourth-grade class? 1. The number of calories that a fourth-grade child should consume in a day. 2. A list of high-calorie foods that all fourth-graders should avoid 3. How to read food labels so children know which foods are good for them. 4. A list of nutritious food with basic scientific information about how they affect the body organs and systems.

4. A list of nutritious food with basic scientific information about how they affect the body organs and systems. rationale: Reviewing nutritious choices keeps the lesson on a poisitive note, and school-age children are very interested in how fond affects their bodies. They are capable of understanding basic medical terminology.

25. Which comment should the parent of a 2-year-old expect from the toddler about a new baby brother? 1. "When the baby takes a nap, will you play with me?" 2. "Can I play with the baby?" 3. "The baby is so cute. I love him." 4. "It is time to put him away so we can play."

4. "It is time to put him away so we can play." rationale: This is a typical statement that would be made by a toddler. Toddlers are very egocentric and do not consider the needs of the other child.

14. An 8-day-old was admitted to the hospital with vomiting and dehydration. The newborn's heart rate is 170, respiratory rate is 44, blood pressure is 85/52, and temperature is 99°F (37.2°C). What is the nurse's best response to the parents who ask if the vital signs are normal? 1. "The blood pressure is elevated, but the other vital signs are within normal limits." 2. "The temperature is elevated, but the other vital signs are within normal limits." 3. "The respiratory rate is elevated, but the other vital signs are within normal limits." 4. "The heart rate is elevated, but the other vital signs are within normal limits."

4. "The heart rate is elevated, but the other vital signs are within normal limits." rationale: A normal heart rate for a child from birth to 1 month is 90 to 160.

42. Which statement accurately describes how the nurse should approach an 11-year-old to do a physical assessment? 1. Ask the child's parents to remain in the room during the physical exam. 2. Auscultate the heart, lungs, and abdomen first. 3. Explain that the physical exam will not hurt. 4. Explain what the nurse will be doing in basic understandable terms.

4. Explain what the nurse will be doing in basic understandable terms. rationale: School-age children are capable of of understanding basic functions of the body and can understand what the nurse will be doing if explained in basic terms.

22. A 2-year-old admitted to the hospital 2 days ago has been crying and is inconsolable much of the time. The nurse's best response to the child's parents who are concerned about this behavior is that the child is in the: 1. Detachment phase of separation anxiety, which is normal for children during hospitalization. 2. Despair stage of separation anxiety, which is normal for children during hospitalization. 3. Bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. Protest stage of separation anxiety, which is normal for children during hospitalization.

4. Protest stage of separation anxiety, which is normal for children during hospitalization. rationale: During the protest stage of separation anxiety, children are often inconsolable, and they often cry more than they do when they are at home. These children also frequently ask to go home.

30. Which approach should the nurse use to gather information from a child brought to the ED for suspected child abuse? 1. Promise the child that her parents will not know what she tells the nurse. 2. Promise the child that she will not have to see the suspected abuser again. 3. Use correct anatomical terms to discuss body parts. 4. Tell the child that the abuse is not her fault and that she is a good person.

4. Tell the child that the abuse is not her fault and that she is a good person. rationale: Many young children believe abuse or illness is their fault, and they should be reminded they are not to blame. Many children of this age believe they have acquired a disease or have been abused because they are bad people.

24. According to developmental theories, which important event is essential to the development of the toddler? 1. The child learns to feed self. 2. The child develops friendships. 3. The child learns to walk. 4. The child participates in being potty-trained.

4. The child participates in being potty-trained. rationale: Developmental theorists like Erickson and Freud believe that toilet training is the essential event that must be mas- tered by the toddler.

5. Which statement accurately describes the best method for assessing a 12-month-old? 1. The nurse should assess the child on the examining table. 2. The nurse should assess the child in a head-to-toe sequence. 3. The nurse should have the child's mother assist in holding her down. 4. The nurse should assess the child while she is in her mother's lap.

4. The nurse should assess the child while she is in her mother's lap. rationale: Infants are most secure when in proximity to the parent. The parent's lap is an excellent place to assess the child.