Unit 1 Review
The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which best exemplifies a school-aged child working toward accomplishing this developmental task? 1 The child signs up for after-school activities. 2 The child performs his bedtime preparations autonomously. 3 The child becomes aware of the opposite sex. 4 The child is developing a conscience.
1 Erikson (1963) describes the task of the school-age years to be a sense of industry versus 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 that help to develop his or her cognitive and social skills. NOT 2 Achieving independence is a task of the preschooler who also is developing a conscience at that age. 3 Awareness of the opposite sex occurs in, but is not the focus of, the school-age child
Shelley, a mother, is new to the community, and the family is in a low-income bracket with limited transportation options. How could the pediatric nurse help Shelley get her new baby to her well-child visits to promote healthy growth and development? The nurse could: 1 link Shelley with the community's child health clinic. 2 give Shelley all information at this visit to save time. 3 schedule the next visit and hope Shelley can make it. 4 tell Shelley this office is her only option for visits.
1 In supervising children's health care, the health care provider must be a link between the child and family and individualize the health plan for each family. The nurse must focus on the support, community, and resources of the family for health promotion. NOT 2.3..4. The other choices do not support Shelley and her family issues. They also do not support compliance with an optimal schedule of well-child visits
Which would be least effective in gaining the cooperation of a toddler during a physical examination? 1 Tell the child that another child the same age wasn't afraid. 2 Allow the child to touch and hold the equipment when possible. 3 Permit the child to sit on the parent's lap during the examination. 4Offer immediate praise for holding still or doing what was asked.
1 Toddlers are egocentric, and telling the toddler how well another child behaved or cooperated probably will not help gain this child's cooperation. NOT 2.3.4. Allowing the child to touch and hold the equipment, permitting the child to sit on the parent's lap during the exam, and offering praise immediately for cooperating would foster cooperation
The nurse is watching toddlers at play. Which normal behavior would the nurse observe? 1 Toddlers engage in parallel play. 2 Toddlers engage in solitary play. 3 Toddlers engage in cooperative play. 4 Toddlers do not engage in play outside the home
1 Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.
The public health nurse is preparing a presentation on barriers to health care. Which barriers should the nurse include? Select all that apply. 1 lack of insurance to cover needed services 2 both parents working 3 lack of knowledge regarding the importance of prenatal or preventive care 4 speaking a different language than the physician 5 the trend to provide care in the home or community-based services
1.2.3.4.5. Barriers to health care include lack of insurance to cover needed services, both parents working (which can lead to transportation difficulties), lack of knowledge regarding the importance of prenatal or preventive care, speaking a different language than the physician, and the trend to provide care in the home or community-based services
The school nurse is teaching a group of 7-year-olds about proper dental hygiene. Which statement made by a 7-year-old indicates a good understanding of dental hygiene? Select all that apply. 1 "I will brush my teeth twice daily." 2 "It's OK if I eat candy if I brush my teeth good." 3 "Since I don't have any cavities I don't need to go to the dentist." 4 "I will drink water with fluoride for strong teeth." 5 "I should go to the dentist every year even if I don't have cavities."
1.2.4. Dental caries are largely preventable with proper brushing and the use of fluoridated water or fluoride application. Dental visits are recommended every 6 months. Dental visits should occur regularly even without cavities. It is important to check for proper teeth eruption and the possibility of malocclusion as well as for caries. When dental caries occur, they should be treated quickly and the child's dental hygiene practices be evaluated and improved.
The nurse sees a 15-month-old at a health maintenance visit. Of the following assessments, which one is generally included in a 15-month checkup? 1 Blood pressure 2 Height and weight measurements 3 Clean-catch urine 4 IQ testing
2 Because height and weight are such strong determinants of health, they are measured at every health assessment
The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? 1 The child has trouble undressing himself. 2 The child is unable to push a toy lawnmower. 3 The child is unable to unscrew a jar lid. 4 The child falls when he bends over
2 Children with normal motor development are able to push toys with wheels at 24 months of age. NOT 1.3.4. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age
When describing organ donation to the family of a dying child, what would the nurse include in the discussion? 1 Tell them that further harm may occur to the child through the process. 2 Tell them that their cultural and religious beliefs will be considered. 3 Include this topic in the discussion of impending death. 4 Inform the family that organ donation will delay the funeral.
2 During organ donation, the family's cultural and religious beliefs must be considered, and the team discussing organ donation with the family must do so in a sensitive and ethical manner. NOT 1 The donating child will not suffer further because of organ donation. 3 The topic of organ donation should be separated from the discussion of impending death or brain death notification. 4 Organs are harvested in a timely fashion after the declaration of death so the family need not worry about delay of the wake or funeral
The nurse is educating a first-time mother who has a 1-week-old infant. Which anticipatory guidance is accurate? 1 describing the effect of neonatal teeth on breastfeeding 2 explaining that the child will need frequent feedings every 2 to 3 hours 3 informing that fontanels (fontanelles) will close by 6 months 4 telling the mother that the step reflex persists until the infant walks
2 Explaining that the infant's stomach is small and will need feedings every 2 to 3 hours is the most helpful and accurate anticipatory guidance. NOT Telling the mother that the step reflex persists until the infant walks and informing the mother that fontanels (fontanelles) will close by 6 months are inaccurate. 4.3. The step reflex disappears at about 2 months and fontanels (fontanelles)close between 12 and 18 months. 1 Neonatal teeth are highly unusual and need no explanation unless they occur.
The mother of a 12-year-old boy is talking with the school nurse about her son's clumsiness. She reports that he seems to fall a lot, his writing is horrible, and as much as he practices he can't play his guitar very well. How should the nurse respond to the mother? 1 "Boys tend to take a bit longer than girls to mature." 2 "Have you spoken with your pediatrician about your observations?" 3 "Boys tend to refine their fine motor skills by this age." 4 "I will make a note of your observations and talk to his teachers."
2 Myelinization of the CNS is reflected by refinement of fine motor skills. The child between 10 and 12 years of age begins to exhibit manipulative skills comparable to adults. In order to determine if the child is delayed in fine motor skill development, the pediatrician should be made aware because further examination or testing may be warranted. NOT 3 Just stating the fact that his motor skills should be developed by this age, although true, does not address the mother's concerns. 4 The teachers can be notified of the mother's observations, but the child should still be assessed by the pediatrician
The nurse has seen a 15-year-old girl and a 16-year-old boy during health surveillance visits. Which physical characteristics would be seen in both teenagers? 1 Increased respiratory rates of 24 to 30 breaths per minute 2 Beginning of secondary sexual characteristic development 3 Increased shoulder, chest, and hip widths 4 Development of muscle tone
3 Both teenagers are in the middle state of adolescence, which is marked by an increase in shoulder, chest, and hip widths. NOT 1 Decreased respiratory rate, not increased, occurs in early adolescence. 2 Secondary sex characteristics occur beginning at puberty. 4 Muscle tone can be present throughout childhood
The parents of a child with a developmental disability express feeling guilty because they sometimes find themselves wondering how their child would be without the disability. Which response by the nurse best shows empathy and encourages the parents to vent their feelings? 1 "I'm sure it must be difficult to have a child developmentally delayed." 2 "There are lots of parents that are experiencing the difficulty and feelings of hopelessness and grief you are having. Maybe if you talk to someone it might help you both." 3 "I can only imagine how hard it is for you. You should know that it is common for parents to have these feelings when having a child with special needs." 4 "It is important to focus on the positives that can come from the experience of being the parents of a child that has these issues."
3 Showing empathy by stating, "I can only imagine how hard it is for you" is important when developing rapport and supporting the parents, and letting them know that they are not alone in the feelings they are experiencing allows them to feel less guilty. NOT 1 Just stating, "I am sure it must be difficult to have a child developmentally delayed" may convey empathy but it does not allow for open conversation. 2 "There are lots of parents that are experiencing the difficulty..." does not convey empathy. 4 "It is important to focus on the positives" does not address the parents feelings
The nurse is performing a physical assessment of a 3-year-old girl. What finding would be a concern for the nurse? 1 The toddler gained 4 pounds in weight since last year. 2 The toddler gained 3 inches in height since last year. 3 The toddler's anterior fontanel (fontanelle) is not fully closed. 4 The circumference of the child's head increased 1 inch since last year.
3 The anterior fontanel (fontanelle) should be closed by the time the child is 18 months old. NOT 1 The average toddler weight gain is 3 to 5 pounds per year. 2 Length/height increases by an average of 3 inches per year. 4 Head circumference increases about 1 inch from when the child is between 1 and 2 years of age, then increases an average of a half-inch per year until age 5
The nurse is caring for a 4-year-old girl of Mexican descent who is recovering in the hospital following a diagnosis of epileptic seizures. The child's mother insists on a visit from her curandera to provide healing powers to her daughter. What would be the best intervention of the nurse in this situation? 1 Explain to the mother that hospital policy does not allow visits from unlicensed practitioners. 2 Encourage the mother to arrange a visit with her curandera when her daughter is released from the hospital. 3 Discuss the situation with the child's physician and arrange for a visit from the curandera at the hospital if appropriate. 4 Distract the child's mother from her demands by focusing on child and family teaching related to her daughter's condition.
3 The curandero (male) or the curandera (female) of the Mexican American community is believed to have healing powers as a gift from God. If the folk remedies or practices of the folk healers are compatible with the health regimen and support appropriate health practices, these practices and beliefs do no harm; in fact, they may even benefit the child and family. However, use of a folk healer can lead to a delay in beneficial treatment or create other problems; therefore, the child's physician should be consulted prior to arranging a visit.
The nurse enters her client's room and finds the infant on a pillow with a bottle propped up while the mother is dressing. What statement should the nurse make? 1 "Look how cute she is." 2 "Are you almost ready to be discharged?" 3 "You should always hold your baby for feedings instead of propping the bottles." 4 "Is she almost done feeding?"
3 The nurse should educate the mother on the risks of propping bottles with infants. Infants are at risk for aspiration of milk and for otitis media. NOT 1.2.4. The other choices do not point out the safety risks or educate the mother
The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond? 1 "Your daughter has acrocyanosis; this is causing her blue hands and feet." 2 "Let's watch her carefully to make sure she does not have a circulatory problem." 3 "This is normal; her circulatory system will take a few days to adjust." 4 "This is a vasomotor response caused by cooling or warming."
3 The nurse should tell the parents that this is normal and that the baby's circulatory system is adjusting to extrauterine life. NOT 1 Using the technical term "acrocyanosis" would most likely scare the parents. 2 Telling the parents that the child may have a circulatory problem is inaccurate as this is a normal variation. 4 Acrocyanosis and the mottling caused by cooling and warming are two different variations.
The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do? 1 "Place her in a booster seat with lap and shoulder belts in the front seat." 2 "Place her in the back seat with the lap and shoulder belts in place." 3 "Place her in a forward-facing car seat with a harness and top tether." 4 "Place her in a booster seat with lap and shoulder belts in the back seat."
4 A child who weighs between 40 and 80 pounds should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap/shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. 3 A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 pounds
A mother reports to the nurse that her 4-year-old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother? 1 "I can imagine that it would be very irritating." 2 "I am sure there are ways to get your daughter to stop imitating you." 3 "This is not normal behavior. I am going to get the doctor's advice." 4 "Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development."
4 The nurse needs to inform the mother that preschoolers have an imagination that is keener than it will be at any other stage. They enjoy games using imitation and they mimic exactly what they see parents do. It is a normal part of their development
Latchkey kid
A latchkey kid, or latchkey child, is a child who returns to an empty home after school or a child who is often left at home with no supervision because their parents are away at work. Child can be any age, alone or with siblings
The nurse practitioner inspects a toddler's teeth. The nurse practitioner encourages the family to establish a dental home in order to achieve optimal dental health for the various family members. Select all reasons for this action that apply. 1 Comprehensive health care is possible only if oral health is part of the equation. 2 Dental care is the most unmet health need of children in the United States. 3 Certain dental interventions including fluoride treatments could significantly reduce the cost of oral care for children. 4 Poor oral health care for children can result in systemic health problems.
All statements are true and underscore the importance of good oral health care best achieved through a dental home.
A group of nursing students are completing a clinical day at a preschool. Which behaviors would they identify as common in this preschool group? Select all that apply. Regression Telling of tall tales Imaginary friends Sibling rivalry Difficulty with sharing Completing multi-step tasks
Common behavior variations of preschoolers include telling tall tales, imaginary friends, regression (returning to a less developed state), sibling rivalry and difficulty with sharing. Multi-step tasks are able to be completed by school-aged children
Ethnocentrism
Ethnocentrism is a belief that one's own culture or customs are superior to those of others
Moro reflex
Infant reflex where a baby will startle in response to a loud sound or sudden movement.
A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? 1 "This is a primitive reflex known as the plantar grasp." 2 "This is a primitive reflex known as the palmar grasp." 3 "This is a protective reflex known as rooting." 4 "This is a protective reflex known as the Moro reflex."
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. 2 During the palmar grasp, the infant reflexively grasps when the palm is touched. NOT 1 The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. 3 The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. 4 The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."