CPN Guide

What is the best way to prepare 4 yo Bryant for his admission to the hospital for same day surgery? a. allow him to play with the medical equipment at the preoperative office visit and explain that he will staying in the hospital for a few days. b. do not mention anything to Bryant until he arrives at the hospital on the morning of the operation. c. Explain the details of the operation and what will happen. d. Tell him that a hospital is a place where kids go and visit with each other and eat ice cream

a. allow him to play with the medical equipment at the preop office visit and explain that he will be staying in the hospital for a few days The preschooler is a magical thinker. It is more developmentally appropriate to give brief and understandable information such as that the child will be staying in the hospital for a few days. Allowing the child to handle equipment in a preop visit is an excellent way to include him. It is always important to tell the truth to children while keeping in mind that concrete explanations without a lot of detail are most appropriate for preschoolers.

When performing a physcial assessment of a 10 yo girl, the nurse keeps in mind that the first sign of sexual maturity is a. breast bud development b. pubic hair c. axillary hair d. menarche

a. breast bud development 10 years- breast bud development 11 years- axillary and pubic hair development 12 years- height spurt 13-14- menarache

Which of the following assessments would be abnormal in a newborn? a. closed anterior fontanel b. red, flaky skin c. crossed-eyes d. vernix

a. closed anterior fontanel the anterior fontanel normally closes between 12 and 18 months of age. Prior to this time, the open anterior fontanel allows for brain growth and compensation of changes in intracranial pressure.

When assessing a school age child's development the nurse understands that a primary developmental task of this age group is: a. developing friends b. learning to read c. learning to trust others d. developing independence

a. developing friends The school age child (5-12) is in Erikson's stage of Industry versus Inferiority. The primary job of the school age child is to develop competence through the achievement in school and the development of friendships. Important nursing assessment for the psycho social, personality development of the school age child is the assessment of adjustment and success in the school setting as well as the formation of friendships.

You are the inpatient nurse caring for a 12 yo who has been admitted for appendicitis. He shares with you that he is concerned about his short stature. Based on your knowledge of growth and development you know that: a. in boys, the height spurt occurs later in puberty than in girls b. in boys, the heigh spurt occurs about the same time during puberty as in girls c. in boys, the height spurt occurs earlier in puberty than in girls. d. it is impossible to predict how much more the child will grow.

a. in boys, the height spurt occurs later in puberty than in girls in boys, the height spurt is a late pubertal event, occurring 2 years later than in girls (13-14). Boys have a longer time to grow and a higher rate of growth during the pubertal growth spurt as compared to girls.

4 year old Erica is being admitted for pyelonephritis, you know she is in which developmental stage according to Erikson? a. Initiative versus guilt. b. identify versus role confusion c. industry versus inferiority d. Autonomy versus shame and doubt

a. initiative versus guilt 0-12 months: trust versus mistrust Trust vs. mistrust (0-12months): trust is promoted through bonding with a caregiver and consistently meeting the infant's basic needs. Autonomy vs. shame and doubt (1-2 years): Autonomy is fostered by promoting freedom to accomplish new things and become more independent Initiative vs. Guilt (3-6 years): initiative is fostered through allowing the child to successfully achieve new skills and become more independent Industry vs. Inferiority (7-12 yo): This stage is successful if the school age child can achieve (as in school or sport activities) and make friendships Identity vs. role confusion (13-19 yo): Identification of roles and integration with society are key issues.

A healthy 6 mo infant brought to the well-baby clinic for a WCC. When assessing the anterior fontanel the nurse expects it to be: a. open b. sunken c. closed d. bulging

a. open Anterior fontanel closes by 12-18 mos Sunken- r/t dehydration Bulging- increased ICP

The nurse should expect a 3 yo child to be able to perform which action? a. ride a tricycle b. tie his shoelaces c. roller-skate d. jump rope

a. ride a tricycle 3 yo- ride tricycle Early school age tying shoelaces and jumping rope

Which of the following would be the most accurate information to share with the mother an 8 yo girl who is asking about the onset of puberty? " In girls puberty begins on average at 10 yo with..." a. the development of breast buds b. the development of pubic hair c. the onset of menses d. a height spurt

a. the development of breast buds breast buds> pubic hair (11yo)> height spurt (12yo)> menarche (13)

Which developmental milestone would you expect to see the 9 mo developing? a. pincer grasp b. walking c. speaking intelligible words d. sitting up without support

a. the pincer grasp 8 mo- sitting up 9 mo- pincer grasp, "mama" "dada" 12-15 mos- walking

why does the nurse instruct the mother of an infant who is being introduced to baby foods for the first time to wait a few days before adding another new type of food this his diet? a. to determine if he has allergies to the new foods. b. to allow his stomach to adjust to the mixture of the various types of foods. c. to determine what type of foods he really likes to ear. d. to allow his digestive system to adjust to individual foods.

a. to determine if he has allergies to the new foods. it is best to wait 4-7 days in between each new food type in order to identify a particular food that may be the source of an allergic reaction.

What is the most important consideration when telling a 4 yo child about an upcoming procedure? a. use simple terms b. speak loudly and clearly c. offer a toy to keep the child happy. d. include every detail.

a. use simple terms Including a lot of details can be confusing and lead to fear and anxiety. Developmentally toys are appropriate they are not the most important component of preparation unless they are being used as a prop for demo.

A 6 mo infant is brought to the clinic for a well baby visit. the mother reports that the infant weighed 7 lbs at birth. Based on the nurse's knowledge of infant weight gain, which current weight would be considered the minimum weight expected for this infant to be within normal range for weight? a. 10 b. 14 c. 18 d. 21

b. 14 pounds Infants weight double by 6 months and triple by 1 year of age.

you expect which of the following developmental assessments of a 2 yo in your primary care clinic? a. toilet training b. 2 to 3 word sentences c. cooperative play d. sharing willingly

b. 2 to 3 word sentences the 2 yo uses 2 to 3 word sentence

You are the nurse in adolescent clinic caring for a 14 year-old Lisa who experienced menarche one year ago. Lisa is concerned that she is short and wants to know if she will grow much taller. Based on your knowledge of growth and development you know that: a. In girls menarche occurs early in puberty before the height spurt. b. In girls menarche occurs late in puberty after the height spurt. c. In girls the peak height velocity is usually around 15 years. d. It is impossible to predict how much more Lisa will grow.

b. Menarche occurs late in puberty The height spurt occurs earlier in puberty among girls as compared to boys. The average peak height velocity among girls is 12 years. There is limited growth potential after menarche with an average of 2.5cm. Girls have a shorter period of time in which to grow and a lower rate of growth during the pubertal height spurt as compared to boys.

Which is an example of cephalocaudal development? a. a child crawls before he walks; walks before he runs; runs before he jumps b. a child lifts his head before lifting his shoulders; sits with support before sitting without support c. a child rakes before developing pincer grasp; develops pincer grasp before feeding himself with a spoon d. a child first develops reflexive behaviors; then develops imitative behaviors.

b. a child lifts his head before lifting his shoulders; sits with support before sitting without support The principle of cephalocaudal development states that a child develops from head to toe.

The nurse would expect a 4 MO to a. sit alone b. attempt to roll over c. begin to crawl d. grasp feet and pull them to mouth

b. attempt to roll over 4 mos: first from stomach to back and then from back to stomach. 5 mos: Infants sit beginning with support 6 mos: the infant pushed up from stomach to hands and knees and rocks back and forth in that position 8 mo: develop the ability to sit without support 9 mos: crawls by

When assessing a toddler's growth and development, the nurse understands that a child in this age group displays behavior that fosters which developmental task? a. initiative b. autonomy c. trust d. industry

b. autonomy 1-2 yo: autonomy vs. shame and doubt stage. Developing the virtue of will. A lot of "Me do" and "no" and "mine". The toddler requires opportunities to accomplish independent tasks and respond to simple instruction, while supervised.

The mother of a 2 yo voices concern because her child does not share and uses the word "mine". You know that this is typical of which developmental stage according to Erikson: a. trust vs mistrust b. autonomy vs shame and doubt c. initiative versus guilt d. industry versus inferiority

b. autonomy vs shame and doubt

When developing a POC for an adolescent, the nurse considers the child's psychosocial needs. During adolescence, psychosocial development depends on: a. becoming industrious b. establishing an identity c. achieving intimacy d. developing initiative

b. establishing an identity The adolescent is in Erikson's psychosocial developmental stage of identity versus identity confusion. If the adolescent successfully masters this phase, she will develop a sense of identify with regard to personal identity, beliefs and/or values, sexual identity and goals for a future job or vocation.

You are the nurse at the community health clinic. The mother of a 2-year-old male expresses concern to you that her previously healthy child is non-verbal. Which of the following responses is most appropriate? a. "try not to worry. Language milestones vary. Boys have a tendency to lag behind girls." b. Given your son's age, we should probably test his hearing to be sure that is not the source of his delayed language skills." c. "Autism is the most frequent reason why children as old as 2 years of age are non-verbal. We will likely consult a developmental pediatrician for evaluation." d. "Let's look at your son's birth order as this is a significant predictor of language skills development."

b. given your son's age, we should probably test his hearing to be sure that is not the source of his delayed language skills. A 2 year old should be speaking in 2-3 word sentences. hearing deficit is the most common cause for young child's failure to develop speech. Birth order does not affect the development of language, but would not explain 2-year olds failure to speak. While autism might explain the failure to speak, it is far less common than a hearing deficit and would accompany other findings such as a lack of eye-contact, repetitive behavior, and lack of social interaction.

A parent calls the clinic to express concern over her childs eating habits. She says the child eats very little and consumes only a single type of food for weeks on end. The nurse knows this behavior is characteristic of: a. toddlers. b. pre-school age children c. school age children d. adolescents

b. preschool age children Preschool age children are known for their relatively small appetites and food jag eating behaviors. Also, preschoolers have a relatively slow rate of growth and, therefore, require fewer calories for growth. Food jags, generally disappear after this developmental phase. Generally, it is recommended that parents and caregivers avoid battles over food, particularly among toddlers and preschoolers.

Which nursing action would be the most important in the psychosocial support of a 2 year-old who is having an invasive procedure performed? a. assuring her that is is not her fault b. providing for parental presence c. providing adequate pain control d. performing the procedure quickly

b. providing for parental presence the 2-year-old is Erikson's stage of autonomy versus shame and doubt and Piaget's sensorimotor stage. Toddlerhood is a marked time of heightened separation anxiety with marked fear of strangers. For a child of this age, the most appropriate psychosocial support is to promote presence of the primary caregivers.

The nurse notes that an infant develops arm movements before fine-motor skills and interprets this as an example of which pattern of development? a. cephalocaudal b. proximodistal c. differentiation d. mass-to-specific

b. proximodistal From trunk to extremities. Manifested in the progression from gross motor large-muscle movement in the younger infant to more fine motor movements in the older infant. 4 months- raking 9 months- pincer grasp

Which of the following developmental milestones of the 5-month-old best reflects the principle of proximodistal growth and development? a. babbling b. raking objects c. rolling over d. eating solid foods

b. raking objects The principle of proximodistal development states that children develop from trunk to tips of the extremities. raking objects, develops at 4 mos, involves the use of the hands to "rake" objects prior to the development of the more specific pincer grasp occurring by 9 mos of age.

At 18 mos Jose is admitted for same day surgery. What does the nurse anticipate is his biggest fear? a. pain b. separation anxiety c. death d. body integrity

b. separation anxiety Sep anx most common for toddlers. Fear of pain and invasion of body integrity are issues of concern for older preschoolers and particularly school age children. Fear of death is a more common concern for the adolescent who is able to think abstractly.

Sam is a 2 mo that weighed 8 lb at birth. Based on your knowledge of pediatric growth you know that his weight at 1 yo should be at least. a. 16 lb b. 20 lb c. 24 lb d. 32 lb

c. 24 Infants should double weight at 6 mos and triple by one year

A baby's length is 20 inches at birth. You approximate her height at 4 yo to be: a. 30 in b. 35 in c. 40 in d. 45 in

c. 40 inches Normal growth patterns predict that a baby's birth length roughly doubles at four years of age.

The five year old uses how many words in a sentence? a. 3-4 b. 4-5 c. 5-6 d. 6-7

c. 5-6 A typical rule-of-thumb to remember is that a typical pre-school age child will speak in a sentence in the number of words equal to his age up to one more than his age. So a 5 yo would speak 5 to 6 word sentence.

When examining a 6 mo who is quietly sitting on her mother's lap, which of the following should the nurse do first? a. assessment of the fontanel b. palpation of pulses c. auscultation of the chest d. palpation of the abdomen

c. auscultation the 6 mo is developing stranger anxiety and may cry during invasive procedures. It is best to perform assessments which require the child to be quiet first. Assessment of the fontanel and pulses can be performed next. Palpation of the abdomen would be performed last.

Which of the following assessments would be most concerning in a 3 month old? a. closed posterior fontanel b. inability to roll over c. failure to track objects through visual fields d. failure to laugh

c. failure to track objects through visual fields The infant should develop the ability to track by 2-3 mo The posterior fontanel closes by 2-3 months, this is normal The infant begins to roll over by 4 mo. Laughing typically occurs at 4 mo.

In which of the following age groups does the child experience the fastest rate of growth in the limbs? a. infancy b. preschool c. school age d. adolescent

c. school age the limbs experience the fastest rate of growth during the school age years. The head experiences the fastest rate of growth during infancy. The trunk grows the fastest during the toddler and preschool years. The trunk, gonads, and associated tissues experience the fastest rate of growth during the adolescent years.

When assessing the development of a 6 mo old which of the following would be most concerning? a. The child weighs twice as much as his birth weight. b. The child does not look for hidden objects. c. The child does not understand the word "no". d. The child does not transfer objects from one hand to the other.

d. The child does not transfer objects from one hand to the other. the infant can transfer objects from one hand to another at five months of age. Failure to achieve this fine motor developmental task is considered a developmental delay. The 6 mo should at least double birth weight. Looking for hidden objects is an example of the understanding of object permanence, a phenomenon that occurs between 8 and 12 months. The infant understands the word no by 9 mos.

Which of the following would likely pose the greatest fear for a 7 yo Dana who was recently admitted to your unit for treatment osteomyelitis? a. oral medications b. a visit from the doctor c. having her mother leave for a few minutes d. a rectal temperature

d. a rectal temperature School age children are particularly fearful of disruption of their body integrity. Stranger anxiety subsides at the end of infancy and separation anxiety typically resolves and the end of toddlerhood.

Which of the following statements is true? a. Growth implies an increase in size and development b. Development refers to the maturation of structures of the body but does not include growth. c. growth and development usually progress from specific to general. d. development refers to the maturation of structures of the body and includes growth.

d. development refers to the maturation of structures of the body and includes growth. Development and growth usually progress from general to specific. Growth implies an increase in size but does not necessarily include development.

Which of the following assessment findings are normal in a healthy 6 mo? a. closed anterior and posterior fontanel b. open anterior and posterior fontanel c. closed anterior and open posterior fontanel d. open anterior and closed posterior fontanel

d. open anterior and closed posterior fontanel 2 mos- posterior fontanel closes 12-18 mos- anterior fontanel closes

Which of the following developmental milestones would be most advanced for 6 mo Harry? a. reaching for objects b. rolling over from back to front c. Laughing out loud d. sitting up unsupported for short periods

d. sitting unsupported for short periods is the most advanced 5mos- sit with support 8mos- without support 4-6 mos- reaching for objects 4mos- rolling over from front to back 5-6 mos- rolling from back to front 4 mos- laughing out loud is a social milestone

Which of the following would be most helpful when assessing a child's bone age? a. birth date b. body mass index c. blood test d. x-rays

d. x-rays Bone age is determined by taking an x-ray of the child's hands and wrists for comparison against an atlas of standard x-rays categorized by age. This test is used to predict the remaining height growth prediction given a certain bone age. Typically, a child's bone age should match his or her chronological age. A delayed bone age as compared to chronological age is consistent with an increased height growth predication, while an advanced bone age as compared to chronological age is consistent with a decreased height growth prediction.