Exam 1 Practice Questions

A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1. Encourage the child's parents to stay with the child. 2. Encourage play with other children of the same age. 3. Advise the family to visit only during the scheduled visiting hours. 4. Provide a private room, allowing the child to bring favorite toys from home.

1. Encourage the child's parents to stay with the child. Rationale: Although the preschooler already may be spending some time away from parents at a day care center or preschool, illness adds a stressor that makes separation more difficult. The child may ask repeatedly when parents will be coming for a visit or may constantly want to call the parents. Options 3 and 4 increase stress related to separation anxiety. Option 2 is unrelated to the subject of the question and, in addition, may not be appropriate for a child who may be immunocompromised and at risk for infection.

The parents of a 13-year-old boy are concerned because he is exhibiting rebellious behavior. The nurse understands that typical adolescent rebellion occurs at which of the following? 1. Final separation-individuation phase 2. Start of aggressive behavior 3. Start of peer relationships 4. Final phase of relationships

1. Final separation-individuation phase Rebellion against parents occurs during the final separation- individuation phase. This assists the adolescent in developing a sense of identity. Typical adolescent rebellion is not a sign of an aggressive personality. Typically, peer relationships start in the school-age years. There is no final relationship phase.

When teaching parents about typical toddler eating patterns, which of the following should be included? 1. Food "jags" 2. Preference to eat alone 3. Consistent table manners 4. Increase in appetite

1. Food "jags" Toddlers become picky eaters, experiencing food jags and eating large amounts one day and very little the next. A toddler's food jags express a preference for the ritualism of eating one type of food for several days at a time. Toddlers typically enjoy socialization and imitating others at meal time. Toddlers prefer to feed themselves and thus are too young to have table manners. A toddler's appetite and need for calories, protein, and fluid decrease due to the dramatic slowing of growth rate.

After administering an I.M. injection to a preschooler, which of the following is the primary reason for the nurse to apply an adhesive bandage to the site? 1. Children will use them to get attention from their parents. 2. Children are afraid that they will leak from the "hole." 3. Bandages help to alleviate fear of strangers. 4. Children collect bandages to show their peers.

2. Children are afraid that they will leak from the "hole." Preschoolers have poorly defined body boundary images. Therefore, they are afraid that their body parts will come out of the injection site. Applying the bandage helps to control this fear. They may use the bandage for attention, but this is secondary. Fear of strangers is more apparent in toddlers. School-age children are more likely to collect things to show their peers.

The nurse is monitoring a 3-month-old infant for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior fontanel is soft and flat. On the basis of this finding, which nursing action is most appropriate? 1. Increase oral fluids. 2. Document the finding. 3. Notify the health care provider (HCP). 4. Elevate the head of the bed to 90 degrees.

2. Document the finding. Rationale: The anterior fontanel is diamond-shaped and located on the top of the head. The fontanel should be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age. The nurse would document the finding because it is normal. There is no useful reason to increase oral fluids, notify the HCP, or elevate the head of the bed to 90 degrees.

The nurse assesses the vital signs of a 12-month-old infant with a respiratory infection and notes that the respiratory rate is 35 breaths/minute. On the basis of this finding, which action is most appropriate? 1. Administer oxygen. 2. Document the findings. 3. Notify the health care provider. 4. Reassess the respiratory rate in 15 minutes.

2. Document the findings. Rationale: The normal respiratory rate in a 12-month-old infant is 20 to 40 breaths/minute. The normal apical heart rate is 90 to 130 beats/minute, and the average blood pressure is 90/56 mm Hg. The nurse would document the findings.

When providing therapeutic play, which of the following toys would best promote imaginative play in a 4-year-old? 1. Large blocks 2. Dress-up clothes 3. Wooden puzzle 4. Big wheels

2. Dress-up clothes Dress-up clothes enhance imaginative play and imagination, allowing preschoolers to engage in rich fantasy play. Building blocks and wooden puzzles are appropriate for encouraging fine motor development. Big wheels and tricycles encourage gross motor development

When developing a plan of safety teaching for children older than 1 year of age, which of the following is the primary cause of death and disability? 1. Cancer 2. Injuries 3. Acquired immunodeficiency syndrome (AIDS) 4. Anomalies

2. Injuries Injuries cause more death and disability in children older than 1 year than all of the other combined causes. Cancer is a leading cause of disability, but it is not the leading cause of death in children older than 1 year. The incidence of AIDS in children older than 1 year is increasing and is becoming a leading cause of death. Congenital anomalies are the leading cause of death in children younger than 1 year.

When providing health teaching for a 4-year-old, the nurse knows that the child is capable of which of the following? 1. Understanding another's point of view 2. Making simple classifications 3. Exhibiting intuitive thought 4. Seeing relationships in reverse

2. Making simple classifications The preconceptual child, age 2 to 4 years, is capable of making simple classifications. Seeing another's point of view occurs during concrete operations, typically between the ages of 7 to 11 years. Intuitive thinking occurs during the intuitive phase, ages 4 to 7 years. Seeing relationships involving the reverse occurs in formal operations, ages 11 to 15 years.

The parents of an 18-month-old express concern over the child's protruding abdomen. The nurse notes that the protrusion is within normal limits. Which of the following would explain the rationale for this finding when the nurse teaches the parents that this is normal? 1. Increased food intake owing to age 2. Underdeveloped abdominal muscles 3. Bowlegged posture 4. Linear growth curve

2. Underdeveloped abdominal muscles Underdeveloped abdominal musculature gives the toddler a characteristically protruding abdomen. During toddlerhood, food intake decreases, not increases. Toddlers are characteristically bowlegged because the leg muscles must bear the weight of the relatively large trunk. Toddler growth patterns occur in a step-like, not linear, pattern.

The nurse is evaluating the developmental level of a 2-year-old. Which does the nurse expect to observe in this child? 1. Uses a fork to eat 2. Uses a cup to drink 3. Pours own milk into a cup 4. Uses a knife for cutting food

2. Uses a cup to drink Rationale: By age 2 years, the child can use a cup and spoon correctly but with some spilling. By age 3 to 4, the child begins to use a fork. By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting.

The order reads: Give acetaminophen 10 mg/kg stat to a 44-lb child. How many mg should the nurse administer?

200 mg A 44-lb child weighs 20 kg (44 ÷ 2.2) = 20. 20 × 10 = 200.

The mother of a 20-month-old boy asks the nurse why her son has temper tantrums. Which of the following would be the nurse's best response? 1. "It is the only way he can get attention from his mother." 2. "He is probably spoiled and needs discipline." 3. "He cannot express his feelings or frustrations verbally." 4. "He is expressing his need for identity."

3. "He cannot express his feelings or frustrations verbally." Temper tantrums are a means for the toddler to exert independence because the child is unable to express his feelings or frustrations verbally. Temper tantrums usually decrease when a child learns words to express himself. Stating that tantrums are the only way to get attention is inappropriate because toddlers use many methods to get their parents' attention. Telling a parent that the child is spoiled is an inappropriate response. Identity is not an issue for toddlers; separation and individuation are.

According to Erikson, which of the following reasons explains why an adolescent may have difficulty mastering appropriate psychosocial tasks? 1. The basic focus is on mastery of sexual relationships. 2. Only a limited interaction occurs between culture and individual development. 3. Modern culture tends to make identity crisis the most challenging to resolve. 4. The adolescent commonly lacks positive role models.

3. Modern culture tends to make identity crisis the most challenging to resolve. According to Erikson, modern culture tends to make identity development challenging. An adolescent must resolve many choices and demands to master the task of identity. Adolescents who cannot develop a sense of who they are and what they can become may experience role diffusion and an inability to solve core conflicts. Mastery of sexual relationships is part of the young adult task of intimacy. Adolescents have several interactions with culture. Peers, teachers, parents, and extended family all serve as role models.

The preschooler typically views parents as which of the following? 1. Necessary evil 2. Persons who keep order 3. Omnipotent persons 4. Very rigid individuals

3. Omnipotent persons Typically, the preschooler believes that parents can do no wrong and enjoys their guidance. Thus, the parents are viewed as omnipotent. The view of parents as a necessary evil is more typical of an adolescent. The preschooler has not yet developed the view of parents as those who keep order. Preschoolers are not bothered by rigidity. In fact, guidelines give them a sense of security.

A 30-month-old girl always puts her teddy bear on the left side of her bed immediately after her mother reads a bedtime story. Which of the following describes the purpose of this repeated behavior? 1. Manipulation of the adults in the child's environment 2. Establishment of learning behaviors 3. Provision of a sense of security 4. Establishment of a sense of identity

3. Provision of a sense of security The child is demonstrating ritualistic behavior. For toddlers, rituals provide a sense of security so that they may achieve autonomy. A toddler's cognitive development is not at a level that would allow her to manipulate the environment. No evidence exists that rituals support learning. Independence, not identity, is the issue for toddlers.

A hospitalized school-age child states: "I'm not afraid of this place, I'm not afraid of anything." This statement is most likely an example of which of the following? 1. Regression 2. Repression 3. Reaction formation 4. Rationalization

3. Reaction formation Reaction formation is the school-age child's typical defensive response when hospitalized. In reaction formation, expression of unacceptable thoughts or behaviors is prevented (or overridden) by the exaggerated expression of opposite thoughts or types of behaviors. Regression is seen in toddlers and preschoolers when they retreat or return to an earlier level of development. Repression refers to the involuntary blocking of unpleasant feelings and experiences from one's awareness. Rationalization is the attempt to make excuses to justify unacceptable feelings or behaviors.

Which of the following statements should the nurse stress when teaching parents to maintain a consistent bedtime schedule for their 9- year-old? 1. The child's need for sleep is greater now than in adolescence. 2. Nightmares and night terrors are common. 3. The child often is unaware of his own fatigue level. 4. Ten hours of sleep every night is the minimum requirement.

3. The child often is unaware of his own fatigue level. School-age children are often unaware of their own fatigue level. If allowed to remain awake, they will be tired the next day. Because of the slowing growth rate during this period, school-age children require less sleep than adolescents do. Nightmares and night terrors are common during the preschool period. Although the requirements may vary, school-age children typically require approximately 8 to 91⁄2 hours of sleep every night.

When teaching parents about the child's readiness for toilet training, which of the following signs should the nurse instruct them to watch for in the toddler? 1. Demonstrates dryness for 4 hours 2. Demonstrates ability to sit and walk 3. Has a new sibling for stimulation 4. Verbalizes desire to go to the bathroom

4. Verbalizes desire to go to the bathroom The child must be able to state the need to go to the bathroom to initiate toilet training. Usually, a child needs to be dry for 2 hours, not 4 hours. The child also must be able to sit, walk, and squat. A new sibling would most likely hinder toilet training.

Which of the following would the nurse use to respond to the mother of an 8-year-old girl who asks about when her child will begin puberty? 1. "It begins between ages 8 and 13." 2. "It begins between ages 10 and 13." 3. "It begins between ages 12 and 15." 4. "It begins between ages 14 and 15."

1. "It begins between ages 8 and 13." In girls, puberty generally begins between ages 8 and 13. In boys, puberty generally begins between ages 9 and 14.

Which of the following skills is the most significant one learned during the school-age period? 1. Collecting 2. Arranging 3. Reading 4. Sorting

3. Reading The most significant skill learned during the school-age period is reading. During this time the child develops formal adult articulation patterns and learns that words can be arranged in structure. Collecting, arranging, and sorting, although important, are not the most significant skills learned.

A health care provider's prescription reads "ampicillin sodium 125 mg IV every 6 hours." The medication label reads "when reconstituted with 7.4 mL of bacteriostatic water, the final concentration is 1 g/7.4 mL." The nurse prepares to draw up how many milliliters to administer 1 dose? 1. 1.1 mL 2. 0.54 mL 3. 7.425 mL 4. 0.925 mL

4. 0.925 mL

Penicillin G procaine, 1,000,000 units IM (intramuscularly), is prescribed for a child with an infection. The medication label reads "1,200,000 units per 2 mL." The nurse has determined that the dose prescribed is safe. The nurse administers how many milliliters per dose to the child? 1. 0.8 mL 2. 1.2 mL 3. 1.4 mL 4. 1.7 mL

4. 1.7 mL

A 16-year-old client is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is most appropriate to facilitate normal growth and development postoperatively? 1. Encourage the client to rest and read. 2. Encourage the parents to room in with the client. 3. Allow the family to bring in the client's favorite computer games. 4. Allow the client to interact with others in his or her (Adolescent) same age group.

4. Allow the client to interact with others in his or her (Adolescent) same age group. Rationale: Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of their peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend. Options 1, 2, and 3 isolate the client from the peer group.

When responding to a mother who is concerned that her 1-year-old is not yet walking, the nurse's response would be based on the knowledge that the age when most children should be able to walk is which of the following? 1. 12 months 2. 15 months 3. 18 months 4. 24 months

2. 15 months Normal neuromuscular development should allow most children to walk without help by age 15 months. Many children walk by age 1 year, but a child is not considered abnormal if he is not walking by this age. By 18 months, the child is usually able to walk upstairs with one hand held; by 24 months, the child walks up and down stairs one step at a time.

When teaching about accident prevention to a group of high school juniors, the school nurse's primary focus would be on which of the following areas? 1. Falls 2. Motor vehicle accidents 3. Firearms 4. Diving accidents

2. Motor vehicle accidents Inexperience, poor judgment, use of drugs and alcohol, and peer pressure make motor vehicle accidents the leading cause of accidental injury in adolescents. Falls are more common in younger children. Although increasing, injuries caused by firearms are not yet the leading cause of accidental injury in adolescents. Diving accidents are a common cause of injuries, but not the leading cause.

The sequence of events that leads parents to seek health care for their child is called which of the following? 1. Chief complaint 2. Present illness (health) 3. Past history 4. Review of systems

2. Present illness (health) The sequence of the present illness (or present health) leads to the chief complaint. Components include symptom analysis of the chief complaint, other current or recurrent illnesses or problems, current medications, and any other health concerns. The chief complaint is the actual reason for seeking health care. The past history involves information regarding past health status, previous problems, and health promotion activities. The review of systems leads to identifying specific problems in each of the body systems.

If parents keep a toddler dependent in areas where he is capable of using skills, the toddler will develop a sense of which of the following? 1. Mistrust 2. Shame 3. Guilt 4. Inferiority

2. Shame According to Erikson, toddlers experience a sense of shame when they are not allowed to develop appropriate independence and autonomy. Infants develop mistrust when their needs are not consistently gratified. Preschoolers develop guilt when their initiative needs are not met while school-age children develop a sense of inferiority when their industry needs are not met.

When assessing a client from a culture different than the nurse's own, which of the following should the nurse do first? 1. Be sensitive to the family's beliefs. 2. Understand her own beliefs. 3. Enact Western values on the family. 4. Modify the family's cultural beliefs.

2. Understand her own beliefs. When dealing with a client from a different culture, nurses should first be aware of their own values and beliefs. This awareness is important to planning and developing a care plan. Once this awareness is gained, additional actions include being sensitive to the family's beliefs and values and never imposing the nurse's own values on clients. Nurses must modify health care to meet the client's beliefs.

The mother of a 5-year-old asks, "When do the deciduous teeth usually begin to fall out?" What age in years should the nurse indicate?

6 y/o The deciduous, or primary, teeth typically begin to fall out by age 6 years. Age 5 is too young, and ages 7 and 8 are too old.

Which of the following factors plays the greatest role in adversely affecting a child's health? 1. Cultural background 2. Religious influences 3. Environmental influences 4. Socioeconomic status

4. Socioeconomic status Socioeconomic status, especially low socioeconomic status, has the most overwhelmingly adverse influence on health. Although cultural, religious, and environmental influences may impact a child's health, socioeconomic status exerts the most adverse influence on health.

The nurse prepares to administer an intramuscular injection to a 4-month-old infant. The nurse selects which best site to administer the injection? 1. Ventrogluteal 2. Lateral deltoid 3. Rectus femoris 4. Vastus lateralis

4. Vastus lateralis Rationale: Intramuscular injection sites are selected on the basis of the child's age and muscle development of the child. The vastus lateralis is the only safe muscle group to use for intramuscular injection in a 4-month-old infant. The sites identified in options 1, 2, and 3 are unsafe for a child of this age.

A 14-year-old boy has acne and, according to his parents, dominates the bathroom by using the mirror all the time. Which of the following remarks by the nurse would be least helpful in talking to the boy and his parents? 1. "This is probably the only concern he has about his body. So, don't worry about it or the time he spends on it." 2. "Teenagers are anxious about how their peers perceive them. So they spend a lot of time grooming." 3. "A teen may develop a poor self-image when experiencing acne. Do you feel this way sometimes?" 4. "You appear to be keeping your face well washed. Would you feel comfortable discussing your cleansing method?"

1. "This is probably the only concern he has about his body. So, don't worry about it or the time he spends on it." Stating that this is probably the only concern the adolescent has and telling the parents not to worry about it or the time he spends on it shuts off further investigation and is likely to make the adolescent and his parents feel defensive. The statement about peer acceptance and time spent in front of the mirror for the development of self-image provides information about the adolescent's needs to the parents and may help to gain trust with the adolescent. Asking the adolescent how he feels about the acne will encourage the adolescent to share his feelings. Discussing the cleansing method shows interest and concern for the adolescent and also can help to identify any patient teaching needs for the adolescent regarding cleansing.

A 2-year-old child is treated in the emergency department for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safety in the home? 1. "We will be sure not to leave hot liquids unattended." 2. "I guess our children need to understand what the word hot means." 3. "We will be sure that the children stay in their rooms when we work in the kitchen." 4. "We will install a safety gate as soon as we get home so the children cannot get into the kitchen."

1. "We will be sure not to leave hot liquids unattended." Rationale: Toddlers, with their increased mobility and development of motor skills, can reach hot water or hot objects placed on counters and stoves and can reach open fires or stove burners above their eye level. The nurse should encourage parents to remain in the kitchen when preparing a meal, use the back burners on the stove, and turn pot handles inward and toward the middle of the stove. Hot liquids should never be left unattended or within the child's reach, and the toddler should always be supervised. The statements in options 2, 3, and 4 do not indicate an understanding of the principles of safety.

The mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse should tell the mother that the most appropriate toy for a 3-year-old is which? 1. A wagon 2. A golf set 3. A farm set 4. A jack set with marbles

1. A wagon Rationale: Toys for the toddler must be strong, safe, and too large to swallow or place in the ear or nose. Toddlers need supervision at all times. Push-pull toys, large balls, large crayons, large trucks, and dolls are some of the appropriate toys. A farm set, a golf set, and jacks with marbles may contain items that the child could swallow.

Which of the following characteristics would the nurse expect to see in an adolescent who has developed the capacity for formal thought? 1. Ability to analyze relationships for their effects 2. Use of random cognitive behavior to approach problems 3. Ability to say that something is wrong but not why 4. Focusing on immediate physical reality of here and now

1. Ability to analyze relationships for their effects With formal thought, the adolescent thinks beyond the present and forms theories about everything. Relationships are hypothesized as causal and are analyzed for effects that they bring. Random cognitive behavior of earlier stages is replaced by a systematic approach to problems. The ability to say that something is wrong but not the reason why it is wrong is characteristic of the intuitive phase of preoperational thought for the toddler. Focusing on the immediate physical reality of the here and now is characteristic of the concrete operations stage for the school-age child.

Which of the following principles of development is being addressed when new parents are taught that infants are able to lift their heads before their trunks? 1. Cephalocaudal 2. Proximodistal direction 3. Simple to the complex 4. General to the specific

1. Cephalocaudal Cephalocaudal development occurs along the body's long axis, in which control over the head precedes control over the upper body, torso, and legs. Proximodistal development progresses from the center of the body to the extremities. The child develops arm movement before fine finger ability. Mass to specific development occurs as the child learns to perform general, more simplified tasks before specific complex ones.

The nurse is beginning the examination of a 2-year-old child; what should the nurse do first? 1. Chest auscultation 2. Abdominal palpation 3. Otoscopic examination 4. Oral examination

1. Chest auscultation Chest auscultation is the least intrusive choice here, and the nurse should always proceed from least to most intrusive when examining a toddler. Abdominal palpation is somewhat intrusive and should be performed after chest auscultation. The otoscopic and oral examinations are very intrusive and should not be performed until the end of the examination.

Wellness promotion for toddlers should include which of the following? (Select all that apply.) 1. Discussing negativity and temper tantrums 2. Discussing nightmares and night terrors 3. Encouraging gross motor skills 4. Reinforcing supine sleeping position 5. Talking about bedtime rituals 6. Helping the child differentiate junk from healthy foods

1. Discussing negativity and temper tantrums 3. Encouraging gross motor skills 5. Talking about bedtime rituals Toddlerhood is the peak time for negativity, tantrums, and ritualistic behaviors. They also are developing their gross motor skills. Nightmares and night terrors occur during the preschool period. The supine sleep position is used during infancy to prevent sudden infant death syndrome, and children cannot differentiate healthy foods from junk foods until their school years.

After learning that he will need surgery to repair his knee, a 16-year- old throws a cup at the nurse. The nurse plans a course of action based on the knowledge that the adolescent is displaying which of the following? 1. Displacement 2. Reaction formation 3. Projection 4. Denial

1. Displacement Displacement, the transferring of a feeling about or a response to one object onto another usually less threatening substitute object, is a common defense mechanism used by the hospitalized adolescent. Reaction formation involves the person acting in a way that is opposite of how he feels. Projection occurs when a person falsely attributes one's own unacceptable feelings, impulses, or thoughts to another. Denial involves ignoring unacceptable realities.

Which interventions are appropriate for the care of an infant? Select all that apply. 1. Provide swaddling. 2. Talk in a loud voice. 3. Provide the infant with a bottle of juice at nap time. 4. Hang mobiles with black and white contrast designs. 5. Caress the infant while bathing or during diaper changes. 6. Allow the infant to cry for at least 10 minutes before responding.

1. Provide swaddling. 4. Hang mobiles with black and white contrast designs. 5. Caress the infant while bathing or during diaper changes. Rationale: Holding, caressing, and swaddling provide warmth and tactile stimulation for the infant. To provide auditory stimulation, the nurse should talk to the infant in a soft voice and should instruct the mother to do so also. Additional interventions include playing a music box, radio, or television, or having a ticking clock or metronome nearby. Hanging a bright shiny object in midline within 20 to 25 cm of the infant's face and hanging mobiles with contrasting colors, such as black and white, provide visual stimulation. Crying is an infant's way of communicating; therefore, the nurse would respond to the infant's crying. The mother is taught to do so also. An infant or child should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, sweetened water, or another sweet liquid because of the risk of nursing (bottle-mouth) caries.

When assessing gross motor development in a 3-year-old, which of the following activities would the nurse expect to find? 1. Riding a tricycle 2. Hopping on one foot 3. Catching a ball 4. Skipping on alternate feet

1. Riding a tricycle A 3-year-old should have the gross motor ability to balance on and ride a tricycle. Hopping on one foot and the ability to catch a ball are accomplished by 4 years. Skipping on alternate feet is accomplished by 5 years.

When assessing a school-age child, which of the following best describes typical annual growth? 1. The child grows an average of 2 inches (5.1 cm) per year. 2. The child gains an average of 3 lb (1.4 kg) per year. 3. Few differences are noted between age mates. 4. Increased fat pads give school-age children a chubby appearance.

1. The child grows an average of 2 inches (5.1 cm) per year. School-age children usually grow about 2 inches (5.1 cm) per year. School-age children normally gain about 41⁄2 to 61⁄2 lbs (2 to 3 kg) per year. School-age children grow at different rates, with girls growing faster than boys do and commonly surpassing them in height and weight. Fat pads normally do not increase until adolescence.

Wellness promotion for toddlers should include: (Select all that apply.) 1. discussing negativity and temper tantrums. 2. discussing nightmares and night terrors. 3. encouraging gross motor skills. 4. reinforcing supine sleeping position. 5. talking about bedtime rituals. 6. helping child differentiate junk foods from healthy foods.

1. discussing negativity and temper tantrums. 3. encouraging gross motor skills. 5. talking about bedtime rituals. Toddlerhood is the peak time for negativity, tantrums, and ritualistic behaviors. Toddlers are also developing their gross motor skills. Nightmares and night terrors occur during the preschool period. The supine sleep position is used during infancy to prevent sudden infant death syndrome, and children cannot differentiate healthy foods from junk foods until their school-age years.

A home health nurse is teaching nutrition to the parents of an 8-year- old. Which of the following statements should the nurse include? 1. "The child should develop impeccable table manners." 2. "The child's preferences should reflect family culture." 3. "I recommend a rigid mealtime environment." 4. "High-energy activity requires high-calorie snacks."

2. "The child's preferences should reflect family culture." The family's cultural values determine the overriding value of nutrition and eating. Table manners are important, but peer pressure and society will help mold them in later life. Mealtime should be relaxed with conversation that includes the children and their interests. School-age children need nutritious snacks, not empty calories. A balanced diet is necessary because resources are being stored for the increased growth needs of adolescence.

The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which is the most appropriate suggestion to the mother? 1. Allow the bottle if it contains juice. 2. Allow the bottle if it contains water. 3. Do not allow the child to have the bottle. 4. Allow the bottle during naps but not at bedtime.

2. Allow the bottle if it contains water. Rationale: A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, sweetened water, or any other sweet liquid because of the risk of nursing (bottle-mouth) caries. If a bottle is allowed at nap time or bedtime, it should contain only water.

Which car safety device should be used for a child who is 8 years old and 4 feet tall? 1. Seat belt 2. Booster seat 3. Rear-facing convertible seat 4. Front-facing convertible seat

2. Booster seat Rationale: All children whose weight or height is above the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet, 9 inches in height (145 cm) and are between 8 and 12 years of age. Infants should ride in a car in a semireclined, rear-facing position in an infant-only seat or a convertible seat until they weigh at least 20 pounds (9 kg) and are at least 1 year of age. The transition point for switching to the forward-facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kilograms (20 pounds) and 1 year of age.

The nurse is providing medication instructions to a parent. Which statement by the parent indicates a need for further instruction? 1. "I should cuddle my child after giving the medication." 2. "I can give my child a frozen juice bar after he swallows the medication." 3. "I should mix the medication in the baby food and give it when I feed my child." 4. "If my child does not like the taste of the medicine, I should encourage him to pinch his nose and drink the medication through a straw."

3. "I should mix the medication in the baby food and give it when I feed my child." Rationale: The nurse would teach the parent to avoid putting medications in foods because it may give an unpleasant taste to the food, and the child may refuse to accept the same food in the future. In addition, the child may not consume the entire serving and would not receive the required medication dosage. The mother should provide comfort measures immediately after medication administration, such as touching, holding, cuddling, and providing a favorite toy. The mother should offer juice, a soft drink, or a frozen juice bar to the child after the child swallows the medication. If the taste of the medication is unpleasant, the child should pinch the nose and drink the medication through a straw.

After teaching a group of parents about accident prevention for school-age children, which of the following statements by the group would indicate the need for more teaching? 1. "School-age children are more active and adventurous than are younger children." 2. "School-age children are more susceptible to home hazards than are younger children." 3. "School-age children are unable to understand potential dangers around them." 4. "School-age children are less subject to parental control than are younger children."

3. "School-age children are unable to understand potential dangers around them." The school-age child's cognitive level is sufficiently developed to enable good understanding of and adherence to rules. Thus school-age children should be able to understand the potential dangers around them. With growth comes greater freedom and children become more adventurous and daring. The school-age child is also still prone to accidents and home hazards, especially because of increased motor abilities and independence. Plus, the home hazards differ from other age groups. These hazards, which are potentially lethal but tempting, may include firearms, alcohol, and medications. School-age children begin to internalize their own controls and need less outside direction. Plus, the child is away from home more often. Some parental or caregiver assistance is still needed to answer questions and provide guidance for decisions and responsibilities.

Sulfisoxazole, 1 g orally twice daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads "500-mg tablets." The nurse has determined that the dosage prescribed is safe. The nurse administers how many tablets per dose to the adolescent? 1. ½ tablet 2. 1 tablet 3. 2 tablets 4. 3 tablets

3. 2 tablets

A pediatric client with ventricular septal defect repair is placed on a maintenance dosage of digoxin. The dosage is 8 mcg/kg/day, and the client's weight is 7.2 kg. The health care provider (HCP) prescribes the digoxin to be given twice daily. The nurse prepares how many mcg of digoxin to administer to the client at each dose? 1. 12.6 mcg 2. 21.4 mcg 3. 28.8 mcg 4. 32.2 mcg

3. 28.8 mcg

A child, age 7, was unable to receive the measles, mumps, and rubella (MMR) vaccine at the recommended scheduled time. When would the nurse expect to administer the MMR vaccine? 1. 1 month from now 2. 1 year from now 3. At age 10 4. At age 13

3. At age 10 Based on the recommendations of the American Academy of Family Physicians and the American Academy of Pediatrics, the MMR vaccine should be given at age 10 if the child did not receive it between ages 4 to 6 years as recommended. Immunization for diphtheria and tetanus is required at age 13 years.

Which of the following is an appropriate toy for an 18-month-old? 1. Multiple-piece puzzle 2. Miniature cars 3. Finger paints 4. Comic book

3. Finger paints Young toddlers are still sensorimotor learners, and they enjoy the experience of feeling different textures. Thus, finger paints would be an appropriate toy choice. Multiple-piece toys such as puzzles are too difficult to manipulate and may be hazardous if the pieces are small enough to be aspirated. Miniature cars also have a high potential for aspiration. Comic books are on too high a level for toddlers. Although they may enjoy looking at some of the pictures, toddlers are more likely to rip a comic book apart.

A preschooler who is made to feel that his imagination and activities are unacceptable is likely to develop a sense of which of the following? 1. Mistrust 2. Shame 3. Guilt 4. Inferiority

3. Guilt According to Erikson, preschoolers develop a sense of guilt when made to feel that their imagination and activities are wrong, thus disallowing the child to develop a sense of initiative. Mistrust develops when an infant's needs are consistently not met and the infant cannot develop a sense of trust. Shame develops when a toddler is not allowed to develop appropriate autonomy. Inferiority develops when a school-age child is not allowed to have a sense of industry.

Unrealistic expectations or a sense of failing to meet standards would cause a school-age child to develop a sense of which of the following? 1. Shame 2. Guilt 3. Inferiority 4. Role confusion

3. Inferiority According to Erikson, during the school-age period, feelings of inadequacy and a failure to develop a sense of industry result in a sense of inferiority. Failure to develop a sense of autonomy results in a sense of shame in the toddler. Failure to develop a sense of initiative results in a sense of guilt in the preschooler. Failure to develop a sense of identity results in a sense of role confusion in the adolescent.

Which of the following would the nurse identify as the underlying rationale for a 4-year-old who tells the nurse that her doll is in the hospital because it was bad? 1. Egocentrism 2. Past experience 3. Magical thinking 4. Oedipal conflict

3. Magical thinking The fantasies of preschoolers can result in a sense of guilt. Because they cannot discern cause and effect, they see hospitalization as punishment for some real or fantasized misdoing. Magical thinking causes preschoolers to view illness as a punishment. Moreover, preschoolers are experiencing psychosexual conflicts and fears of mutilation, making them especially fearful of procedures such as rectal temperatures and urinary catheterizations. Egocentrism accounts for the preschooler's inability to see another's point of view. Past experience can affect the preschooler's reaction to hospitalization, but this is not the underlying rationale here. Oedipal conflicts do not directly affect hospitalization.

Which of the following suggestions should the nurse offer the parents of a 4-year-old boy who resists going to bed at night? 1. "Allow him to fall asleep in your room, then move him to his own bed." 2. "Tell him that you will lock him in his room if he gets out of bed one more time." 3. "Encourage active play at bedtime to tire him out so he will fall asleep faster." 4. "Read him a story and allow him to play quietly in his bed until he falls asleep."

4. "Read him a story and allow him to play quietly in his bed until he falls asleep." Preschoolers commonly have fears of the dark, being left alone especially at bedtime, and ghosts, which may affect the child's going to bed at night. Quiet play and time with parents is a positive bedtime routine that provides security and also readies the child for sleep. The child should sleep in his own bed. Telling the child about locking him in his room will be viewed by the child as a threat. Additionally, a locked door is frightening and potentially hazardous. Vigorous activity at bedtime stirs up the child and makes it more difficult to fall asleep.

The nurse is conducting an interview of a 4-year-old client; the nurse should do which of the following? 1. Ask detailed questions. 2. Maintain confidentiality. 3. Disallow the use of equipment. 4. Avoid words with double meaning.

4. Avoid words with double meaning. Preschoolers are prelogical and understand only one meaning of a word. Words with more than one meaning will create confusion and possible apprehension. The prelogical thought patterns are too immature to allow preschoolers to understand detailed questions. Although important, confidentiality is a more relevant concern for older children and adolescents. Nurses should encourage preschoolers to handle equipment. Doing so helps to alleviate fears that are common to the preschooler.

The nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which is the most appropriate activity for this child? 1. A radio 2. A sports video 3. Large picture books 4. Crayons and a coloring book

4. Crayons and a coloring book Rationale: In the preschooler, play is simple and imaginative, and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh. A radio or a sports video is most appropriate for the adolescent. Large picture books are most appropriate for the infant.

Which of the following activities, when voiced by parents following a teaching session about the characteristics of school-age cognitive development, would indicate the need for additional teaching? 1. Collecting baseball cards and marbles 2. Arranging dolls according to size 3. Considering simple problem-solving options 4. Developing plans for the future

4. Developing plans for the future The school-aged child is in the stage of concrete operations, marked by inductive reasoning, logical operations, and reversible concrete thought. The ability to consider the future requires formal thought operations, which are not developed until adolescence. Collecting baseball cards and marbles, arranging dolls by size, and simple problem-solving options are examples of the concrete operational thinking of the school-age child.

A 2-year-old's mother has just left the hospital to check on her other children. Which of the following would best help the 2-year-old who is now crying inconsolably? 1. Taking a nap 2. Peer play group 3. Large cuddly dog 4. Favorite blanket

4. Favorite blanket The mother's departure has triggered the protest stage of separation anxiety in this child. Therefore, a favorite blanket or other transitional object (representation of parent) will help best ease separation fears. A nap may actually increase separation fears. A 2-year-old is too young to interact with peers, other than in parallel play. Toddlers are usually fearful of large dogs.

When teaching the parents of a toddler about the child's normal fears, which of the following fears would the nurse typically associate with toddlerhood? 1. Mutilation 2. The dark 3. Ghosts 4. Going to sleep

4. Going to sleep During toddlerhood, typical fears include going to sleep, loss of parents, stranger anxiety, loud noises, and large animals. Fear of mutilation, the dark, and ghosts are fears commonly associated with preschoolers.

A mother arrives at a clinic with her toddler and tells the nurse that she has a difficult time getting the child to go to bed at night. What measure is most appropriate for the nurse to suggest to the mother? 1. Allow the child to set bedtime limits. 2. Allow the child to have temper tantrums. 3. Avoid letting the child nap during the day. 4. Inform the child of bedtime a few minutes before it is time for bed.

4. Inform the child of bedtime a few minutes before it is time for bed. Rationale: Toddlers often resist going to bed. Bedtime protests may be reduced by establishing a consistent before-bedtime routine and enforcing consistent limits regarding the child's bedtime behavior. Informing the child of bedtime a few minutes before it is time for bed is the most appropriate option. Most toddlers take an afternoon nap and, until their second birthday, also may require a morning nap. Firm, consistent limits are needed for temper tantrums or when toddlers try stalling tactics.

When assessing family structure, which of the following would be inappropriate? 1. Composition of family and community environment 2. Occupation and education of family members 3. Cultural and religious background 4. Intrafamily communication patterns

4. Intrafamily communication patterns Evaluation of communication patterns among family members is part of the assessment of family function. Composition of family and community environment, occupation and education of family members, and cultural and religious background are components of family structure assessment.

When assessing a child with Down syndrome (trisomy 21), what should the nurse expect to find? 1. Cat cry, microcephaly, wide-spaced eyes 2. Low-set ears, small jaw, cardiac defects 3. Maladaptive behaviors, long face, prominent jaw 4. Oblique palpebral fissures, small nose, high-arched palate

4. Oblique palpebral fissures, small nose, high-arched palate Oblique palpebral fissures, small nose, and high-arched palate are seen in Down syndrome. Microcephaly, wide-spaced eyes, and the characteristic cat-cry are noted in cri du chat syndrome. Low-set ears, small jaw, and wide-spaced eyes are seen in Edwards' syndrome. Maladaptive behaviors with a long face and prominent jaw are found in children with fragile X syndrome.

3. The adolescent's inability to develop a sense of who he is and what he can become results in a sense of which of the following? 1. Shame 2. Guilt 3. Inferiority 4. Role confusion

4. Role confusion According to Erikson, role diffusion develops when the adolescent does not develop a sense of identity and a sense of where he fits in. Toddlers develop a sense of shame when they do not achieve autonomy. Preschoolers develop a sense of guilt when they do not develop a sense of initiative. School-age children develop a sense of inferiority when they do not develop a sense of industry.