Exam 1 practice questions (ch 26-39, 47, 49)

infants most at risk for sudden infant death syndrome (SIDS) are those: (select all that apply) a. who sleep supine b. who sleep prone c. who were premature d. with prenatal drug exposure e. with a cousin who died of SIDS

infants at increased risk for SIDS are low birth weight, have low apgar scores, sleep prone, co-sleep, were premature and have a mother who smokes

the causative agent for erythema infectiosum (fifth disease) is: a. paramyxovirus b. human parovirus B19 c. human herpes virus types 1 and 2 d. group A beta-hemolytic streptococci

b. human parovirus B19 - *paramyxovirus causes mumps *group A beta-hemolytic streptococci is the causative agent for scarlet fever

the predominant characteristic of the intellectual development of the child ages 2-7 years is egocentricity. what best descries this concept? a. selfishness b. inability to put self in another's place c. self-centeredness d. preferring to play along

b. inability to put self in another's place

nursing responsibilities in the management of adolescent obesity include: a. planning a low-calorie, low-protein diet b. incorporating favorite foods into the child's diet c. encouraging diversional activities during mealtimes d. using nutritious foods as a method of reward

b. incorporating favorite foods into the child's diet - small amounts of favorite foods will increase adherence to the nutritional plan *a food plan high in nutrients, with calories and fat kept at a healthy level is recommended *diversional activities during mealtimes may contribute to overeating *food shouldn't be used as a reward

a characteristic of a toddler's language development at age 18 months is: a. vocabulary of 25 words b. increasing level of comprehension c. use of holophrases d. approximately 1/3 of speech understandable

b. increasing level of comprehension - during the 2nd year of life, the understanding of speech increases to a level far greater than the child's vocabulary

by the time children reach their 12th bday, they should have learned to trust others and should have developed a sense of: a. identity b. industry c. integrity d. intimacy

b. industry - the developmental task of school-age children. by age 12, children engage in tasks that can carry through to completion. they learn to compete and cooperate with others and they learn rules *identity vs role confusion is the developmental task of adolescence. integrity and intimacy aren't developmental tasks of childhood

according to Erikson's theory, at which stage does a child start to have fantasies and an active imagination? a. trust vs mistrust b. initiative vs guilt c. identity vs role confusion d. autonomy vs shame and doubt

b. initiative vs guilt - characterized by a child having fantasies and imaginations that motivate them to explore the environment *birth to 1 y/o is when an infant develops trust toward their parents or caregivers (trust vs mistrust) *identity vs role confusion starts after adolescence; during this stage, an individual tries to figure out their own identity *between the ages of 1 and 3 y/o, a child starts walking, feeding, using the toilet and handling some basic self-care activities (autonomy vs shame and doubt)

denial is a common reaction to the dx of a disability or chronic illness. the nurse knows that the use of denial as a defense mechanism: a. is maladaptive b. is a necessary cushion to prevention disintegration c. prevents a sense of hope d. prevents the mobilization of energies toward goal-directed, problem-solving behavior

b. is a necessary cushion to prevention disintegration - adaptive denial is effective as the family begins to learn the effect that the dx will have on their family *denial isn't maladaptive until it interferes with tx goals *denial may allow a sense of hope at a time when the family is feeling overwhelmed by the dx *using denial at first to cope with the dx enables families to mobilize energies toward goal-directed problem solving

a hospitalized toddler clings to a worn, tattered blanket. she screams when anyone tries to take it away. what's the nurse's BEST explanation to the parents for the child's attachment to the blanket? a. it encourages immature behavior b. it's an important transitional object c. she hasn't mastered the developmental task of individuation-separation d. she hasn't bonded adequately with her mother

b. it's an important transitional object - transitional objects are important to help toddlers separate. the blanket provides security when the child is separated from the parents; transitional objects are helpful when the child is experiencing an increased stress situation such as hospitalization

a 16 y/o adolescent male tells the school nurse that he is gay. the nurse's MOST appropriate response should be based on the knowledge that: a. he's too young to have had enough sexual activity to determine this b. it's important to provide a nonthreatening environment in which he can discuss this c. the nurse should be open to discussing their own beliefs about homosexuality d. homosexual adolescents don't have concerns that differ from heterosexual adolescents

b. it's important to provide a nonthreatening environment in which he can discuss this - the nurse needs to be open and nonjudgmental in interactions with adolescents; this will provide a safe environment to provide appropriate health care *adolescence is when sexual activity develops *the nurse's own beliefs shouldn't bias the interaction with this student *homosexual adolescents face very different challenges as they grow up because of society's response to homosexuality

which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postop period? a. codeine b. morphine c. methadone d. meperidine

b. morphine - most common meds Rx in PCAs include morphine, hydromorphone and fentanyl

when changing a drsg on the leg of a 16 y/o pt who suffered 2nd degree burn injuries, the nurse expects to observe which characteristics of pain expression? (select all that apply) a. stomping feet on the ground and screaming, "no" b. attempting to move leg out of reach of the nurse c. repeatedly stating, "you're hurting me" d. clinching fists and tensing arms in anticipation e. scooting away and asking parents to stop the nurse

developmental characteristics of the adolescent's response to pain include: less vocal protest; less motor activity; more verbal expressions such as ,"it hurts" or "you are hurting me" and increased muscle tension and body control

match the sequence of cephalocaudal development that the nurse expects to find in the normal infant with the appropriate step numbers. begin with the first development expected, sequencing to the final a. crawl b. sit unsupported c. lift head when prone d. gain complete head control e. walk

step 1: lift head when prone >cephalocaudal development is from head to tail. infants achieve structural control of the head before they have control of their trunks and extremities step 2: gain complete head control step 3: sit unsupported step 4: crawl step 5: walk

a child is brought to the ED after falling down the basement stairs. on assessment, what findings may cause the nurse to suspect child maltreatment? (select all that apply) a. the child's bruises are located only on the R arm and leg b. the child is brought to the ED by an unrelated adult c. the child has a hx of a broken arm last year from falling off a swing d. the child's caregiver is anxious that the child get immediate medical attention e. the child has red, green, and yellow bruises on more than 1 plane of the body

*a child brought to a provider for trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse *varying degrees of healing bruises in more than 1 plane of the body is a warning of abuse *falling down stairs can be an unintentional injury *a child with an isolated documented injury isn't a warning sign of abuse *multiple fractures of differing ages are a warning sign of abuse *an anxious caregiver is a normal response for an injured child *a delay in seeking care is a warning sign of abuse

a terminally ill male adolscent is being admitted to the hospital d/t lack of pain relief. when communicating with this pt about his feelings on death, the nurse should incorporate which actions into the plan of care? (select all that apply) a. reassure the adolescent that the illness isn't a result of him not cleaning his room b. establish an alliance with the pt to build a rapport with him c. speak to the pt keeping in mind that he views death as temporary d. discuss what future implications his death may have on his friends and family e. emphasize the need to frequently talk about his prognosis and tx plan f. allow the adolescent to participate in the tx decisions as much as possible

*adolescents are likely to see deviations from accepted behavior as reasons for their illness *the nurse should avoid alliances with either parent or child when discussing death *adolescents usually have a mature understanding of death rather than view death as temporary *adolescents are usually concerned only about the present, not past or future *adolescents' orientation to the present compels them to worry about physical changes even more than the prognosis *the nurse should structure hospital admission to allow for maximum self-control and independence

when teaching about the effects of social media on the adolescent population, the nurse should include which negative impacts? (select all that apply) a. possibility of cyberbullying b. opportunity for adolescents without many friends to interact with others c. disruptive texting during school d. sharing of personal info with sexual preditors e. time management

*adolescents without many friends may benefit from social media outlets *time management would be a positive impact, not negative *the other responses place the adolescent at risk for injury, harm or acts of violence

when preparing to administer hepatitis B vaccine to newborn, the nurse should (select all that apply) a. initiate an immunization record b. confirm the hep B status of the newborn's mother c. obtain a syringe with a 25 gauge, 5/8 inch needle d. assess the dorsogluteal muscle as the preferred injection site e. confirm that the newborn's mother has signed the informed consent

*an immunization record is important for the nurse to initiate and give to the mother so that a continuous record of immunizations is maintained *hep B vaccine is the primary prevention for the disease *if the mother is positive for the Hep B virus, the newborn will need to receive the HBIG in addition to the hep B vaccine *the dose of hep B vaccine is 0.5 mL to be given with a 25 gauge, 5/8 inch needle, IM *signed informed consent must be obtained from the mother before administration of the vaccine *the only safe IM injection site for the newborn is the vastus lateralis muscle

when caring for a child with an IV infusion, the most appropriate nursing interventions are to: (select all that apply) a. use an infusion pump with a microdropper to ensure the prescribed infusion rate b. check IV fluids and infusion rate with another licensed professional c. avoid restraining teh child to prevent undue emotional stress d. observe the insertion site frequently for signs of infiltration e. change the insertion site every 24 hours

*an infusion pump with a microdropper is recommended for IV infusions in peds to ensure the correct amount is infused and checked at least every 1-2 hours to ensure that the desired rate is infused *IV fluids and infusion rates should be checked with another licensed professional to ensure right fluids and correct infusion rate based on the pediatric age and weight *the nurse is responsible for close observation at least every 1-2 hours to ensure the system remains intact and the infusion site remains free of redness, edema, infiltration or irritation *soft restraints may be required at times in peds to ensure the IV site is protected *IV infusion rates don't need to be changed every 24 hours unless a problem is found with the site

the school nurse is teaching a class of safety. which activities require protective athletic gear? (select all that apply) a. lacrosse b. football c. swimming d. gymnastics e. skateboarding

*any sport that involves body contact such as lacrosse, football and skateboarding requires a child to wear protective equipment

autism is a complex developmental DO. dx criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (select all that apply) a. parallel play b. social interaction c. gross motor development d. inability to maintain eye contact e. language as used in social communication

*children dx with autism show delayed or abnormal functioning in social interactions *hallmark characteristics of autism include the child's inability to make and maintain eye contact, delay of language at an early age or the sudden deterioration in extant expressive speech *when interacting with other children in other forms of play they display functional limitations

which sx are commonly seen in a child with depression? (select all that apply) a. focus on violence b. excessive laughing c. somatic complaints d. increased motor activity e. poor school performance

*children with depression make nonspecific complains such as not feeling well *they show a lack of interest in doing HW or achieving in school and getting lower grades than usual *focus on violence can be associated with depression in the adolescent *a child with depression exhibits predominantly sad facial expression with absence or diminished motor activity and c/o being too tired

the nurse is DCing a 10 y/o pt admitted the hospital in DKA. the child has been newly dx with DM1 on this admission. the nurse should teach the child and parents with signs of type 1? (select all that apply) a. weight gain b. nocturia c. irritability d. cool, clammy skin e. blurred vision

*clinical manifestations of DM1 include polyphagia, polyruia and polydipisa, weight loss, enuresis, irritability, short attention span, dry skin, blurred vision, poor wound healing, fatigue, flushed skin, headache, frequent infections, hyperglycemia, ......

a 15 y/o is admitted to the ICU with a spinal cord injury. the MOST appropriate nursing interventions for this adolescent are: (select all that apply) a. monitoring neurologic status b. administering corticosteroids c. monitoring for respiratory complications d. discussing long-term care issues with the family e. monitoring and maintaining hemodynamic status

*close monitoring of sensory and motor function is important to prevent further deterioration of neurologic status as a result of spinal cord edema *corticosteroids are given to minimize the inflammation associated with the injury *close monitoring of respiratory status for possible need of ventilator support *remember "ABCs" *monitoring and maintaining hemodynamic status may require immediate attention r/t IICP resulting in hypotension and bradycardia *the discussion of long-term care issues with the family isn't appropriate in the acute phase of spinal cord injury

which health promotion teaching points should a nurse include in a dental teaching plan to help prevent dental caries? (select all that apply) a. drink fluoridated water b. begin dental hygiene after eruption of both front teeth c. schedule regular dental appts after age 2 d. dates and locations of free dental clinics e. dental caries are preventable

*dental caries is the single most common chronic disease of childhood *the most common form of early dental disease is early childhood caries, which may begin before the 1st bday and progress to pain and infection within the 1st years of life *preschoolers of low-income families are twice as likely to visit the dentist as other children *early childhood caries is a preventable disease, and nurses play an essential role in educating children and parents about practicing dental hygiene beginning with the 1st tooth eruption, drinking fluoridated water, including bottled water and instituting early dental preventative care

the parents of a toddler as the nurse how to handle their child's increasing number of temper tantrums. the nurse should include which positive reinforcement methods of reducing the number of tantrums? (select all that apply) a. suggest that parents provide the child an "all or none" position b. suggest that parents ignore the behavior as long as child isn't harming self c. encourage the parents to provide comfort once the child has calmed down d. ask parents to praise the child for positive behavior when not having a tantrum e. tell parents not to give in to the original request that started the temper tantrum

*during tantrums, ignore the behavior, provided it's not injurious *during periods of no tantrums, practice developmentally appropriate positive reinforcement *other suggestions include: "all or none," picking one's battles, ignoring small skirmishes over unimportant issues *giving comfort once the child is able to control emotions but not giving into the original request *praising the child for positive behavior when they're not having a tantrum

the nurse is providing education to a parents of a 10 month old infant receiving iron supplements. what will be included in the teaching? (select all that apply) a. administer iron with meals b. place iron toward the back side of the mouth with a dropper c. mix iron with milk for greater absorption d. report black, tarry stools to HCP e. apply barrier ointment if needed to buttocks

*ideally iron should be administered between meals for greater absorption *liquid iron may stain the teeth, therefore give with a dropper toward the back and side of the mouth *in older children, give liquid iron through a straw *avoid giving iron with milk products, as these bind to free iron and prevent absorption *educate parents that iron supplements will turn stools black or tarry green *iron may cause constipation

the nurse is preparing the playroom on a newly opened peds unit. the nurse should include which items to foster the development of the preschool child? (select all that apply) a. large blocks b. alphabet flashcards c. 100 piece puzzles d. dolls e. hand puppetsq

*manipulative, constructive, creative and educational toys provide for quiet activities, fine motor development and self-expression *easy construction sets, large blocks of various seizes and shapes, a counting frame, alphabet or number flash cards, paints, crayons, simple carpentry tools, musical toys, illustrated books, simple sewing or handcraft sets, large puzzles, and clay are suitable *the most characteristic and pervasive preschool activity is imitative, imaginative, and dramatic play *dress-up clothes, dolls, housekeeping toys, dollhouses, play store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes and hand puppets and medical kits provide hours of self-expression toys *100 piece puzzles are probably too small and may frustrate the preschooler

the nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8 week old make which statement? (select all that apply) a. I only smoke in the kitchen b. I put my baby to sleep on her back c. I have my baby sleep with me instead of alone in the crib d. I make sure my baby wears a flannel sleeper and has 2 blankets to keep warm in her crib e. I always have my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night

*maternal smoking, co-sleeping and overheating increase the risk of SIDS *leaving a stuffed animal in the crib is a suffocation risk and should be addressed as a safety hazzard

when admitting a child to the inpt peds unit, the nurse should assess for which risk factors that can increase the child's stress level associated with hospitalization? (select all that apply) a. mild temperament b. lack of fit between parent and child c. below-average intelligence d. age e. gender

*risk factors for increased stress level of a child to illness or hospitalization: -difficult temperament, lack of fit between child and parents, age (especially between 6 months and 5 y/o), male gender, average intelligence, multiple and continuing stresses (eg frequent hospitalizations)

characteristics of physical development of a 30 month old child are the: (select all that apply) a. anterior fontanel is open b. birth weight has doubled c. genital fondling is noted d. sphincter control is achieved e. primary dentition is complete

*sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age *primary dentition is usually completed by 30 months of age *the anterior fontanel closes between 12 and 18 months of age *birth weight should double at 5-6 months of age and quadruple by 2.5 years of age *genital fondling isn't a characteristic of physical development of this age group

the primary goals in the nutritional management of children with failure to thrive (FTT) are: (select all that apply) a. allow for catch-up growth b. correct nutritional deficiencies c. achieve ideal weight for height d. restore optimum body composition e. educate the parents or primary caregivers on child's nutritional requirements f. educate the parents or primary caregivers that the child will need tube feedings first

*the goal is to provide sufficient calories to support "catch-up" growth, which is a rate of growth greater than the expected rate for age *correction of nutritional deficiencies is another goal that may require multivitamin and dietary supplements with high calorie foods and drinks in addition to treating any coexisting medical problems *a goal is to provide education to the parents or primary caregiver of the child's nutritional requirements along with appropriate feeding methods

when completing a health hx on a hospitalized child, the nurse should assess for which factors that can commonly affect the parents reaction to the child's illness? (select all that apply) a. previous experience with illness or hospitalization b. available support systems c. medical procedures involved with tx d. previous coping abilities e. cultural and religious beliefs

ALL OF THEM *factors that affect parents responses to their child's illness or hospitalization include: -seriousness of threat to the child -previous experience with illness or hospitalization -medical procedures involved in dx and tx -available support systems -personal ego strengths -previous coping abilities -additional stresses on the family system -cultural and religious beliefs -communication patterns among family members

which of the following steps of the nursing process are part of caring for a child with pneumonia (select all that apply) a. determine whether abx therapy has been effective by reviewing WBC count b. administer abx as ordered c. listen to the child's breath sounds and monitor vitals d. identify the problem of impaired gas exchange e. establish therapeutic goals and prioritize health care provider orders

ALL of them! *the correct steps in the nursing process are: -assessment: listening to breath sounds -dx: identifying the problem of impaired gas exchange -planning: establish goals and prioritize -implementation: administer abx -evaluate: determine effectiveness of abx

the practice of cultural humility is continual and an important concept in the nursing process. nurses can facilitate this process by: (select all that apply) a. integrating cultural knowledge b. recognizing cultural differences c. acting in a culturally appropriate manner d. being aware of their own beliefs and practices e. helping the family adapt to the health care practices

a, b, c, d - integrating cultural knowledge is essential to providing care to families and the community. recognizing cultural difference is a component of cultural awareness, humility and competence. acting culturally appropriate is essential in understanding and being able to deal effectively with families in a multicultural community. nurses must be aware of their own beliefs and practices before they can begin to understand the varied and numerous cultural influences on the life of children and family. it's essential that nurses make an effort to adapt health care practices to the family's health needs rather than the attempt to change longstanding beliefs

a nurse is presenting a class on injury prevention to parents of prechoolers. which injuries should the nurse identify as occurring in this age group? (select all that apply) a. falls b. drowning c. poisoning d. sports injuries e. tricycle and bicycle accidents

a, b, c, e *falls occur frequently in preschoolers *closely monitor playground activity such as climbing on a jungle-gym *closely supervise around water and ensure swimming pools are securely fenced to prevent near drowning *place all meds and poisons out of reach and in locked cabinets - keep poison control number by the phone *give meds as drugs not "candy" *when riding bikes and trikes children forget not to ride in the streets *sports injuries occur in older children

the charge nurse is observing a student nurse obtain a temp on a pediatric pt. the nurse would intervene when observing the student: (select all that apply) a. obtain a rectal thermometer probe for a child with diarrhea b. attempt to take an oral temp on a child who's receiving oxygen c. take an oral temp on a 12 y/o child who ate ice cream 2 hrs ago d. documenting an axillary temp for a 3 y/o child e. taking an axillary temp of a 3 week old infant

a, b, d *an oral temp is appropriate for a 12 y/o child who hasn't had anything hot or cold to eat or drink recently *an axillary temp is appropriate for a 3 y/o *rectal measurement remains the clinical gold standard for the precise dx of fever in infants and children compared with other methods; however, this procedure is more invasive and is contraindicated in infants less than 1 month old, children with recent rectal surgery, children with diarrhea or anorectal lesions and children receiving chemo *oral temps are considered the standard for temp but are contraindicated in children who have altered level of consciousness, receiving oxygen, are mouth breathing, experiencing mucositis, had recent oral surgery or trauma or are under 5 y/o *axillary temps are inconsistent and insensitive in infants and children over 1 month old

the nurse is caring for a Vietnamese child and observes various marks on the child's body. when completing a thorough assessment, the nurse should keep which applicable cultural practices in mind? (select all that apply) a. coining b. cupping c. forced kneeling d. topical garlic application e. burning

a, b, d - cultural practices possibly considered abusive by the dominant culture are: -coining (a Vietnamese practice that may produce welt-like lesions on the child's back when the edge of a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of disease) -cupping (an old world practice, also Vietnamese, of placing a container such as a tumbler, bottle or jar containing steam against the skin surface to draw out the poison or other evil element; when the heated air within the container cools, a vacuum is created that produces a bruise-like blemish on the skin directly beneath the mouth of the container) -and burning (a practice of some southeast asian groups whereby small areas of skin are burned to treat enuresis and temper tantrums

a nurse is conducting a health hx on an adolescent. components of the health history include: (select all that apply) a. sexual hx b. review of systems c. physical assessment d. growth measurements e. family medical hx

a, b, e *physical assessment and growth measurements are a component of the physical exam

during a well-baby visit, the parents of a 12 month old ask the nurse for advice on age-appropriate toys for their child. based on the nurse's knowledge of developmental levels, the most approrpiate toys to suggest are: (select all that apply) a. push-pull toys b. toys with black-white patterns c. pop-up toys, such as jack-in-the-box d. soft toys that can be put in the mouth e. toys that pop apart and go back together

a, c, e *both gross and fine motor skills are becoming more developed and children at this age enjoy toys that can help refine these skills *children at this age enjoy more colorful toys *children at this age are less interested in placing toys in the mouth and are more interested in toys that can be manipulated

during a 6 month well-child checkup, an infant should have mastered all of the following developmental tasks: (select all that apply) a. sits in highchair b. pulls up to stand c. pincer grasp is evident d. holds head at 90 degrees without any head lag e. imitates sounds

a, d, e *should have good head control by 4 months *pincer grasp and pulling self to stand up are expected to develop by 9 months of age

the nurse is teaching an adolescent, newly dx with DM1, ways to minimize discomfort with insulin injections. which interventions are helpful in minimizing injection discomfort? (select all that apply) a. don't reuse needles b. inject insulin when it's cold c. flex or tense the muscle during injection d. rotate sites e. don't move the direction of the needle syringe during insertion or withdrawal

a, d, e *the reuse of needles leads to more discomfort on injection from decrease sharpness of the needle and being and infection control problem *rotate sites to enhance absorption and minimize skin irritation *keeping the direction of the syringe constant during the insertion and WD minimizes discomfort *insulin should be injected at room temp to minimize discomfort *flexing or tensing muscles during injections causes more discomfort

the nurse is DCing a young child from the hospital. the nurse should instruct the parents to look for which posthospital child behaviors? (select all that apply) a. tendency to cling to parents b. jealousy toward others c. demands for parents attention d. anger toward parents e. new fears such as nightmares

a, d, e *young children's posthospital behaviors include: -showing initial aloofness toward parents, which may last a few minutes (most common) to a few days -this is frequently followed by dependency behaviors such as tendency to cling to parents, demands for parents attention and vigorous opposition to any separation *other negative behaviors include: new fears (nightmares), resistance to going to bed, night waking, withdrawal and shyness, hyperactivity, temper tantrums, food peculiarities, attachment to blanket or toy, regression in newly learned skills *posthopsital behaviors in older children include: negative behaviors like emotional coldness followed by intense, demanding dependence on parents, anger toward parents, jealousy toward others

apnea of infancy has been dx in an infant who will soon be DC'd home with monitoring. when teaching the parents about the infant's care, what's the most important info the nurse should include in the DC teaching plan? a. CPR b. administration of IV fluids c. reassurance that the infant cannot be electrocuted during monitoring d. advice that the infant not be left with other caretakers such as baby-sitters

a. CPR - essential for parents and caregivers to know *the child most likely won't have IV access

the nurse is explaining that the destruction of pancreatic beta-cells is the cause of which DO? a. DM 1 b. DM 2 c. impaired glucose tolerance d. gestational DM

a. DM 1 - characterized by destruction of the insulin-producing pancreatic beta cells *DM 2 is a result of insulin resistance combined with relative (versus absolute) insulin deficiency

when teaching an adolescent mother about risk factors for neonatal death, the most important factor is: a. LBW b. injuries to the mother during pregnancy c. newborn obesity d. chronic illness of the mother

a. LBW - which is closely r/t early gestational age, is considered the leading cause of neonatal death in the US *injuries are the leading cause of death in children over age 1 year, with the majority being MVAs

a young child from Mexico is hospitalized for a serious illness. the father tells the nurse that "the child is being punished by God for being bad." the nurse should recognize this as: a. a health belief common in this culture b. an early indication of potential child abuse c. a misunderstanding of the family's common beliefs d. a belief common when fortune tellers have been used

a. a health belief common in this culture - a common belief in the Mexican-American cultural group is that health is controlled by the environment, fate, and teh will of God. this comment has no relation to child abuse. the father wouldn't misunderstand the family's beliefs. this is a cultural belief. Mexicans may use the services of cuanderos (healers) not fortune tellers

what has had the greatest impact on reducing infant mortality in the US? a. access to high-quality prenatal care b. decreased incidence of congenital anomalies c. better maternal nutrition d. improved funding for health care

a. access to high-quality prenatal care - a promising preventative strategy to decrease early delivery and infant mortality *the improvements in perinatal care, in particular respiratory care and care of the mother-baby dyad before delivery, has had the greatest impact *there has been a decrease in some congenital anomalies such as spina bifida, but this isn't the greatest impact *better maternal nutrition has had a positive influence but not greatest impact overall

which statement is most accurate in describing tetanus? a. acute infectious disease caused by an exotoxin produced by an anaerobic gram-positive bacillus b. inflammatory disease that causes extreme, localized muscle spasm c. acute infection that causes meningeal inflammation resulting in sx of generalized muscle spasm d. disease affecting the salivary gland with resultant stiffness of the jaw

a. acute infectious disease caused by an exotoxin produced by an anaerobic gram-positive bacillus - tetanus is an acute, preventable disease caused by an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus, clostridum tetani *these sx are caused by the effect of the toxins becoming fixed on nerve cells

a nurse is preparing to assess a preschool-age child. which of the following is an appropriate action by the nurse to prepare the child? a. allow the child to role-play using miniature equipment b. use medical terminology to describe what will happen c. separate the child from her parent during the exam d. keep medical equipment visible to the child

a. allow the child to role-play using miniature equipment

which method should the nurse use to view the tonsils and oropharynx of a cooperative 6 y/o child? a. ask child to open mouth wide and say "ahh" b. ask child to open mouth wide and then place the tongue blade in the center back area of the tongue c. examine the mouth when the child is crying to avoid use of tongue blade d. pinch nostrils closed until the child opens their mouth and then insert the tongue blade

a. ask child to open mouth wide and say "ahh" - if the child is cooperative, the child can open their mouth and move the tongue around for the examiner; a tongue blade isn't necessary if the child is cooperating *during crying, there's insufficient opportunity to completely visualize the tonsils and oropharynx *d is traumatic and there's no reason to use such measures, especially with cooperative children

which approach would be best to use to ensure a positive response from a toddler? a. assume an eye-level position and talk quietly b. call the toddler's name while picking him or her up c. call the toddler's name and say, "I'm your nurse." d. stand by the toddler, addressing them by their name

a. assume an eye-level position and talk quietly - it's important that the nurse assume a position at the child's level when communicating with them; by speaking quietly and focusing on the child, the nurse should be able to obtain a positive response *the nurse should engage the child and inform the toddler what is going to occur; if the nurse picks up the child without explanation, the child is most likely going to be come upset *the toddler may not understand the meaning of the phrase "I'm your nurse" *if a positive response is desired, the nurse should assume the child's level when speaking, if possible

which accomplishment would the nurse expect of a healthy 3 y/o child? a. balance on 1 foot for a few seconds b. jump rope c. ride a 2-wheeled bicycle d. skip on alternate feet

a. balance on 1 foot for a few seconds

a hospitalized teenager and family are praying at the bedside. the nurse is aware that the most accurate description of the spiritual development of the older adolescent is that: a. beliefs become more abstract b. rituals and practices become increasingly important c. strict observance of religious customs is common d. emphasis is placed on external manifestations, such as whether a person goes to church

a. beliefs become more abstract - because of their abstract thinking abilities, adolescents are able to interpret analogies and symbol *rituals and practices become less important as the adolescent questions values and ideals of families

which assessment data would cause the nurse to suspect that a toddler is experiencing physical abuse? a. bruises in various stages of healing b. blood underclothing c. recurrent UTIs d. abdominal distension

a. bruises in various stages of healing - this would cause the nurse to suspect physical abuse *abdominal distension, a sx of malnutrition, would cause the nurse to suspect physical neglect *blood underclothing and recurrent UTIs would cause the nurse to suspect sexual abuse

a nurse is performing a family assessment. which of the following shouldn't be included? a. child's physical growth b. parent's educational level c. support systems d. medical hx

a. child's physical growth

the nurse is assessing a preschool age child who is stuttering when answering the nurse's questions. the nurse should offer alternate methods of responding to the stuttering when observing the parent: a. completing the child's sentences b. listening attentively c. encouraging the child to speak slowly d. helping the child relax

a. completing the child's sentences - the national institute of deafness and other communication DOs encourages parents and caregivers of children who stutter to speak slowly and relaxed, refrain from criticizing them and resist completing their sentences; take time to listen attentively

during their school-age years, children best understand concepts that can be seen or illustrated. the nurse knows this type of thinking is termed as: a. concrete operations b. preoperational c. school-age rhetoric d. formal operations

a. concrete operations - black and white reasoning involves a situation in which only 2 alternatives are considered, when in fact there are additional options *preoperational thinking is concrete and tangible *during the school-age years, children deal with thoughts and learn through observation; they don't have the ability to do abstract reasoning and learn best with illustration; thought at this time is dominated by what the school-age child can see, hear or otherwise experience; school-age rhetoric simply refers to the type of ideas that arise out of the years children attend school *formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years

which best describes Piaget's cognitive stage of formal operations? a. deductive and abstract reasoning b. inductive reasoning and beginning logic c. transductive reasoning and egocentrism d. cause-and-effect reasoning and object permanence

a. deductive and abstract reasoning *Piaget's cognitive stage of formal operations occurs between the ages of 11 and 15; deductive and abstract reasoning are developed *inductive reasoning and beginning logic begin in the concrete operations stage between the ages of 7 and 11 *transductive reasoning and egocentrism occur in the preoperational stage at age 2-7 *cause and effect and object permanence occur during the sensorimotor stage from birth to 2 years

to assess language development of a 3 y/o child at a well-child visit, the nurse would ask the parent: a. does your child ask who, what and where questions? b. does your child imitate animal sounds? c. does your child speak in complete sentences? d. does your child seem to comprehend explanations that provide the "what" and "why" of things?

a. does your child ask who, what and where questions? *at this age, children should be able to ask these questions *imitating animals is a language skill that should've been acquired at the age of 1 y/o *speaking in complete sentences is a characteristic of 4-5 y/o *the ability to comprehend explanations that provide the "what" and "why" of things occurs between the ages of 5 and 6

during an otoscopic exam on an infant, in which direction is the pinna pulled? a. down and back b. down and forward c. up and forward d. up and back

a. down and back *pulling the pinna down and forward is the correct position for a child age 3 years and over *pulling the pinna up and forward or up and back won't allow sufficient visualization of the ear

the MOST important nursing consideration r/t congenital hypothyroidism is: a. early identification of the DO b. facilitation of parent-infant attachment c. initiating referrals for cognitive impairment d. helping parents deal with future prospects for the child

a. early identification of the DO - early dx is imperative because brain growth is complete by 2-3 y/o, the deficiency must be detected and replacement therapy begun ASAP *the parent-infant attachment is important for all infants *with appropriate intervention, the child may not have any developmental deficit

what's the MOST important strategy to use when teaching about smoking prevention in teenagers? a. emphasizing immediate effects of smoking b. emphasizing long-term effects of smoking c. promoting large-scale public information campaigns d. threatening the social norms of groups most likely to smoke

a. emphasizing immediate effects of smoking - this has proven to be the most effective strategy for preventing smoking; information focuses on tobacco smell and other negative aesthetic issues *long-term effects aren't important to them because this age group isn't future oriented

the nurse is planning care for a child recently dx with diabetes insipidus. the plan should include: a. encouraging the child to wear medical identification b. discussing with the child and family ways to limit fluid intake c. teaching the child and family how to do required urine testing d. reassuring the child and family that this is usually not a chronic or life-threatening illness

a. encouraging the child to wear medical identification - because of the unstable nature of teh child's fluid and electrolyte balance, this is an extremely important intervention *with diabetes insipidus, the child should have unrestricted access to fluid *there's no urine testing with this condition *this condition is both lifelong and life threatening and medication must be taken, monitoring the effects closely

when completing the health assessment for a 2 y/o child, the nurse should expect the child to: a. engage in parallel play b. fully dress self with supervision c. have a vocabulary of at least 500 words d. be 1/3 of the adult height

a. engage in parallel play - 2 y/o typically play alongside each other

a 10 y/o female child requires daily meds for a chronic illness. her mother tells the nurse that she is always nagging her to take her medicine before school. what's the MOST appropriate nursing action to promote the child's compliance? a. establishing a contract with her, including rewards b. suggesting time-outs when she forgets her medicine c. discussing with her mother the damaging effects of nagging d. asking the child to bring her medicine containers to each appt so they can be recounted

a. establishing a contract with her, including rewards - for school age children, behavior contracting associated with desirable rewards is an effective method for achieving compliance *time-outs should be used only if the behavioral contracting isn't successful *although nagging isn't an effective strategy, the nurse needs to assist the mother in problem solving rather than criticize the actions *monitoring the medicine supply may be tried if the contracting isn't successful

an infant is born with ambiguous genitalia. tests are being done to assist in gender assignment. the parents tell the nurse that family and friends are asking what caused the baby to be this way. the nurse's MOST appropriate action is to: a. explain the DO so parents can explain it to others b. help parents understand that no one knows how this occurs c. suggest that parents avoid family and friends until the gender is assigned d. encourage parents not to worry while the tests are being done

a. explain the DO so parents can explain it to others - this is the most therapeutic approach while the parents await the gender assignment; the DO is caused by a decreased enzyme activity required for adrenal cortical production of cortisol *option C is impractical and would isolate the family from their support system *telling the parents to worry without giving them specific alternative actions isn't effective

guidelines for a nurse using an interpreter in developing a care plan for an 8 y/o admitted to rule out epilepsy include: a. explaining to the interpreter what info is necessary to obtain from the pt and family b. encouraging the interpreter to ask several questions at a time to make the best use of time c. not giving the interpreter too much info so the interview evolves d. discouraging the interpreter and client from discussing topics that are deemed irrelevant to the original intent of the interview

a. explaining to the interpreter what info is necessary to obtain from the pt and family - the interpreter should be given guidance about what info is necessary to obtain *1 question should be asked at a time, leaving sufficient time for the family to answer *the interpreter shouldn't have to guess what to ask and what info to obtain *the interpreter should gain as much info from the family as they are willing to share based on the question posed *limits shouldn't be placed on the interview

the mother of a 3 month old breastfed infant asks about giving her baby water since it's summer and very warm. the nurse should recommend that: a. fluids in addition to breast milk aren't needed b. water should be given if the infant seems to nurse longer than usual c. water once or twice a day will make up for losses caused by environmental temp d. clear juices would be better than water to promote adequate fluid intake

a. fluids in addition to breast milk aren't needed - the child will nurse according to needs, add'l fluids aren't necessary for the breastfed baby and supplemental water shouldn't be given because it may cause water intoxication

what should the nurse recommend to help a toddler cope with the birth of a new sibling? a. give the toddle a doll on which they can imitate parenting b. discourage them from helping with care of new sibling c. prepare them for upcoming changes about 1-2 weeks before birth of the sibling d. explain to them that a new playmate will soon come home

a. give the toddle a doll on which they can imitate parenting - the toddler can participate in the activity of caring for a new family member and should be encouraged to participate in accordance with their abilities

girls experience an increase in weight and fat deposition during puberty. nursing considerations r/t these changes include: a. giving reassurance that these changes are normal b. suggesting dietary measure to control weight gain c. recommending increased exercise to control weight gain d. encouraging low-fat diet to prevent fat deposition

a. giving reassurance that these changes are normal - a certain amount of fat is increased along with lean body mass to fill the characteristic contours o the child's gender *a healthy balance must be achieved between healthy weight gain and obesity *some fat deposition is essential for normal hormone regulation

the potential effects of chronic illness of disability on a child's development vary at different ages. which is a threat to a toddler's normal development? a. hindered mobility b. poorly defined body image c. limited opportunities for socialization d. sense of guilt that the child caused the illness or disability

a. hindered mobility - the inability to move about and master the environment will inhibit the toddler's developing autonomy *the rest indicate effects on a preschooler's development

based on Piaget's theory of cognitive development, what's 1 basic concept a child is expected to attain during the first year of life? a. if an object is hidden, that doesn't mean that it's gone b. he or she cannot be fooled by changing shapes c. parents are not perfect d. most procedures can be reversed

a. if an object is hidden, that doesn't mean that it's gone - part of learning permanence is learning that although an object is no longer visible, it still exists *at 1 year of age, a child may not be able to understand that an object that changes shape is still the same object *understanding conservation occurs between ages 7 and 11 years

the nurse observes erythema, pain, and edema at a child's IV site with streaking along the vein. what should the nurse do FIRST? a. immediately stop the infusion b. check for a good blood return c. ask another nurse to check the IV site d. increase the IV drip for 1 min and recheck

a. immediately stop the infusion - this describes an extravasation/infiltration and the IV must be stopped to prevent further damage to the child *blood return suggests that the catheter is still in the vein, but the description here is a definition of infiltration

a child has an avulsed (knocked-out) tooth. the parents are reluctant to reimplant the tooth. where should the tooth be placed for transport to the dentist? a. in cold milk b. in cold water c. in warm salt water d. in a dry, clean jar

a. in cold milk

when discussing pubertal growth changes with an adolescent male, the nurse will be sure to include with info? a. in girls, puberty occurs about 1 year before it appears in boys b. in girls puberty occurs about 3 years before it appears in boys c. in boys puberty occurs about 1 years before it appears in girls d. the onset of puberty is about the same in both boys and girls

a. in girls, puberty occurs about 1 year before it appears in boys - average age of onset is 9.5 year for girls and 10.5 for boys

during the summer many children are more physically active. what changes in the management of the child with diabetes should be expected as a result of more exercise? a. increased food intake b. decreased food intake c. increased risk of hyperglycemia d. decreased risk of insulin shock

a. increased food intake - food intake should be increased in the summer when the child is more active; races and other competitions may require more food than other practice times *increased activity lowers blood glucose levels *blood sugars must be monitored closely to avoid the administration of too much insulin during a time of reduced need

the best explanation for why pulse oximetry is used on young children is that it: a. is noninvasive b. is better than capnography c. is more accurate than ABGs d. provides intermittent measurements of O2

a. is noninvasive *capnography measures carbon dioxide exhalation *it's less invasive and easier to test than ABGs *it can provide continuous or intermittent measurements of O2

the nurse should include which info when teaching a pt about Cushing's syndrome? a. it's caused by excessive production of cortisol b. the major clinical feature associated with this disease is exopthalmia c. tx involves replacement of cortisol d. dx is suspected with findings of hypotension, hyperkalemia and polyuria

a. it's caused by excessive production of cortisol *exopthalmia is a manifestation of hyperthyroidism *tx is the reduction of circulation cortisol *if the cause is a pituitary tumor, surgery is indicated *HTN and hypokalemia are expected findings

the correct interpretation of the immunization schedule for infants and children regarding the administration of the influenza vaccine would be: a. it's given annually to children age 6 months thru 18 yr b. it's given annually to children age 2 months thru 10 yr c. it's given to infants at 6 months and then once again to adolescents of 18 y/o d. it's only given to infants and children who are immunocompromised

a. it's given annually to children age 6 months thru 18 yr *according to the CDC administration schedule, it's appropriate to give the flu vaccine annually to children aged 6 months thru 18 years

it's time to give a 3 y/o boy his medication. which approach is MOST likely to receive a positive response? a. it's time for your medication now. would you like water or apple juice afterward? b. wouldn't you like to take your medicine? c. you must take your medicine, because the dr says it will make you better d. see how nicely this boy took his medicine? now take yours

a. it's time for your medication now. would you like water or apple juice afterward? - this statement provides the child with a structured choice with 2 acceptable options *posed as a question, this approach allows the child the option to say "no" *encouraging competition isn't appropriate for this age group

an appropriate nursing intervention when providing comfort and support for a child whose death is imminent is to: a. limit care to essentials b. avoid playing music near the child c. explain to the child the need for constant measurement of vitals d. whisper to the child instead of using a normal voice

a. limit care to essentials - when death is imminent, care should be limited to interventions for palliative care *music may be used to provide comfort for the child *vitals don't need to be measured frequently *the nurse should speak to the child in a clear, distinct voice

nonpharmacologic strategies for pain management: a. may reduce pain perception b. make pharmacologic strategies unnecessary c. usually take too long to implement d. trick children into believing that they don't have pain

a. may reduce pain perception - nonpharmacologic techniques for pain management may help the child with associated fears and stress r/t pain. the strategies may provide assistance with coping that may reduce the perception of pain, decrease anxiety, and increase effectiveness of meds. the child with moderate to severe pain will require pharmacologic intervention. the child should be taught nonpharmacologic pain management strategies before pain occurs, thus reducing implementation time

a mother tells the nurse that she will visit her 2 y/o son tomorrow about noon. during the child's bath, he asks for mommy. the nurse's BEST response is: a. mommy will be here after lunch b. mommy always comes back to see you c. your mommy told me yesterday that she would be here today about noon d. mommy had to go home for a while, but she will be here today

a. mommy will be here after lunch - since toddlers have a limited conception of time, the nurse should translate mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time *noon is a meaningless concept for a toddler

while caring for hospitalized adolescents, the nurse observes that sometimes they're skeptical of their parents' religious beliefs/practices. the nurse should recognize that this is: a. normal in spiritual development b. abnormal in spiritual development c. r/t illness and occurs only at times of crisis d. r/t the inability of parents to explain adequately their beliefs/practices

a. normal in spiritual development - this describes stage 4 in spiritual development. adolescents attempt to determine which of their parental standards and beliefs to incorporate into their own

the parent of a hospitalized child tells the nurse, "we don't eat meat. we are practicing Buddhists and strict vegetarians." the most appropriate intervention by the nurse is to: a. order the child a meatless tray b. tell the parent to take any meat off the child's meal tray c. ask the parent if they would like to have a Buddhist priest visit d. explain to the parent that meat provides protein needed to heal their child

a. order the child a meatless tray - it's essential for the nurse to respect the religious practices of the child and parent. *the nurse is not culturally sensitive to the religious practices of the child and parent and should ensure that nutritionally complete vegetarian meals are prepared by the dietary dept *asking the parent if they would like a Buddhist priest isn't addressing the vegetarian diet and not being respectful of the child and parent's religious beliefs *the nurse shouldn't encourage the child and parent to go against their religious beliefs

the nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. they talk with these parents more than with the nurses. the nurse should recognize that the: a. parent-to-parent support is valuable b. parent-to-parent dependence is unhealthy c. situation has developed because the nurses are unresponsive to the parents d. situation is unusual and has the potential to increase friction between the parents and the nursing staff

a. parent-to-parent support is valuable - this type of support is unique and not available from other sources; being with other parents who have shared similar experiences (eg hospitalization) allows a mutually supportive environment *nurses can't provide the same type of support as another parents who has has the "lived experience"

the nurse's BEST approach for effective communication with a preschool age child is through: a. play b. speech c. actions d. drawing

a. play

when discussing sex and sexual activities with adolescents, the nurse should: a. present normal body functions in a straight forward manner b. refer the adolescents to their parents for sexual information c. use scientific terminology to convey content d. defer giving info about pregnancy unless the adolescents are sexually active

a. present normal body functions in a straight forward manner - the nurse should provide accurate and complete info that's presented using correct terminology *parents are important influences regarding the morals and values surrounding sexual activities; nurses should provide adolescents with accurate, complete info about the normal physical aspects of sex

the nurse is caring for a child hospitalized with acute adrenocortical insufficiency. which tx option should be implemented to restore fluid volume? a. provide hypertonic saline dextrose solution (5%) with parenteral hydrocortisone b. increase rate of IV fluids c. restrict intake of fluids for 8 hrs d. provide isotonic fluids PRN to restore fluid balance

a. provide hypertonic saline dextrose solution (5%) with parenteral hydrocortisone - tx options to restore fluid volume for a child with this condition focus on administration fo 5% dextrose saline (hypertonic) with IV hydrocortisone; it''s given to replace fluid, electrolytes and glucose *an increase in IV rate could lead to fluid overload and vascular compromise resulting in cardiac failure *restriction of fluids would lead to further dehydration

categorizing growth and behavior into approximate age stages: a. provides a convenient means to describe the majority of children b. determines the speed of each child's growth c. helps to account for individual differences in children d. can be applied to all children with some degree of precision

a. provides a convenient means to describe the majority of children

when a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. punishment b. threat to child's self image c. an opportunity for regression d. loss of companionship with friends

a. punishment - if a preschooler isn't prepared for hospitalization, the typical fantasy is to attribute it to punishment for real or imagined misdeeds *B and D are typical reactions of school-age children *C is a response characteristic of toddlers threatened with loss of control

a 7 y/o female child has a fever associated with a viral illness. she's being cared for at home. the nurse should recognize that the principle reason for treating fever in this child is: a. relief of discomfort b. reassurance that illness is temporary c. prevention of secondary bacterial infection d. prevention of life-threatening complications

a. relief of discomfort - this is the primary reason for treating a fever with pharmacologic or environmental interventions *tx doesn't provide reassurance that illness is temporary *fever-reducing meds don't have antibacterial actions and may inhibit the fever-enhancing effects on the immune system

the nurse is caring for a 12 y/o child who sustained major burns when putting charcoal lighter on a campfire. the nurse observes that the child is "very brave" and appears to accept pain with little or no response. what is the most appropriate nursing action? a. request a psychological consultation b. ask why the child doesn't have pain c. praise the child for the ability to withstand pain d. encourage continued bravery as a coping strategy

a. request a psychological consultation - this will assist the child in verbalizing fears. this age group is very concerned with physical appearance. the psychologist can help integrate the issues the child is facing. it's likely that the child is having pain but not acknowledging it

which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis and upper respiratory tract infections? a. short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue b. pulse and RR are slower than those in infancy c. respirations are abdominal d. defense mechanisms are less efficient than those during pregnancy

a. short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue

a 6 y/o child has difficulty hearing faint or distant speech. his speech is normal, but he's having problems with his school performance. this hearing loss would MOST likely be classified as: a. slight b. severe c. moderate d. moderately severe

a. slight - this is the definition of light hearing loss *with severe loss the child may hear a loud voice if nearby and may be able to identify loud environmental noises *moderate hearing loss results in sx of being able to understand conversation at a distance of only 3-5 ft *with a moderately severe hearing loss, he would be unable to understand a conversation unless it was very loud

a 6 y/o girl born with a myelomeningocele has a neurogenic bladder DO. her parents have been performing clean intermittent cathetarization. the nurse's MOST appropriate action is to: a. teach the child to do self-cathetarization b. teach the child appropriate bladder control c. continue having the parents do cathetarization d. encourage the family to consider urinary diversion

a. teach the child to do self-cathetarization - this child should be able to perform the intermittent cath herself, giving her more control and mastery over er disability *bladder control cannot be taught to a child with a neurogenic bladder *a urinary diversion isn't necessary

a 3 y/o girl was adopted immediately after birth. the parents have just asked the nurse how they should tell the child she's adopted. which guideline concerning adoption should the nurse use in planning her response? a. telling the child is an important aspect of their parental responsibilities b. the best time to tell the child is between ages 7-10 years c. it's not necessary to tell the child who was adopted so young d. it's best to wait until the child asks about it

a. telling the child is an important aspect of their parental responsibilities - it's important for the parents NOT to withhold the info from the child. it's an essential component of the child's identity. there's not recommended best time to tell children, it's believed that children should be told young enough so that they don't remember a time when they didn't know. it should be done before the children enter school to keep 3rd parties from telling the children before the parents have had the opportunity

parents ask the nurse for advice when telling their 4 y/o about a grandmother's death. the nurse's best response involves teaching the parents that the child's conception of death is: a. temporary b. permanent c. personified in various forms d. inevitable at some age

a. temporary - death is seen as a temporary departure *they think that life and death can change places with each other *personification is typical of school-age children *children 9-10 y/o have an inevitable understanding of death

an adolescent asks the nurse, "how will I know if I am going through puberty?" the nurse discusses physical changes that usually occur, the first change being: a. testicular enlargement b. voice changes c. growth of dark pubic hair d. increased size of penis

a. testicular enlargement - the first change of puberty in boys; usually occurs between the ages of 9.5 and 14

a preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. which statement is appropriate developmentally for this age group? a. the amount of medicine is less b. the amount of medicine didn't change, only its appearance c. pouring medicine makes the medicine hot d. the glass changed shape to accommodate the medicine

a. the amount of medicine is less *the preschool child doesn't have the ability to understand the concept of conservation, which doesn't develop until school age *understanding conservation occurs between 7 and 10 years of age, when a child begins to realize that physical factors, such as volume, weight and # remain the same even though outward appearances are changed *children are able to deal with a # of different aspects of a situation simultaneously; this isn't an expected response by a child *a preschool child will not typically believe the glass changed shape to accommodate the medicine but rather that the amount of medicine is less in the short, wide glass

the nurse preparing a nutritional teaching plan for the parents of a preschool child should include which information? a. the quality of the food consumed is more important than the quantity b. nutrition requirements for preschoolers are very different from requirements for toddlers c. requirement for calories per unit of body weight increases slightly during the preschool period d. average daily intake of preschoolers should be about 3000 calories

a. the quality of the food consumed is more important than the quantity - it's essential that the child eat a balanced diet with essential nutrients

which statement is true concerning folk remedies? a. they may be used to reinforce the tx plan b. they're incompatible with modern medical regimens c. they're a leading cause of death in some cultural groups d. they're not a part of the culture in large, developed countries

a. they may be used to reinforce the tx plan - whenever they are compatible, fold remedies should be used to reinforce the tx plan. this will assist in establishing a caring environment

which statement is correct about young children who report sexual abuse? a. they may exhibit various behavioral manifestations b. in most cases the child has fabricated the story c. their stories aren't believed unless other evidence is apparent d. they should be able to retell the story the same way to another person

a. they may exhibit various behavioral manifestations - there is no diagnostic profile of the child who is being sexually abused *adults are reluctant to believe children and sexual abuse goes unreported *a physical exam is normal in 80% of abused children *children will usually try to protect parents and may accept responsibility for the act

Matt, age 14 y/o, seems to always be eating, although his weight is appropriate for his height. the best explanation for this is: a. this is normal because of increased body mass b. this is abnormal and suggestive of future obesity c. his caloric intake needs to be excessive d. he's substituting food for unfilled needs

a. this is normal because of increased body mass

the nurses caring for a child are concerned about the child's frequent requests for pain medication. during a team conference, a nurse suggests that they consider giving a placebo instead of the usual pain med. this decision would be based on knowledge that: a. this practice is unjustified and unethical b. this practice is effective in determining whether a child's pain is real c. the absence of a response to a placebo means that the child's pain has an organic basis d. a positive response to a placebo won't occur if the child's pain has an organic basis

a. this practice is unjustified and unethical - position statement issued by the American society of pain management nursing maintains that placebos shouldn't be used in the assessment and tx of pain. placebos should never be given as a means to determine whether pain is real

the nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: a. trust b. industry c. initiative d. separation

a. trust - the task of infancy is the development trust

the parents of a toddler state their child is having trouble sleeping. what's the BEST suggestion to improve sleep habits? a. using a transitional object b. varying the bedtime ritual c. restricting stimulating activities during the day d. explaining away fears

a. using a transitional object - may help the child ease anxiety and facilitate sleep as well as a consistent ritual

a 6 y/o child is hospitalized with a fractured femur. based on the nurse's knowledge of opioid side effects, the nurse should include which actions in the pt's plan of care to prevent constipation? (select all that apply) a. instruct the child to remain supine while in bed b. administer colace c. encourage fluid intake d. encourage the child to eat fruit e. administer benadryl

b, c, d - these can all help prevent constipation

the nurse is developing a teaching plan about preventing fetal exposure to teratogens. the nurse should include which teratogenic agents or conditions? (select all that apply) a. acetaminophen (tylenol) b. isotetinoin (accutane) c. cocaine d. hyperthermia e. ethyl alcohol f. phenytoin (dilantin)

b, c, d, e, f - teratogens, agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors *types of teratogens include drugs (phenytoin, warfarin, isotretinoin), chemicals (ethyl alcohol, cocaine, lead), infections agents (rubella, cytomegalovirus), physical agents (maternal ionizing radiation, hyperthermia) and metabolic agents (maternal PKU) *many of these teratogenic exposures and the resulting effects are completely preventable, such as ingestion of alcohol resulting in fetal alcohol effects, which causes severe birth defects, including cognitive impairement

at the beginning of the school year, the school nurse identifies several new children at the school. the nurse knows that which factors place the children at high risk adjustment problems? (select all that apply) a. the child is from a middle class family b. the child hasn't attended a preschool program c. the child exhibits signs of emotional immaturity d. the parents of a child demonstrate warm, loving behaviors e. the child appears physically immature

b, c, e *successful adjustment is r/t the child's physical and emotional maturity and the parent's readiness to accept the separation associated with school entrance *unfortunately, some parents express their unconscious attempts to delay the child's maturity by clinging behavior, particularly with their youngest child *middle class children have fewer adjustments to make *

the peds clinic nurse completes an assessment on a 4 month old infant brought in because the parents are concerned that something is "just not right" with their baby. the nurse should alert the HCP to which assessment findings? (select all that apply) a. inability to sit up without support b. poor head control and clenched fists c. inability to crawl d. failure to smile e. extreme irritability

b, d, e *the infant wouldn't be expected to sit up without support until 6-7 months *early signs of CP include: failure to meet any developmental milestones such as rolling over, raising head, sitting up, crawling; persistent primitive reflexes such as moro, assymmetrical tonic neck reflex; poor head control (head lag) and clenched fists after 3 months old; stiff or rigid arms or legs; scissoring legs; pushing away or arching back; stiff posture; floppy or limp body posture, especially while sleeping; inability to sit up without support by 8 months; using only 1 side of the body or only the arms to crawl; feeding difficulties; persistent gagging or choking when feed; after 6 months old, tongue pushing soft food out of the mouth; extreme irritability or crying; failure to smile by 3 months old; lack of interest in surroundings

when planning a child safety health fair presentation addressing causes of death in children, the nurse should include which topics? (select all that apply) a. suicide prevention support groups for 5-9 y/o b. STI prevention for 15-19 y/o c. BP screenings for 5-9 y/o d. gun safety for 10-14 y/o e. info on bullying and violence prevention for 15-19 y/o

b, d, e *the leading causes of death in children 5-9 y/o includes injuries (accidents), malignant neoplasms, congenital anomalies, assault (homicide), and heart disease *in children 10-14 y/o, suicide is the 3rd leading cause of death after injures (accidents) and malignant neoplasms *in youth 15-19 y/o, assault (homicide), suicide, malignant neoplasms, and heart disease following accidents as the most prevalent causes of death *suicide isn't prevalent in 5-9 y/o and HTN isn't isn't a leading cause of death or safety concern for the 5-9 y/o age group

a nurse is completing a pain assessment of an infant. which of the following pain scales should the nurse use? a. FACES b. FLACC c. oucher d. non-communicating children's pain checklist

b. FLACC

parents are often confused by the terms growth and development and use the terms interchangeably. based on the nurse's knowledge of growth and development, the most appropriate explanation of development is: a. a child grows taller all through early childhood b. a child learns to throw a ball overhand c. a child's weight triples during the first year d. a child's brain increases in size until school age

b. a child learns to throw a ball overhand *development is the mental and cognitive attainment of skills *growth is the increase in physical size - both height and weight

the nurse should recognize that, when a child develops DKA, it's: a. an expected outcome b. a life-threatening situation c. best treated at home d. best treated at the practitioner's office/clinic

b. a life-threatening situation - this is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment; DKA is the state of complete insulin deficiency *ICU can provide assessment, insulin administration and fluid and electrolyte replacement

when considering the impact of culture on the peds pt, the nurse recognizes that culture: a. refers to a group of people with similar physical characteristics b. affects the development of health beliefs c. refers to the universal manner and sequence of growth and development d. is synonymous with race

b. affects the development of health beliefs

a nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to: a. feed lunch b. allow the toddler to start making choices about what to wear c. allow the toddler to pull a talking duck toy d. turn on a TV show with bright colors and loud songs

b. allow the toddler to start making choices about what to wear - a toddler is developing autonomy and is able to start making some choices about what they can wear *they are focusing on doing things for themselves and therefore to wouldn't want the mother to feed them *the child is at the stage of autonomy versus shame and doubt, as defined by Erikson; at this age, the mother should provide opportunities for the child to be active and learn by experience and imitation *providing toys the child can control will help achieve this stage *a toddler might easily become overstimulated by images from TV and loud sounds; they are more interested in manipulating and learning from objects in the environment

what explains the importance of detecting strabismus in young children? a. color vision deficit may result b. amblyopia, a type of blindness, may result c. epicanthal folds may develop in affected eye d. ptosis may develop secondarily

b. amblyopia, a type of blindness, may result - amblyopia may develop if the eyes don't work together; the brain may ignore the visual cues from 1 eye, resulting in blindness *color vision depends on rods and cones in the retina, not muscle coordination *epicanthal folds are present at birth *ptosis, or drooping eyelids, isn't r/t strabismus (cross-eyes)

a nursing strategy that won't threaten a 2 y/o child's developmental level and will provide atraumatic care when giving an immunization would be to: a. tell the child the shot will hurt but it'll be done quickly b. apply EMLA cream before the procedure c. encourage the parent to wait outside while the injection is given d. tell the child that "big boys" are brave and hold still when getting a shot

b. apply EMLA cream before the procedure *EMLA cream is a autectic mixure of lidocaine 2.5% and prilocaine 2.5% that acts as a topical anesthetic for painful procedures *telling the child the shot will hurt is threatening *not having the parents present during any painful procedure is very traumatic for most children *telling a child to be brave is a form of coercion that is nontherapeutic

several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. they say they felt especially close to both the child and the family. the supervisor should recognize that attending the funeral is: a. appropriate because families expect this expression of concern b. appropriate because it can assist in the resolution of personal grief c. inappropriate because it's unprofessional d. inappropriate because it increases burnout

b. appropriate because it can assist in the resolution of personal grief - nurses should attend the funeral of a child if they felt closeness with the family, this will help them grieve and gain closure

a nurse screens an adolescent for depression. all of the following questions should be asked in this screening except: a. how often do you feel irritable and angry? b. are you happy? c. describe for me what school activities you're involved in d. tell me about your friends and what kinds of things you enjoy doing with them e. what has been your experience with using alcohol or drugs?

b. are you happy? *questions about irritability, anger, relationships with friends and experience with experimentation or use of drugs and alcohol are all important to ask when screening an adolescent for depression *although asking if they're happy may provide useful info, "yes/no" closed-ended questions won't provide the most helpful response

the nurse is ready to begin a physical exam on an 8 month old infant. the child is sitting contentedly on his mother's lap, chewing on a toy. what should the nurse do FIRST? a. elicit reflexes b. auscultate heart and lungs c. examine eyes, ears and mouth d. examine head, systematically moving toward feet

b. auscultate heart and lungs - should be performed while the child is quiet *a and c may disturb or upset the child, making auscultation and the remainder of the exam difficult *although d is the way most physical exams proceed, the nurse should perform the assessment for a child in an order that moves from least disturbing to most disturbing from the child's perspective

when is bronchial (postural) drainage generally performed? a. immediately before all aerosol therapy b. before meals and at bedtime c. immediately on arising and at bedtime d. 30 mins after meals and at bedtime

b. before meals and at bedtime - this is the most effective time for bronchial drainage *it's more effective after other respiratory therapy, such as bronchodilators or neb txs *the procedure should be done 3-4 times per day *when drainage is done after meals, it may cause the child to vomit

the parents of a 5 month old girl complain to the nurse that they're exhausted because she still wakes up as often as every 1- hours during the night. when she awakens, they change her diaper, and her mother nurses her back to sleep. what should the nurse suggest to help them deal with this problem? a. putting her in parent's bed to cuddle b. beginning to put her to bed while still awake c. letting her cry herself back to sleep d. giving her a bottle of formula instead of breastfeeding her so often at night

b. beginning to put her to bed while still awake - parents need to develop bed time rituals that involve putting the child in bed when awake. if the child is put to bed awake, they will be able to return to sleep more easily if awakening at night

which statement best describes the infant's physical development? a. binocularity is well established by 8 months b. birth weight doubles by age 6 months and triples by age 1 year c. maternal iron stores persist during the first 12 months of life d. anterior fontanel closes by age 6-10 months

b. birth weight doubles by age 6 months and triples by age 1 year

1 of the major tasks of toddlerhood is toilet training. in teaching the parents about a child's readiness for toilet training, it's important for the nurse to emphasize that: a. nighttime bladder control develops first, so parent should focus on that in the initial teaching with their toddler b. bowel control is accomplished before bladder control, so the parent should focus on bowel training first c. the toddle must have the gross motor skill to climb up to the adult toilet before training has begun d. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years

b. bowel control is accomplished before bladder control, so the parent should focus on bowel training first - because of its greater regularity and predictability; the sensation to defecate is stronger than that of urination; the completion of bowel training will give them a sense of accomplishment that can be carried onto bladder training

the nurse is caring for a child dying from cancer. physical signs that the child is approaching death include: a. rapid pulse b. change in respiratory pattern c. sensation of cold, although body feels hot d. loss of hearing followed by loss of other senses

b. change in respiratory pattern - in the final hours of life the respiratory pattern may become more labored, with periods of apnea *the pulse becomes weak and slowed *there's a sensation of heat, although the body feels cold *hearing is the last sense to fail

the nurse should teach volunteers in the after school program that which characteristics MOST descriptive of the social development of school-age children? a. identification with peers is minimal b. children frequently have "best friends" c. boys and girls play equally well with children of either gender d. peer approval isn't yet an influence toward conformity

b. children frequently have "best friends" - same sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid *identification with peer group is an important factor toward gaining independence from families

which of the following is an important factor for consideration in understanding the pain experience in children? a. children cannot tell where they hurt b. children may not admit having pain c. narcotics are dangerous for children d. children's sensitivity to pain is less than that of adults

b. children may not admit having pain - children may not admit to having pain to avoid an injection. with constant pain, children may not realize how much they are hurting and believe that adults will know how they are feeling

a camp nurse is assessing a group of children attending summer camp. based on the nurse's knowledge of special parenting situations, which group of children is at risk for a sense of belonging? a. children adopted as infants b. children recently placed in foster care c. children whose parents recently divorced d. children who recently gained a stepparent

b. children recently placed in foster care - are at greatest risk to have problems perceiving a sense of belonging *children adopted at birth have fewer problems with acceptance when parents follow preadoption counseling about disclosure *children of divorced parents often fear abandonment *children who gain a stepparent are at risk for having trust problems with the new parent

the MOST common cause of secondary hyperparathyroidism is: a. DM b. chronic renal disease c. congenital heart disease d. growth hormone deficiency

b. chronic renal disease

which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? a. inactivity b. clings to parent c. depressed, sad d. regression to earlier behavior

b. clings to parent - in the protest phase, the child aggressively responds to separation from parents

according to Piaget's theory, which behavior does a 9 y/o child show? a. logical reasoning b. concrete thinking c. object permanence d. imaginary audience

b. concrete thinking *logical reasoning is observed in individuals starting from age 11 *object permanence is observed in children between birth and 2 y/o *the idea of being constantly observed by an imaginary audience is observed in individuals starting from the age of 11

a sexually active adolescent asks the school nurse about prevention of STDs. the nurse should recommend: a. prophylactic abx b. condom use c. any type of contraception method d. withdrawal method of contraception

b. condom use - condoms provide a barrier to the organisms that cause STDs

when caring for a youngster with anorexia nervosa, the MOST important nursing intervention is to: a. encourage weight gain b. correct malnutrition c. limit fluid intake d. prevent depression

b. correct malnutrition - the priority goal of tx *the individual with anorexia would probably not be receptive to encouragement of weight gain because of the complex etiology of the DO *fluids are often restricted by the individual with anorexia *it's important to correct fluid and electrolyte imbalances if present *depression may be a component of the process

a mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. she plays "house" in it with her toddler brother. based on the nurse's knowledge of growth and development, the nurse recognizes that this is: a. unsafe play that should be discouraged b. creative play that should be encouraged c. suggestive of limited family resources d. suggestive of limited family supervision

b. creative play that should be encouraged - after children create something new, they can then transfer it to other situations

which term best describes a group or people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? a. race b. culture c. ethnicity d. social group

b. culture - culture is a pattern of assumptions, beliefs and practices that unconsciously frames or guides the outlook and decisions of a group of people. a culture is composed of individuals who share a set of values, beliefs and practices that serve as a frame of reference for individual perceptions and judgments *race is defined as a division of humankind that possesses traits transmissible by descent and sufficient to characterize it as a distinct human type *ethnicity is an affiliation of a set of persons who share a unique cultural, social and linguistic heritage *a social group consists of systems of roles carried out in groups

an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. provide for privacy b. encourage parents to room in c. explain procedures and routines d. encourage contact with children the same age

b. encourage parents to room in - a toddler experiences separation anxiety secondary to being separated from the parents; to avoid this, parents should be encouraged to room in as much as possible *maintaining routines and ensuring privacy are helpful interventions, but they wouldn't substitute for the parents

transdermal fentanyl (Duragesic) is being used for an adolescent with cancer who is in hospice care. the adolescent has been comfortable for several hours but now c/o severe pain. the most appropriate nursing action is to: a. give demerol IM b. give morphine sulfate immediate release IV c. use a nonpharmacologic strategy d. place another fentanyl patch on

b. give morphine sulfate immediate release IV - relief of breakthrough pain *IM should be avoided in cancer pts d/t increased risk of bleeding and they don't act immediately *nonpharmacologic strategies aren't effective in severe pain

which statement about early childhood caries (ECC) is correct? a. the syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple b. giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome c. the syndrome can be prevented by breastfeeding d. giving the child juice in the bottle instead of milk at bedtime prevents this syndrome

b. giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome - sweet liquids pooling in the mouth during sleep cause dental caries

*ON QUIZ a child who has been receiving morphine IV will now start receiving it orally. the nurse should anticipate that, to achieve equianalgesia (equal analgesic effect), the oral dose will be: a. the same as the IV dose b. greater than the IV dose c. half of the IV dose d. a fourth of the IV dose

b. greater than the IV dose - when the route is changed from IV to oral, it's essential that the dose be increased to achieve an equianalgesic effect

what nursing intervention is appropriate for a child going through the stage of autonomy vs sense of shame and doubt? a. help the parents to cope with the hospitalization of an infant b. guide the parents to help the child achieve self-control and willpower c. help hospitalized adolescence make decisions about their tx plan d. assist physically ill adults in choosing reactive ways to foster social development

b. guide the parents to help the child achieve self-control and willpower *the nurse helps the parent cope with hospitalization of an infant during the trust versus mistrust stage *the nurse helps hospitalized adolescents make decisions about their tx plan during the identity vs role confusion stage *the nurse assists physically ill adults in choosing creative ways to foster social development in during the generativity vs self-absorption and stagnation stage

families progress through various stages of reactions when a child is dx with a chronic illness or disability. after the shock phase, a period of adjustment usually follows. this is often characterized by: a. denial b. guilt and anger c. social reintegration d. acceptance of child's limitation

b. guilt and anger - for most families, the adjustment phase is accompanied by several responses that are normally part of the adjustment process *guilt, self-accusation, bitterness and anger are common reactions *the initial dx is often met with intense emotion and characterized by shock and denial *social reintegration and acceptance of the child's limitations is the culmination of the adjustment process

a parents phones the nurse and says that her child just knocked out a permanent tooth. the nurse's instructions to the parent should include: a. rinsing the tooth in hot water b. holding tooth by the crown and not by the root area c. taking the child and tooth to the dentist within 48 hours d. taking the child to the hospital ED if mouth is bleeding

b. holding tooth by the crown and not by the root area - the root area shouldn't be touches *only if dirty should the tooth be rinsed with running water *reimplantation should occurs ASAP *the child needs to be seen by a competent dentist ASAP

what is frequently associated with infant botulism? a. contaminated soil b. honey and corn syrup c. commercial infant cereals d. improperly sterilized bottles

b. honey and corn syrup - unlike adult botulism, infant botulism is caused by ingesting spores of c. botulinum and the resultant release of toxin; the bacterium has been found in honey and corn syrup that was fed to affected infants

the nurse is preparing a health teaching session for school-age children. the nurse should include which info about injury prevention in the plan? a. peer pressure isn't strong enough to affect risk-taking behavior b. most injuries occur in or near school or home c. injuries from burns are the highest at this age because of fascination with fire d. lack of muscular coordination and control results in increased incidence of injuries

b. most injuries occur in or near school or home *peer pressure is significant in this age group *automobile accidents account for the majority of severe accidents, either as a pedestrian or passenger *school-age children have more refined muscle development, which results in an overall decrease in the # of accidents

an 8 y/o child is hospitalized with infectious polyneuritis (Guillain-Barre syndrome). when explaining this disease process to the parents, the nurse should consider that: a. paralysis is progressive with little hope for recovery b. muscle function will gradually return, and recovery is possible for most children c. disease results from an apparently toxic reaction to certain meds d. disease is inherited as an autosomal, sex-linked, recessive gene

b. muscle function will gradually return, and recovery is possible for most children - the paralysis is progressive, but most children have full recovery; the return of function is in reverse order of onset *supportive nursing care is essential; most pts regain full muscle strength *it's an immune-mediated disease associated with viral and bacterial infections

parents tell the nurse their 3 y/o daughter and a male cousin of the same age have been inspecting each other closely as they used the BR. which of the following is the most appropriate response by the nurse? a. punish children so this behavior stops b. nether condone nor condemn the curiosity c. allow children unrestricted permission to satisfy this curiosity d. get counseling for this unusual and dangerous behavior

b. nether condone nor condemn the curiosity

cultural beliefs and practices are an important part of nursing assessment, because when analyzed and incorporated into the nursing process, these beliefs: a. are very similar from one culture to another b. often assist in the plan of care c. can be manipulated more easily if known d. must be in unison with standard health practices

b. often assist in the plan of care

when preparing parents to teach their preschool child about human sexuality, the nurse should emphasize that: a. parent's words may have a greater influence on the child's understanding than the parent's actions b. parents should determine exactly what the child wants to know before answering questions about sex c. parents should avoid using corerect anatomic terms because they're confusing to the preschooler d. parents should allow children to satisfy their sexual curiosity by playing "doctor"

b. parents should determine exactly what the child wants to know before answering questions about sex - it's important that the parent answer the question the child is asking *using correct terminology lays a foundation for later discussion *actions may have a greater influence because language isn't fully developed *parents should encourage the asking of questions to resolve curiosity without undue investigation on the child's part

during a well-child visit, the father of a 4 y/o boy tells the nurse that he's not sure if his son is ready for kindergarten, his bday is close to the cutoff date, and he hasn't attended preschool. the nurse's BEST recommendation is to: a. start kindergarten b. perform development screening c. observe a kindergarten class d. postpone kindergarten and go to preschool

b. perform development screening - this will provide the necessary info to help the family determine readiness

the nurse's BEST approach for effective communication with a preschool age child is through: a. speech b. play c. drawing d. actions

b. play - the child's way to learn to understand and adjust to situations

in which developmental stage is the child first able to localize pain and describe both the amount and the intensity of the pain felt? a. toddler stage b. preschool stage c. school-age stage d. adolescent stage

b. preschool stage - for example, "ear hurts bad"

the feeling of guild that the child "caused" the disability or illness is especially critical in which child? a. toddler b. preschooler c. school-age d. adolescent

b. preschooler - preschoolers are most likely to be affected by feelings of guilt that they caused the illness/disability or are being punished for wrongdoings *toddlers are focused on establishing their autonomy; the illness will foster dependency *school-agers will have limited opportunities for achievement and may not be able to understanding limitations *adolescents are faced with the task of incorporating disabilities into the changing self-concept

the primary goal in caring for the child with cognitive impairment is to: a. encourage play b. promote optimum development c. help families adjust to future care d. develop vocational skills

b. promote optimum development - a comprehensive approach is desirable to establish acceptable social behavior and feelings of self-worth in the child *provide parents guidance for the selection of developmentally appropriate activities

the nurse is caring for a neonate born with a myelomeningocele. surgery to repair the defect is scheduled for the next day. the most appropriate way to position and feed this neonate is to place him: a. prone and tube feed b. prone, turn head to side and nipple feed c. supine in an infant carrier and nipple feed d. supine with defect supported with rolled blankets and nipple feed

b. prone, turn head to side and nipple feed - in the prone position, feeding is a problem. the infant's head is turned to 1 side for feeding. if the child is able to nipple feed, no indication is present for tube feeding. before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma

a child with spina bifida has developed a latex allergy from numerous bladder cathetarizations and surgeries. a PRIORITY nursing intervention is to: a. recommend allergy testing b. provide a latex-free environment c. use only powder-free latex gloves d. limit use of latex products as much as possible

b. provide a latex-free environment - this is the most important nursing intervention *allergy testing may expose the child to the allergen *from birth on, the limitation of exposure to latex is essential in an attempt to minimize sensitization *gloves contain latex and will contribute to sensitization

*ON QUIZ the nurse needs to start an IV line on an 8 y/o child to begin administering IV abx. the child starts to cry and tells the nurse, "do it later, ok?" the nurse should: a. start the IV line because allowing the child to manipulate the nurse is bad b. provide an explanation of the procedure prior to initiating therapy c. postpone starting the IV line until the next shift so that the child is ready and experiences a sense of control d. postpone starting the IV line until the child is ready so the child's anxiety is reduced

b. provide an explanation of the procedure prior to initiating therapy - this may help to decrease anxiety and offer an element of participative control for the child in the hospital setting *IV abx are a priority action for the nurse *a short delay may be possible to allow the child some choice, but postponing initiation of abx therapy until the next shift will delay prompt tx and may serve to increase the anxiety

a nurse is caring for an adolescent who's mother expresses concerns about her son sleeping such long hours. the nurse should inform the mother that additional sleep is needed during adolescence d/t which of the following? a. sleep terrors b. rapid growth c. elevated zinc levels d. slowed metabolism

b. rapid growth

nursing responsibilities when caring for the suicidal adolescent include: a. emphasizing that a suicide attempt is an immature way of dealing with stress b. recognizing the warning signs that indicate a young person might attempt suicide c. ignoring threats of suicide because they are usually bids for attention d. recognizing a suicide attempt as an impulsive act resulting from a temporary crisis

b. recognizing the warning signs that indicate a young person might attempt suicide - it's imperative that the nurse recognize warning signs of potential suicide *for the depressed young person, suicide may appear to be the only way out *all threats must be taken seriously

a 16 y/o girl tells the school nurse that she hasn't started to menstruate yet. onset of secondary sexual characteristics occurred about 4 years ago. the nurse should: a. explain that this isn't unusual b. refer adolescent for an evaluation c. assume that the adolescent is pregnant d. suggest that adolescent stop exercising until menarche occurs

b. refer adolescent for an evaluation - this meets the definition of primary amenorrhea and should be evaluated *menstruation usually begins 2 years after the beginning of secondary sexual characteristics *the nurse shouldn't assume until further assessment is performed *there's no indication that she's exercising excessively

a 4 y/o boy has been having increasingly more frequent angry outbursts in preschool. he's very aggressive toward the other children and the teachers. this behavior has been a problem for approximately 8-10 weeks. his parent asks the nurse for advice. the MOST appropriate intervention is to: a. explain that this is normal in preschoolers, especially boys b. refer the child for professional help c. talk to the preschool teacher to obtain validation for the behavior the parent reports d. encourage the parent to try more consistent and firm discipline

b. refer the child for professional help - this is not expected behavior and the child should be referred to a competent professional to deal with his aggression

the nurse teaching parents of an adolescent about nutrition will include which important information? a. adolescents are usually mature enough to make healthy food choices b. resources to assist lower income families about obtaining enough protein c. behavior problems in this age-group aren't r/t nutritional deficiencies d. parental influence has the greatest impact on food choices at this age

b. resources to assist lower income families about obtaining enough protein - lower income families may need resources and information about how to obtain assistance in getting expensive foods such as meats to get enough protein intake *during adolescence, parental influence diminishes and they make food choices r/t peer acceptability and sociability; occasionally these choices are detrimental to those with chronic illness such as DM, obesity, chronic lung disease, HTN, cardiovascular risk factors and renal disease *families that struggle with lower incomes, homelessness, and migrant status generally lack the resources to provide their children with adequate food intake, nutrition foods like fruits and veggies and appropriate protein intake *the result is nutritional deficiencies with subsequent growth and developmental delays, depression and behavior problems

a 4 y/o female child sometimes wakes her parents up at night screaming, thrashing, sweating and apparently frightened. yet she isn't aware of her parents' presence when they check on her. she lies down and sleeps without any parental intervention. this is MOST likely described as: a. a nightmare b. sleep terror c. seizure activity d. sleep apnea

b. sleep terror - the child is only partially aroused; therefore doesn't remember her parent's presence *a nightmare is a frightening dream followed by full awakening

early detection of a hearing impairment is critical because of its effect on areas of the child's life. the nurse should evaluate further for effects of the hearing impairment on: a. reading development b. speech development c. relationships with peers d. performance at school

b. speech development - the ability to hear sounds is essential for the development of speech; babies imitate the sounds that they hear *the child will have greater difficulty learning to read, but the primary issue of concern is the effect on speech *relationships with peers and performance in school will be affected

a 3 y/o male child has cerebral palsy and is currently hospitalized for orthopedic surgery. his mother says that he has difficulty swallowing and cannot hold a utensil to feed himself. he's slightly underweight for his height. the MOST appropriate nursing action r/t feeding this child is to: a. bottle- or tube-feed him a specialized formula until he gains sufficient weight b. stabilize his jaw with 1 hand (either from a front or side position) to facilitate swallowing c. place him in a well-supported, semireclining position to make use of gravity flow d. place him in a sitting position with his neck hyperextended to make use of gravity flow

b. stabilize his jaw with 1 hand (either from a front or side position) to facilitate swallowing - the neuromuscular compromise of the jaw interfered with the child's ability to eat; because the jaw is compromised, more normal control can be achieved if the feeder provides stability; manual jaw control assists with head control, correction of neck and trunk hyperextension, and jaw stabilization *age 3 is too old for bottle feeding *the child should be sitting up for meals *for swallowing, the neck shouldn't be hyperextended

poisoning in toddlers can best be prevented by: a. consistently using safety caps b. storing poisonous substances in a locked cabinet c. keeping ipecac syrup in the home d. storing poisonous substances out of reach

b. storing poisonous substances in a locked cabinet - not all poisonous substances have safety caps; ipecac isn't recommended

the exhausted parents of a 2 month old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. the nurse's initial action is to: a. advise the mother to follow a milk-free diet for 3-5 days b. take a thorough, detailed hx of usual daily events c. administer simethicone drops to provide relief from gas pains d. explain that the parents need to stay calm so the infant will remain calm

b. take a thorough, detailed hx of usual daily events - this is the initial step in managing colic including: diet, time of day when child cries, presence of family members, type of cry, etc.

a Mexican American adolescent states to the nurse, "I have cancer because it's God's will. It will make me stronger." the MOST appropriate response by the nurse is: a. you're too young to think that way. you still have many years to live b. tell me how you feel about the treatment plan c. I will move your family into the waiting area to give you some quiet time d. I will contact the hospital chaplain for you

b. tell me how you feel about the treatment plan - it's common in the Mexican-American culture for pts to feel that health is controlled by environment, fate, and will of God. asking the pt an open-ended question to assess how the pt feels about the tx plan will provide the nurse with more info about what the pt understands about the illness and exactly what tx measures that pt desires *the nurse shouldn't provide false reassurance *family and strong kinship is important in this culture *separating a family member isn't the most appropriate action *the nurse should ask about religious preferences 1st before assuming the pt would like to speak with a chaplain

a nurse is knowledgeable about both growth and development. which assessment finding indicates that child's development is on target? a. the child hasn't gained weight for 3 months b. the child can throw a large ball but not a small ball c. the child's arms are the most rapidly growing part of the child's body d. the child can pull themselves their their feet before the child is able to sit steaily

b. the child can throw a large ball but not a small ball - development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large object before small ones *not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child's development may not be on target *in children, the legs are normally the most rapidly growing part of the body; if this isn't the case, the child's development may not be on target *a child whose development is on target can sit steadily before pulling themselves up to their feet

which of the following assessment findings would be considered most abnormal? a. the infant who begins to roll from front to back at 4 months b. the infant who displays head lag at 6 months of age c. the infant who displays head lag at 3 month of age d. the infant who begins to roll from front to back at 6 months

b. the infant who displays head lag at 6 months of age

an important consideration when using the FACES pain rating scale with children is: a. that children color the face with the color they choose to best describe their pain b. the scale can be used with most children, including those as young as 3 y/o c. the scale isn't appropriate for use with adolescents d. the scale is useful in pain assessment but isn't accurate when assessing physiologic responses

b. the scale can be used with most children, including those as young as 3 y/o

an important consideration when using the FACES pain rating scale with children is: a. that children color the face with the color they choose to best describe their pain b. the scale can be used with most children, including those as young as 3 y/o c. the scale isn't appropriate for use with adolescents d. the scale is useful in pain assessments but isn't as accurate when assessing physiologic response

b. the scale can be used with most children, including those as young as 3 y/o

which statement helps explain the growth and development of children? a. development proceeds at a predictable rate b. the sequence of development milestones is predictable c. rates of growth are consistent among children d. at times of rapid growth, there is also acceleration of development

b. the sequence of development milestones is predictable - there is a fixed, precise order to development *there are periods of both accelerated and decelerated growth and development. each child develops at their own rate *physical growth and development proceed at differing rates

the nurse is teaching the parents of a 24 month old about motor skill development. the nurse should include which statement in the teaching? a. the toddler walks alone but falls easily b. the toddler's activities begin to produce purposeful results c. the toddler is able to grasp small objects but cannot release them at will d. the toddler's motor skills are fully developed but occur in isolation from the environment

b. the toddler's activities begin to produce purposeful results - the child is able to walk up and down stairs at this age; gross and fine motor mastery occur with other activities

the nurse is caring for a dying by whose religion is Islam (Muslim/Moslem). an important nursing consideration r/t his impending death and religion is that: a. there are no special rites b. there are specific practices to be followed c. the family is expected to "wait" away from the dying person d. baptism should be performed if it hasn't been done previously

b. there are specific practices to be followed - the nurse should contact someone from the person's mosque to assist. Islam has specific rituals for bathing and wrapping the body in cloth before it's to be moved. family may be present. no baptism is performed at this time

what is characteristic of the preoperational stage of cognitive development? a. thinking is logical b. thinking is concrete c. reasoning is inductive d. generalizations can be made

b. thinking is concrete - and tangible. children in this age group cannot reason beyond the observable and they lack the ability to make deductions or generalizations. increasingly logical thought, inductive reasoning and the ability to make generalizations are characteristic of the concrete operations stage of development, ages 7-11 years

a parent of an 8 month old infant tells the nurse that the baby cries and screams whenever they are left with the grandparents. the nurse's reply should be based on knowledge that: a. the infant is most likely spoiled b. this is a normal reaction for this age c. this is an abnormal reaction for this age d. grandparents aren't responsive to the infant

b. this is a normal reaction for this age - the infant is experiencing stranger anxiety, which is expected for this age

a nurse is planning care for an infant who is experiencing pain. which of the following interventions isn't appropriate for this age group? a. offer a pacifier b. use guided imagery c. use swaddling d. encourage kangaroo care (skin-to-skin contact)

b. use guided imagery

a mother is bringing her 4 month old infant into the clinic for a routine well-baby check. the mother is exclusively breastfeeding. there are no other liquids given to the infant. what vitamin does the nurse anticipate the provider will Rx for this infant? a. vitamin B b. vitamin D c. vitamin C d. vitamin K

b. vitamin D - the American academy of pediatrics recommends that infants who are exclusively breastfed receive 400 IUs of vitamin D daily in the first few days of life and continued daily supplementation to decrease vitamin D deficiency

informed consent is valid when: (select all that apply) a. universal consent is used b. it's completed only for major surgery c. a person is over the age of majority and competent d. info is provided to make an intelligent decision e. the choice exercised is free of force, fraud, duress, or coercion

c, d, e *the age of majority is usually 18 y/o *the term competent is defined as possessing the mental capacity to make choices and understand their consequences *enough info is provided so that the persona can make an intelligent decision *the person giving consent does so voluntarily = freely, without coercion, in any form of constrain, force, fraud, duress, or deceit *universal consent isn't sufficient *informed consent must be obtained for each surgical or diagnostic procedure, including major, minor, diagnostic tests, medical txs, release of medical info, postmortem exam, removal of a child from the HCP against medical advice and photographs for medical, educational or public use

at what age would the nurse advise parents ot expect their infant to be able to say "mama" and "dada" with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

c. 10 months

a nurse is discussing various developmental theories at a parenting class. which individual is associated with the moral development theory? a. Erikson b. Fowler c. Kohlberg d. Freud

c. Kohlberg - developed the theory of moral development sequence for children, which includes how children acquire moral reasoning and is based on cognitive development theory *Erikson developed the theory of psychosocial development *Fowler developed the theory of spiritual development *Freud developed the theory of psychosexual development

a frequent health problem of migrant children and adolescents in the US is: a. suicide b. diabetes c. TB d. cardiovascular disease

c. TB - the rate of TB among migrant families is high. a high risk factor for children of migrant families is the migration from areas that have high prevalence of TB

the s/s in a nursing dx describe: a. projected changes in an individual's health status, clinical conditions or behavior b. an individual's response to health pattern deficits in the child, family or community c. a cluster of cues and/or defining characteristics that are derived from pt assessment and indicate actual health problems d. physiologic, situational and maturational factors that cause the problem or influence its development

c. a cluster of cues and/or defining characteristics that are derived from pt assessment and indicate actual health problems

which statement is true concerning the increased use of telephone triage by nurses? a. telephone triage has led to an increase in health care costs b. ED visits aren't recommended by nurses and thus aren't a Perry component of telephone triage c. access to high-quality health care services has increased through telephone triage d. home care is often recommended when it's not appropriate

c. access to high-quality health care services has increased through telephone triage *health care costs have decreased because of fewer visits to the ED *based on the response to screening questions, the triage nurse determines whether the child needs to be referred to emergency medical services; the nurse can then initiate the call if needed *the judicious use of telephone triage has decreased the # of unnecessary visits, allowing time for improved care *home care is recommended only when indicated on the basis of the screening questions

a child in the clinic exhibits reduced visual acuity in 1 eye despite appropriate optical correction. the nurse expects the child's HCP to dx the child with: a. myopia b. hyperopia c. amblyopia d. astigmatism

c. amblyopia *myopia is nearsightedness; the ability to see objects up close but not clearly at a distance *hyperopia is farsightedness; the ability to see distant objects clearly but not those up close *astigmatism is an alteration in vision caused by unequal curvature in the refractive apparatus of the eye

a child is playing in the playroom. the nurse needs to take a BP on the child. which is the appropriate procedure for obtaining the BP? a. take the BP in the playroom b. ask the child to come to the exam room to obtain the BP c. ask the child to return to their room for the BP, then escort the child back to the playroom d. document that the BP wasn't obtained because the child was in the playroom

c. ask the child to return to their room for the BP, then escort the child back to the playroom - the playroom is a safe haven for children, free from medical or nursing procedures *the exam room is reserved for painful procedures that shouldn't be performed in the child's hospital bed *documenting that the BP wasn't obtained because the child was in the playroom is inappropriate

before transporting a 16 y/o American Indian female for a MRI scan, the nurse notices the girl is wearing a decorated amulet necklace. the nurse's next BEST action is to: a. remove the necklace and place it at the nurse's station b. explain the risks of wearing the necklace during the MRI c. ask the pt if there's a special reason for wearing the necklace d. place tape around the neck covering the necklace

c. ask the pt if there's a special reason for wearing the necklace - the nurse should first ask the pt the purpose of wearing the necklace; it may be worn as a religious ritual or simply as an accessory. after assessing why the amulet is worn, the nurse could then explain the reason for having to remove it for the procedure *placing tape around the neck isn't an appropriate action and could be unsafe *the necklace should be left with family members if possible or in a locked cabinet, rather than at the nurse's station

the parents of a cognitively impaired child ask the nurse for guidance with discipline. the nurse's BEST response is: a. discipline is ineffective with cognitively impaired children b. discipline isn't necessary for cognitively impaired children c. behavior modification is an excellent form of discipline d. physical punishment is the most appropriate form of discipline

c. behavior modification is an excellent form of discipline - this is effective in children with cognitive impairment *discipline is essential in assisting the child in developing boundaries *positive behaviors and desirable actions should be reinforced *most children with cognitive impairment won't be able to understand the reason for physical punishment; consequently, behavior won't change as a result of the punishment

which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake? a. using developmental stimulation by a specialist during feedings b. avoiding solids until after the bottle is well accepted c. being persistent through 10-15 mins of food refusal d. varying schedule of routine activities on a daily basis

c. being persistent through 10-15 mins of food refusal - calm perseverance is important; parents often fail to persist through the child's refusals *feeding time should have a non-stimulating environment so the focus is on the meal *daily schedule should be structured

the psychosexual conflicts of preschool children make them extremely vulnerable to: a. separation anxiety b. loss of control c. bodily injury and pain d. loss of identity

c. bodily injury and pain - intrusive procedures, whether or not they are perceived as painful, are threatening to the preschool child because of the poorly developed concept of body integrity *separation anxiety is a characteristic of infancy *loss of control is a characteristic fear of school-age children *loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual

the nurse is teaching the parent of a 2 y/o child how to care for the child's teeth. which of the following should be included? a. flossing isn't recommended at this age b. the child is old enough to brush teeth effectively c. brush teeth with plain water if child doesn't like toothpaste d. toothbrush should be small and have hard, rounded, nylon bristles

c. brush teeth with plain water if child doesn't like toothpaste - flossing should be done after brushing; some children don't like the flavor of toothpaste or the foam; water alone can be used

how does an adolescent establish group identity during psychosocial development? a. by evaluating their own health with a feeling of well-being b. by fostering their independence with balance family structure c. by building close peer relationships to achieve acceptance is the society d. by achieving marked physical changes with masculine and feminine behaviors

c. by building close peer relationships to achieve acceptance is the society - by building close peer relationships, adolescents develop a sense of belonging, approval, and the opportunity to learn acceptable behavior, which establishes the group identity *by evaluating their own health with a feeling of well-being, an adolescent establishes health identity *an individual establishes family identity by fostering their independence with balanced family structure *the sound and healthy growth of an adolescent with marked physical changes helps to build sexual identity

*ON QUIZ a 4 y/o child will be having cardiac surgery next week. the child's parents call the hospital, asking about hwo to preapre her for this. the nurse's BEST response is to inform the parents that: a. preparation at this age will only increase the child's stress b. preparation needs to be at least 2-3 weeks before hospitalization c. children who are prepared experience less fear and stress during hospitalization d. children who are prepared experiencing overwhelming fear by the time hospitalization occurs

c. children who are prepared experience less fear and stress during hospitalization - preparation will reduce stress by having the child incorporate the threat more slowly *for this age group, 1 week of prep is recommended *tours, handling some of the equipment, or being told stories about what to expect will increase the familiarity with items

the mother of a school-age child tells the school nurse that she and her spouse are going through a divorce. the child hasn't been doing well in school and sometimes has trouble sleeping. the nurse should recognize this as: a. indicative of maladjustment b. suggestive of lack of adequate parenting c. common reaction to divorce d. unusual response that indicates need for referral

c. common reaction to divorce

what info should the nurse include when giving parents guidelines about helping their children in school? a. help children as much as possible with their homework b. punish children who fail to perform adequately c. communicate with teachers if there appears to be a problem d. accept responsibility for children's successes and failures

c. communicate with teachers if there appears to be a problem - parents should communicate with teachers if there's a problem and not wait for a scheduled conference *children need to do their own HW, which cultivates responsibility *discipline should be used to help children control behaviors *school-age children can use reasoning skills

a father tells the nurse that his child is "filling up the house with collections" such as seashells, bottle caps, baseball cards and pennies. the nurse should recognize that the child is developing: a. object permanence b. preoperational thinking c. concrete operational thinking d. ability to use abstract symbols

c. concrete operational thinking - during concrete operations, children develop logical thought processes. they are able to classify, sort, order, and otherwise organize facts about the world. this ability fosters the child's ability to create collections *object permanence is the realization that items that leave the visual field still exist. this is a task of infancy and doesn't contribute to collections *preoperational thinking is concrete and tangible. children in this age group cannot reason beyond the observable and they lack the ability to make deductions or generalizations. collections are not typical for this developmental level *the ability to use abstract symbols is a characteristic of formal operations, which develops during adolescence. these children can develop and test hypotheses

frequent developmental assessments are important for which reason? a. stable developmental periods during infancy provide an opportunity to identify any delays or deficits b. infants need stimulation specific to the stage of development c. critical periods or development occur during childhood d. child development is unpredictable and needs monitoring

c. critical periods or development occur during childhood - critical periods of blocked time during which children are ready to master specific developmental tasks. the earlier that delays in development are discovered and intervention initiated, the less dramatic their effect will be. infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage

the nurse is assessing a 6 month old infant who smiles, coos, and has a strong head lag. the nurse should recognize that: a. this assessment is normal b. the child is probably cognitively impaired c. developmental/neurologic eval is needed d. the parent needs to work with the infant to stop the head lag

c. developmental/neurologic eval is needed - a 6 month old should have social interaction beyond smiling and cooing. the head lag should be gone by 4 months of age

several types of long-term central venous access devices are used. a benefit of using an implanted port (eg port-a-cath) is that it: a. is easy to use for self-administered infusions b. doesn't need to pierce the skin for access c. doesn't need to limit regular physical activity, including swimming d. cannot dislodge from the port, even if child plays with port site

c. doesn't need to limit regular physical activity, including swimming - because the device is under the skin, there's no activity limitations *because the port is totally under the skin, a needle must be used to access it

when discussing a child's precocious puberty with the parents, the nurse should tell them that: a. the child isn't yet fertile b. heterosexual interest is usually advanced c. dress and activities should be appropriate to chronologic age d. appearance of secondary sexual characteristics doesn't proceed in the usual order

c. dress and activities should be appropriate to chronologic age - *functioning sperm or ova may be produced, thereby making the child fertile at an early age *heretosexual interest is usually appropriate to chronologic age *because of the early sexual maturation, both family and child require extensive teaching *secondary sex characteristics proceed in the usual order

an important consideration for the school nurse planning a class on injury prevention for adolescents is that: a. adolescents generally aren't risk takers b. adolescents can anticipate the long-term consequences of serious injuries c. during adolescence a need exists for discharging energy, often at the expense of logical thinking d. during adolescence participation in sports should be limited to prevent permanent injuries

c. during adolescence a need exists for discharging energy, often at the expense of logical thinking *adolescents are risk takers because of their feelings of indestructibility, which are common and interfere with understanding of the consequences *the physical, sensory and psychomotor development of adolescents provides a sense of strength and confidence *sports can be a useful way to them to discharge energy

nursing interventions to promote health during middle childhood include: a. stressing the need for increased calorie intake to meet increased demands b. instructing parents to defer questions about sex until child reaches adolescence c. educating the child and parents to the need for good dental hygiene because these are the years in which permanent teeth erupt d. advising parents that the child will need decreasing amounts of rest toward the end of this period

c. educating the child and parents to the need for good dental hygiene because these are the years in which permanent teeth erupt - because the permanent teeth are present, it's important for the child to learn how to care for these teeth *caloric needs are diminished; however, a balanced diet is important to prepare for the adolescent growth spurt *parents should approach sex education with a lifespan approach and respond with a child's questions with an answer appropriate to the child's age *children often need to be reminded to go to sleep

the school nurse is discussing dental health with some children in 1st grade. what should the nurse included in the discussion? a. teaching how to floss teeth properly b. recommending a toothbrush with hard nylon bristles c. emphasizing the importance of brushing before bedtime d. recommending nonfluoridated toothpaste approved by the american dental association

c. emphasizing the importance of brushing before bedtime - children should be taught to brush their teeth after meals, after snacks and before bed *parents should help with flossing until children develop the dexterity required, which usually occurs at about 3rd grade *a toothbrush with soft nylon bristles is recommended *fluoridated toothpaste is recommended for this age group

a school-age child recently dx with DM1 asks the nurse if he can still play soccer, baseball, and swim. the nurse's response should be based on the knowledge that: a. exercise is contraindicated b. soccer and baseball are too strenuous, but swimming is acceptable c. exercise isn't restricted unless indicated by other health conditions d. the level of activity depends on the type of insulin required

c. exercise isn't restricted unless indicated by other health conditions - *exercise is highly encouraged because it lowers blood glucose levels *the decrease in blood glucose can be accommodated by having snack available *sports are encouraged to help regulate the insulin and food should be adjusted according to the amount of exercise *the child needs to be cautioned to monitor responses to the exercises *

a 2 y/o child has recently started having temper tantrums during which she holds her breath and sometimes faints. the nurse should: a. refer the child for respiratory evaluation b. refer the child for psychological evaluation c. explain to the parent that this isn't harmful d. explain to the parent that the child is spoiled

c. explain to the parent that this isn't harmful - this isn't a respiratory issue; temper tantrums are part of this developmental stage; if they persist, an eval may be indicated; the rising levels of carbon dioxide levels in the child will automatically restart the breathing process

the nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be DCing home. whom should the nurse invite to the conference? a. family and nursing staff b. social worker, nursing staff and primary care physician c. family and key health professionals involve in child's care d. primary care physician and key health professionals involve in child's care

c. family and key health professionals involve in child's care - a multidisciplinary conferee is necessary for coordination for children with complex health care needs *nursing staff can address the nursing care needs of the child with the family, but other involved disciplines must be included *the family must be involved to allow them to determine what education they will require and the resources needed at home

when caring for a preschool-age child, the nurse should incorporate knowledge that body image has developed to include: a. a well-defined body boundary b. knowledge about their internal anatomy c. fear of intrusive procedures d. anxiety and fear of separation

c. fear of intrusive procedures - fear their insides will come out with intrusive procedures

the leading cause of death among African-American boys ages 15-19 years is: a. suicide b. HIV infection c. firearm homicide d. occupational injuries

c. firearm homicide - this is the 2nd overall cause of death in this age-group but the leading cause of death in african american males

an appropriate intervention to provide comfort for the child with itching associated with chickenpox is to: a. encourage frequent warm baths b. give ASA or tylenol c. give an antipruritic med such as benadryl d. apply thick coat of Caladryl lotion over open lesions

c. give an antipruritic med such as benadryl - useful for severe itching, which interferes with sleep and may contribute to secondary infection

the MOST appropriate recommendation for relief of teething pain is to instruct the parents to: a. rub gums with aspirin to relieve inflammation b. apply hydrogen peroxide to gums to relieve irritation c. give child a frozen teething ring to relieve inflammation d. have child chew on a warm teething ring to encourage tooth eruption

c. give child a frozen teething ring to relieve inflammation - cold reduces inflammation and should be used for relief of teething irritation

what is appropriate advice for parents who are preparing to tell their children about their decision to divorce? a. avoid crying in front of children b. avoid discussing the reason for the divorce c. give reassurance that the divorce isn't the children's fault d. give reassurance that the divorce won't affect most aspects of the children's lives

c. give reassurance that the divorce isn't the children's fault - if parents are able, they should hold and touch children and reassure them that they're not the cause of the divorce *parents can cry in front of children; if may give the children permission to do the same *parents should provide the reasons for the divorce in a manner the children will understand *this would most likely be false reassurance because many aspects will change

a mother calls to say that her child who received an immunization yesterday at the clinic now has a fever of 100.2F. the nurse's best response would be: a. bring your child in to be seen at the clinic today b. does your child also have vomiting? c. give your child a dose of tylenol d. what known allergies does your child have?

c. give your child a dose of tylenol *the most common side effects of childhood immunizations include: -pain, redness at side -low grade fever -child experiences fussiness but is consolable -anorexia *a low grade fever is best tx with an age-appropriate dose of tylenol

standard precautions for infection control include that: a. gloves are worn any time a pt is touched b. needles are capped immediately after use and disposed of in a special container c. gloves are worn to change diapers when there are loose or explosive stools d. masks are needed only when caring for pts with airborne infections

c. gloves are worn to change diapers when there are loose or explosive stools - this situation has the greatest risk for exposure to body substances *gloves aren't indicated unless there is potential for contact with body substances *needles shouldn't be recapped; they should be disposed of immediately in a rigid, puncture-proof container *masks are a component of transmission-based precautions and not standard precautions

a neonate with a goiter has just been admitted to the newborn nursery. a PRIORITY nursing intervention is to: a. position the infant on the L side b. explain transient paralysis to parents c. have a tracheostomy set at bedside d. suction the infant at least every 5-10 mins

c. have a tracheostomy set at bedside - goiter puts the infant at risk for respiratory failure; preparations are made for emergency ventilation, including a trach set at the bedside *hyperextension of the child's neck may facilitate breathing *transient paralysis doesn't exist *there's no indication for suctioning

the parents of a 4 y/o girl are worried because she has an imaginary playmate. the nurse's BEST response is to tell the parents: a. a psychosocial evaluation is indicated b. an evaluation of possible parent-child conflict is indicated c. having imaginary playmates is normal and useful at this age d. having an imaginary playmate is abnormal after about age 2 years

c. having imaginary playmates is normal and useful at this age - the peak incidence for imaginary playmates occurs at 2.5-3 years of age

during the first 4 days of hospitalization, Erich, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. now the nurse observes that Erich appears to be "settled in" and unconcerned about seeing his parents. the nurse should interpret this as which of the following? a. he has successfully adjusted to the hospital environment b. he has transferred his trust to the nursing staff c. he may be experiencing detachment, which is the 3rd stage of separation anxiety d. because he is "at home" in the hospital now, seeing his mother frequently will only start the cycle again

c. he may be experiencing detachment, which is the 3rd stage of separation anxiety - detachment is a behavioral manifestation of separation anxiety *superficially it appears that the child has adjusted to the loss and transferred his trust to the nursing staff *detachment is a sign of resignation, not contentment *parents should be encouraged to be with their child *if parents restrict visits, they may begin a pattern of misunderstanding the child's cues and not meeting his needs

a nurse is assessing a 2.5 y/o toddler at a well-child visit. which of the following findings should the nurse report to the provider? a. anterior and posterior fontanels closed b. current weight equals 4 times the birth weight c. head circumference exceeds chest circumference d. height increased by 7.5 cm (3 in) in the past year

c. head circumference exceeds chest circumference

nurses play an important role in current issues and trends in health care. which is a current trend in pediatric nursing and health care today? a. the pt is the unit of care for the HCP b. DC planning begins when the physician writes the orders c. health promotion resources enable children to achieve their full potential d. the focus of pediatric health care is trending toward acute hospital care

c. health promotion resources enable children to achieve their full potential - health promotion provides opportunities to reduce differences in current health status among members of different groups and provides a better chance to achieve the fullest health potential *the pt and family is the unit of care for the HCP *DC planning begins when the pt is admitted *the focus of pediatric health care setting is trending away from acute hospital settings

the nurse is interviewing the mother of Adam, 9 y/o. as the nurse begins to assess Adam's school performance, the MOST appropriate question to ask is: a. did adam go to preschool? b. does adam have problems at school? c. how is adam doing in school? d. how well does adam seem to be doing in school?

c. how is adam doing in school? - an open-ended question without any descriptive terms that may limit the mother's resopnses *a is a closed-ended question, which will elicit a yes or no answer *b is a closed-ended question that implies that adam isn't doing well *d is a closed-ended question that will have a short answer and assumes that adam is doing well

the nurse is interviewing the mother of a 9 y/o. as the nurse begins to assess his school performance, the MOST appropriate question to ask is: a. did he go to preschool? b. does he have problems at school? c. how is he doing in school? d. how well does he seem to be doing in school?

c. how is he doing in school?

the nurse notices that a toddler is more cooperative when taking medicine from a small cup rather than from a large cup. this is an example of which characteristic of preoperational thought? a. egocentrism b. irreversibility c. inability to conserve d. transductive reasoning

c. inability to conserve - the smaller cup makes it look like less medicine

the nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. what should the nurse consider when dealing with this issue? a. sterilization is recommended for any adolescent with cognitive impairment b. sexual drive and interest are limited in individuals with cognitive impairment c. individuals with cognitive impairment need a well-defined, concrete code of sexual conduct d. sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused

c. individuals with cognitive impairment need a well-defined, concrete code of sexual conduct - adolescents with moderate cognitive impairment may be easily persuaded and lack judgement. a well-defined, concrete code of conduct with specific instructions for handling certain situations should be defined for them

the nurse is giving anticipatory guidance to the parent of a 5 y/o. in this guidance, it's MOST important to: a. prepare the parent for increased aggression b. encourage the parent to offer the child choices c. inform the parent to expect a more tranquil period at this age d. advise the parents that this is the age when stuttering may develop

c. inform the parent to expect a more tranquil period at this age

according to Erikson, the preschooler's primary psychosocial taks of this period is acquiring a sense of: a. trust b. belonging c. initiative d. autonomy

c. initiative

according to Erikson, the primary psychosocial task of the preschool period is developing a sense of: a. identity b. intimacy c. initiative d. industry

c. initiative - initiative vs guilt *identity is associated with adolescence *intimacy is an adult stage *industry is an adult stage

the parents of 9 y/o twin children tell the nurse, "they have filled their bedroom with collections of rocks, shells, stamps, and cars." the nurse should recognize that this behavior is: a. indicates giftedness b. indicates typical "twin" behavior c. is characteristic of cognitive development at this age d. is characteristic of psychosocial development at this age

c. is characteristic of cognitive development at this age - classification skills develop during the school-age years and this age group enjoys sorting objects according to shared characteristics

which statement BEST describes pseudohypertrophic (Duchenne) muscular dysrophy? a. it's inherited as an autosomal dominant DO b. it's characterized by weakness of proximal muscles of both pelvic and shoulder girdles c. it's characterized by muscle weakness usually beginning about 3 y/o d. onset occurs in later childhood and adolescence

c. it's characterized by muscle weakness usually beginning about 3 y/o - these individuals usually reach early development milestones; the muscular weakness is usually observed in the 3rd year of life *it's inherited as an X-linked recessive trait *the first weakness is usually noted in walking, then a progressive involvement of other muscle groups

a nurse is providing education to a community group in preparation for a mission trip to a 3rd world country with limited access to protein-based food sources. the nurse is aware that children in this country are at increased risk for: a. rickets b. marasmus c. kwashiorkor d. pellagra

c. kwashiorkor - defined as primarily a deficiency of protein with an adequate supply of calories *rickets is from deficiency of vitamin D, calcium or phosphate *marasmus results from general malnutrition of both calories and protein *pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet

a neonate had corrective surgery 3 days ago for esophageal atresia. the nurse notices that after the child receives his gastrostomy feeding, there is often a backup for formula feeding into the tube. as a result, the nurse should: a. position the child in a supine position after feedings b. position the child on their L side after feedings c. leave the gastrostomy tube open and suspended after feedings d. leave the gastrostomy tube clamped after feedings

c. leave the gastrostomy tube open and suspended after feedings - by keeping the tube open to air, the buildup of pressure on the operative site will be prevented *the child should be positioned on the R side when head elevated at about 30 degrees *the formula is backing up into the tube because of the delayed emptying *leaving the tube clamped will create pressure on the operative site

a parent tells the nurse, "I'm worried about my 13 y/o son. he hasn't started puberty, and my daughter did when she was 11 years of age." the nurse should explain to this parents that this is: a. unusual and requires further evaluation of the son b. unusual because the onset of pubescence is usually the same in siblings c. normal because the onset of pubescence is usually earlier in girls than boys d. abnormal because the onset of pubescence is usually earlier in boys than girls

c. normal because the onset of pubescence is usually earlier in girls than boys - the average onset of puberty in boys is 12 y/o and the age of pubescence is gender-related *girls begin puberty an average of approx 2 years before boys

the nurse observes that a 13 y/o male has gynecomastia (breast enlargement). the nurse should explain that this is a: a. signs of too much body fat b. sign of hormone imbalance c. normal occurrence during puberty d. sx of precocious puberty

c. normal occurrence during puberty - common during mid-puberty in about 1/3 of boys *if gynecomastia persists beyond 2 years then a hormonal cause may need to be investigated *precocious puberty is the early onset of puberty, before age 9 in boys

the nurse is caring postoperatively for an 8 y/o child with multiple fractures and other trauma resulting from a motor vehicle injury. the child is experiencing severe pain. an important consideration in managing the child's pain is to: a. give only an opioid analgesic at this time b. increase the dosage of analgesic until the child is adequately sedated c. plan a preventative schedule of pain medication around the clock d. give the child a clock and explain when they can have pain meds

c. plan a preventative schedule of pain medication around the clock - ATC pain administration strategy should be used for a child recovering from trauma and surgery. this schedule will help prevent low plasma levels of the drug, leading to breakthrough pain. the child should be frequently assessed for pain and med doses titrated accordingly

latasha is a breastfed infant being seen in the clinic for her 6-month checkup. her mother tells the nurse that latasha recently began to suck her thumb. which of the following is the best nursing intervention? a. recommend that the mother substitute a pacifier for latasha's thumb b. assess latasha for other signs of sensory deprivation c. reassure the mother that thumb-sucking is normal at this age d. suggest that the mother breasfeed latasha more often to satisfy sucking needs

c. reassure the mother that thumb-sucking is normal at this age

the nurse is caring for a comatose child with multiple injuries. the nurse should recognize that pain: a. cannot occur if a child is comatose b. may occur if a child regains consciousness c. requires astute nursing assessment and management d. is best assessed by family members who are familiar with the child

c. requires astute nursing assessment and management - because the child cannot communicate pain through 1 of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. pain can occur in a comatose child

the parents of a toddler ask the nurse for suggestions about discipline. when discussing the use of timeous, which of the following suggestions should the nurse include? a. send the child to their room b. if the child cries, refuses, or is more disruptive, try another approach c. select an area that is safe and non-stimulating, such as a hallway d. the general rule for length of time is 1 hour per year of age

c. select an area that is safe and non-stimulating, such as a hallway - the area must be non-stimulating and safe, as the child becomes bored in this environment and then changes their behavior to rejoin activities

the MOST overwhelming adverse influence on health is: a. race b. customs c. socioeconomic status d. genetic constitution

c. socioeconomic status - although children of different racial groups have differing health issues, this is a key predictor *customs usually don't have an adverse effect on health *a higher % of lower-class individuals have some health problem at any 1 time than other individuals in different classes *there is a high correlation between poverty and poor nutrition *on a population basis, genetic constitution isn't an overwhelming adverse influence

what most accurately describes bowel function in children born with a myelomeningocele? a. incontinence cannot be prevented b. enemas and laxatives are contraindicated c. some degree of fecal continence can usually be achieved d. colostomy is usually required by the time the child reaches adolescence

c. some degree of fecal continence can usually be achieved - although a lengthy process, continence can be achieved with modification of diet, use of laxatives and/or enemas *these aren't contraindicated and are part of the process to achieve some degree of fecal continence *colostomy usually isn't required

the parents of an 8 y/o girl tell the nurse that their daughter wants to join a soccer team. the nurse's suggestions regarding participation in sports at this age should include: a. organized sports such as soccer aren't appropriate at this age b. competition is detrimental to the establishment of a positive self-image c. sports participation is encouraged if the sport is appropriate to the child's abilities d. girls should compete only against girls because at this age boys are larger and have more muscle mass

c. sports participation is encouraged if the sport is appropriate to the child's abilities - organized sports can provide safe, appropriate activities with supportive parents and coaches; school-age children enjoy competition *parents and children need to recognize the child's abilities and teach proper techniques so the child can compete safely

what's the most appropriate teaching point to include in a health promotion teaching plan for parents of children age 5-14? a. causes of mechanical suffocation b. keeping all meds out of childrens' reach c. storing firearms in locked cabinets d. warning signs of violent crimes

c. storing firearms in locked cabinets - improper use of firearms is the 4th leading cause of death from injury in children 5-14 *mechanical suffocation is the leading cause of death from injury in infants *homicide is the 2nd leading cause of death in 15-19 year olds *poisoning causes a considerable # of injuries in children <4 y/o

a 17 y/o boy with DM tells the school nurse that he has recently started drinking alcohol with his friends on the weekends. the nurse should: a. tell him not to do this b. ask him why he's drinking alcohol c. teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake d. provide an immediate referral for counseling so he understands the serious consequences of alcohol consumption

c. teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake - the nurse is taking a proactive approach; he is provided with info to facilitate the management of his disease *admonishing him won't help him if he chooses to continue drinking *asking him why will provide info to the nurse but won't address the info that he needs to have about managing his disease *a recommendation for counseling can be included in the teaching plan but providing an immediate referral may be viewed as adversarial

a parent and 3 month old infant are visiting the well-baby clinic for a routine exam. what instruction should the nurse include in the accident-prevention teaching plan? a. remove slam objects from the floor b. cover electrical outlets with safety plugs c. test the temp of water before bathing d. remove toxic substances from accessible areas

c. test the temp of water before bathing - excessively high temps can damage the delicate skin of an infant *although infants are capable of putting small things in their mouths, a 3 month old isn't yet able to crawl and probably won't be placed on the floor *at 3 months, infants aren't yet able to explore the environment to the point that electric outlets pose a problem *at 3 months, infants are still too small and haven't developed motor capabilities to get into containers of poison

a 12 y/o child being seen in the clinic hasn't received the hepatitis B (HBV) vaccine. the nurse should recommend that: a. only 1 dose of HBV will be needed sometime during adolescence b. only a booster will be needed c. the 3 dose series of HBV should be started d. the 3 dose series of HBV should be started at age 16 or sooner if the adolescent becomes sexually active

c. the 3 dose series of HBV should be started - 3 doses are necessary to achieve immunity *the recommendation is that the hep B vaccine series be started at birth

a 9 y/o child has several physical disabilities. his father explains to the nurse that his son concentrates on what he can, rather than cannot do and is as independent as possible. the nurse's best interpretation of this is that: a. the father is experiencing denial b. the father is expressing his own views c. the child is using an adaptive coping style d. the child is using a maladaptive coping style

c. the child is using an adaptive coping style - the child learns to accept physical limitations but finds achievements in a variety of compensatory motor and intellectual pursuits

the nurse is caring for an 8 y/o child who has a chronic illness. the child has a trach, and a parent is rooming-in during this hospitalization. the parent insists on providing almost all of the child's care and tells the nurses how to care for the child. when planning the child's care, the primary nurse should recognize that this parent is: a. controlling and demanding b. assuming the nurse's role c. the expert in care of the child d. not allowing the nurses to function independently

c. the expert in care of the child - because these parents care for this child with complex health needs at home, they are most familiar with the care requirements and routine *the nurse's role includes the assessment and evaluation, not just the implementation phase

which of the following descriptions wouldn't be correct using the current definition of the term family? a. the family members share a sense of belonging ot their own family b. the family may be related or unrelated c. the family members are always related by legal ties to genetic relationships and live in the same household d. the family is what the pt considers it to be

c. the family members are always related by legal ties to genetic relationships and live in the same household

a nurse is providing teaching about age-appropriate activities to the parent of a 2 y/o. which of the following statements by the parent indicates a need for further teaching? a. my child likes to ride a straddle truck in the dining room while I'm cooking b. I send my child's favorite stuffed animal when she will be napping away from home c. the soccer team by child will be playing on starts practicing next week d. putting large-piece puzzles together is 1 of my child's favorite activities

c. the soccer team by child will be playing on starts practicing next week

the nurse in the peds clinic identifies which infants at risk for developing vitamin D-deficient rickets? a. lacto-ovo vegetarians b. those who are breastfed exclusively c. those using yogurt as primary source of milk d. those exposed to daily sunlight

c. those using yogurt as primary source of milk - yogurt may not be supplemented with vitamin D

parents of a 10 y/o child are concerned that their child has recently been showing signs of loneliness and abandonment. what should the nurse consider when discussing this issue with the parents? a. changing self-esteem is difficult after about age 5 b. self-esteem is the objective judgment of one's worthiness c. transitory periods of loneliness and abandonment are expected developmentally d. high self-esteem develops when parents show adequate love for the child

c. transitory periods of loneliness and abandonment are expected developmentally - self esteem changes with development *self-esteem is influenced throughout adolescence *one aspect of self-esteem is a subjective judgment of one's worthiness *transient changes are expected and with positive encouragement and support are only temporary *self-esteem is based on several components including competence, sense of control, moral worth, and worthiness of love and acceptance

parents of a 10 y/o child are concerned that their child has been recently showing signs of low self-esteem. which should the nurse consider when discussing this issue with the parents? a. changing self-esteem is difficult after about 5 y/o b. self-esteem is the objective judgement of one's worthiness c. transitory periods of lowered self-esteem are expected developmentally d. high self-esteem develops when parents shower adequate love for the child

c. transitory periods of lowered self-esteem are expected developmentally - transient declines are expected and, with positive encouragement and support, are only temporary *self-esteem changes with development *self-esteem is influenced throughout adolescence *self-esteem is based on several factors, including competence, sense of control, moral worth and worthiness of love and acceptance

a 4 month old infant is brought to the clinic by his parents for a well-baby checkup. what should the nurse include at this time concerning injury prevention? a. never shake baby powder directly on your infant because is can be aspirated into his lungs b. don't permit your child to chew paint from window ledges because he might absorb too much lead c. when your baby learns to roll over, you must supervise him whenever he's on a surface from which he might fall d. keep doors of appliances closed at all times

c. when your baby learns to roll over, you must supervise him whenever he's on a surface from which he might fall - rolling over from the abdomen to back occurs between 4 and 7 months. this is appropriate anticipatory guidance for this age

the mother of a child with DM1 asks why her child cannot avoid all those "shots" and take pills as an uncle does. the nurse's BEST reply is: a. the pills work with an adult pancreas only b. the drugs affect fat and protein metabolism, not sugar c. your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin d. perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics

c. your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin - *oral meds have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose; they're not insulin substitutes *in DM1, the beta cells have been destroyed; it's necessary to supply the insulin that they no longer produce *without a pancreas beta cell transplant, it's unlikely that insulin would be produced

the parent of a 6/o child is concerned that her son is small for his age. the child's weight is 42 lbs and he's 42 in tall. the nurse's best response to his parent's concern would be: a. I am concerned too. I will request a nutritional consult for you and your child b. actually, your child is somewhat overweight and tall for his age c. your son's weight and height are in the average range for a boy his age d. all children vary in their weight and height, so I wouldn't be concerned

c. your son's weight and height are in the average range for a boy his age *average weight for a boy is 45 lb and average height is 45 in so he's neither under nor over weight for his gender and age *telling a parent not to worry is false reassurance, which is nontherapeutic

an infant who weighs 7 lbs at birth would be expected to weigh how many pounds at 1 year of age? a. 14 b. 16 c. 18 d. 21

d. 21 - in general birth, weight triples by the end of the first year of life

the nurse would expect that most children would be using sentences of 6-8 words by age: a. 18 months b. 24 months c. 3 years d. 5 years

d. 5 years *an 18 month old has a vocabulary of about 10 words *a 24 month old uses 2-3 word phrases *a 3 y/o uses 3-4 word sentences

the nurse is preparing a plan to teach a mother how to give 1.5 tsp of medicine to her 6 month old child. the nurse should recommend using: a. a household measuring spoon b. a regular silverware tsp c. a paper cup measure in 5 mL incriments d. a plastic syringe (without needle) calibrated in mL

d. a plastic syringe (without needle) calibrated in mL - this offers the most accurate measurement and the nurse should teach the mother to give the child 7.5 mL of the med *household measuring spoons can be used if other more precise devices aren't available *a dinner table utensil isn't acceptable because household tsp vary in size *a paper cup doesn't contain calibration for the additional 2.5 mL that's needed

the nurse expects which characteristic of fine motor skills in a 5 month old infant? a. strong grasp b. neat pincer grasp c. able to build a tower of 2 cubes d. able to grasp object voluntarily

d. able to grasp object voluntarily

a 12 y/o has had a BMI in the 60th percentile. anticipatory guidance that the nurse would provide to this child and his parent would include: a. discussing weight-reduction strategies b. implementing a plan for increased physical activity c. referring the child and parent to a nutritionist for weight-management strategies d. encouraging the child to continue to maintain his current diet and level of activity

d. encouraging the child to continue to maintain his current diet and level of activity - a BMI greater than the 5th percentile and less than the 85th percentile indicates a healthy weight, so changes aren't warranted

the nurse is planning care for a pt with cultural background different from that of the nurse. an appropriate goal is to: a. strive to keep cultural background from influencing health needs b. encourage continuation of cultural practices in the hospital setting c. attempt in a nonjudgmental way to change cultural beliefs d. adapt as necessary cultural practices to health needs

d. adapt as necessary cultural practices to health needs - whenever possible, nursing care should facilitate the integration of cultural practices into health needs *the cultural background is part of the individual; it would be very difficult to eliminate its influence *the cultural practices need to evaluated within the context of the health care setting to determine whether they're conflicting *the cultural background is part of the individual; it would be very difficult to eliminate its influence

the school nurse is teaching a class on injury prevention. what should be included when discussing firearms? a. adolescents are too young to use a gun properly for hunting b. gun carrying among adolescents is on the rise, primarily among inner-city youth c. nonpowder guns (air rifles, BB guns) are a relatively safe alternative to powder guns d. adolescence is the peak age for being a victim and/or offender in the case of injury involving a firearm

d. adolescence is the peak age for being a victim and/or offender in the case of injury involving a firearm - the increase in gun availability is linked to increased gun deaths among children *adolescents can be taught to safely use guns for hunting, but they must be stored properly and used only with supervision *gun carrying is on the rise among adolescents and isn't limited to just the sterotypic inner-city youth population *these types of nonpowder guns (in answer c) cause almost as many injuries as powder guns

an 8 y/o female child is dx with moderate cerebral palsy (CP). she recently began participation in a regular classroom for part of the day. her mother asks the school nurse about having her daughter join the after-school girl scout troop. the nurse's response should be based on the knowledge that: a. most activities such as girl scouts cannot be adapted for children with CP b. after-school activities usually result in extreme fatigue for children with CP c. trying to participate in activities such as girl scouts leads to lowered self-esteem in children with CP d. after-school activities often provide children with CP opportunities for socialization and recreation

d. after-school activities often provide children with CP opportunities for socialization and recreation - recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs *most activities can be adapted for children *the child, family and activity director should assess the degree of activity to ensure that it meets with the child's capabilities *a supportive environment will add to the child's self-esteem

a 3 month old bottle-fed infant is allergic to cow's milk. the nurse's BEST option for a substitute is: a. goat's milk b. soy-based formula c. skim milk diluted with water d. amino acid formula

d. amino acid formula

preschoolers engage in group play with similar or identical activities without rigid organization or rules. this type of play is: a. solitary b. dramatic c. parllel d. associative

d. associative

the parents of a toddler express frustration to the nurse because their child is a "fussy eater." the nurse's BEST response is: a. you should provide larger servings of different foods b. provide more bland food varieties as toddlers have few food preferences c. table manners will improve if you provide finger foods d. becoming a fussy eater is expected during the toddler years

d. becoming a fussy eater is expected during the toddler years - toddlers have a decrease in appetite and strong taste preferences

the nurse is teaching a community health promotion class to parents and school-age children r/t bicycle safety. issues to cover in the sessions include: a. bicycle helmets need to be worn only if the child is planning to ride in traffic b. reflectors should be installed only on bicycles that are to be ridden at night c. bicycles should be ridden against the traffic so that the rider can see the cars d. bicycles should be walked through busy intersections

d. bicycles should be walked through busy intersections - to allow the child to have full view of the traffic and be able to react accordingly, with safety the #1 priority *helmets should be worn at all times *reflectors should be installed on all bikes *bikes should always be ridden with the traffic

the school nurse is asked to speak with the parents of a 10 y/o boy who has been bullying other children. the nurse's response should be based on the knowledge that: a. bullying at this age is considered normal b. children who bully others usually join gangs c. children who bully others usually have low self-esteem d. bullies often have difficulties developing and maintaining relationships

d. bullies often have difficulties developing and maintaining relationships - long term this negativity continues into adulthood, causing difficulties developing and maintaining relationships *bullying is a maladaptive response to poor relationships with peers and lack of group identification *these individuals usually have strong self-esteem and little anxiety *children who are bullys are defiant toward adults, antisocial, and likely to break school rules *bullies may come from homes where physical punishment is used and there's a lack of parental involvement and warmth

the nurse is starting an IV line on a school-age child with cancer. the child says, "I have had a million IVs. they hurt." the nurse's response should be based on the knowledge that: a. children tolerate pain better than adults b. children become accustomed to painful procedures c. children often lie about experiencing pain d. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures

d. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures - pain is whatever the experiencing person defines it to be. children with chronic illness are more likely to identify invasive procedures as stressful compared with children with acute illness

myelination of the spinal cord is almost complete by 2 years of age. as a result of this, the toddle can gradually achieve: a. throwing a ball without falling b. slowing of GI transit time c. visual acuity of 20/20 d. control of anal and urethral sphincters

d. control of anal and urethral sphincters - occurs between 18 and 24 months

the nurse is talking to a group of parents about different types of play in which children engage. which statement made by a parent would indicate a correct understanding of the teaching? a. parallel play children borrow and lend play materials and sometimes attempt to control who plays in the group b. in associative play, children play independently but among other children c. during onlooker play, children play along with toys different from those used by other children in the same area d. cooperative play is organized and children play in a group with other children

d. cooperative play is organized and children play in a group with other children *play in which children borrow and lend play materials and attempt to control who plays in the group is known as associative play *parallel play occurs when children play independently but among other children *onlooker play is described as play in which children watch but make no attempt to enter into play with other children *cooperative play is that play that's organized; children play in a group with other children and plan activities for purposes of accomplishing an end

the nurse is discussing toddler development with a parent. which intervention will foster the achievement of autonomy in the toddler? a. helping the toddler complete tasks b. providing opportunities for the toddler to play with other children c. helping the toddler learn the difference between right and wrong d. encourage the toddler to do things for self when capable of doing them

d. encourage the toddler to do things for self when capable of doing them *to successfully achieve autonomy, the toddler needs to have a sense of accomplishment; this doesn't occur if parents complete tasks for the toddler *children at this age engage in parallel play *toddlers have an increased ability to control their bodies, themselves and the environment *autonomy develops when children complete tasks of which they are capable

the nurse is discussing toddler development with a parent. which intervention will foster the achievement of autonomy? a. help the toddler complete tasks b. provide opportunities for the toddler to play with other children c. help the toddler learn the difference between right and wrong d. encourage the toddler to do things for themselves when they are capable of doing them

d. encourage the toddler to do things for themselves when they are capable of doing them - autonomy develops when children complete tasks of which they're capable; to successfully achieve this, they need to have a sense of accomplishment

the parents of a child with fragile X syndrome want to have another baby. they tell the nurse they worry that another child might be similarly affected. the MOST appropriate nursing action is to: a. reassure them that the syndrome isn't inherited b. assess for family hx of the syndrome c. recommend that they not have another child d. explain that prenatal dx of the syndrome is now available

d. explain that prenatal dx of the syndrome is now available - fragile X syndrome can now be detected prenatally and the family should be referred for genetic counseling *the syndrome is inherited on the X chromosome *assessing for family hx should be done, but it doesn't address the parents' concern and need for genetic counseling *the nurse shouldn't offer a recommendation, although a referral for genetic counseling is indicated

the nurse needs to give an injection in the deltoid to a 4 y/o child. the BEST approach to use is to: a. smile when giving the injection to help the child relax b. tell the child that you'll be so quick that it won't even hurt c. explain that the child will experience a little stick in the arm d. explain with concrete terms, such as "putting medicine under the skin"

d. explain with concrete terms, such as "putting medicine under the skin"

the nurse needs to give an injection in the deltoid to a 4 y/o child. the BEST approach to use is to: a. smile while giving the injection to help child relax b. tell the child that you will be so quick that the injection won't even hurt c. explain that the child will experience a little stick in the arm d. explain with concrete terms, such as putting medicine under the skin

d. explain with concrete terms, such as putting medicine under the skin - by using concrete terms the nurse helps the child understand what the nurse is going to do *the nurse doesn't know the injection won't hurt the child; lying or distorting the truth is never appropriate *c will block trust, especially if the injection doesn't hurt the child, who may visualize an actual stick being placed in the arm; children at this age are very literal

the most consistent indicator of pain in infants is: a. increased respirations b. increased HR c. clenching of teeth and lips d. facial expression of discomfort

d. facial expression of discomfort

*ON QUIZ the most consistent indicator of pain in infants is: a. increased respirations b. increased HR c. clenching the teeth and lips d. facial expression of discomfort

d. facial expression of discomfort - this is the most consistent behavioral manifestation of pain in infants *respiratory pattern may be markedly variable in an infant in pain, thus is not a consistent indicator of pain. HR may initially decrease in some infants with pain, ten increase *clenching the teeth and lips are a sign of pain often assessed in the toddler

the nurse working in an outpt surgery center for children should understand that: a. children's anxiety is minimal in such a center b. waiting isn't stressful for parents in such a center c. accurate and complete DC teaching is the responsibility of the surgeon d. families need to be prepared for what to expect after DC

d. families need to be prepared for what to expect after DC *although anxiety may be reduced because of the lack of an overnight stay, the child will still experience the stress associated with a medical procedure *the waiting period while the child is having the procedure is a very stressful time for families *DC teaching is a responsibility of both the surgeon and the nursing staff; DC instructions should be provided in both written and oral form *DC instructions need to include normal responses to the procedure and when to notify the practitioner if untoward reactions are occurring

the parent of a 12 month old infant says to the nurse, "he pushes the teaspoon right out of my hand when I feed him. I cannot let him feed himself; he makes too much of a mess." the nurse's BEST response is: a. it's important not to give into this kind of temper tantrum at this age. simply ignore the behavior and the mess b. you need to try different types of utensils, bowls and plates. some are specifically designed for young children c. it's important to let him make a mess. just try not to worry about it so much d. feeding himself will help foster his growth and development. perhaps we can discuss ways to make the messes more tolerable

d. feeding himself will help foster his growth and development. perhaps we can discuss ways to make the messes more tolerable - the child is developmentally ready for self feeding

the school nurse knows that which attribute is characteristic of the psychosocial development of school age children? a. a developing sense of initiative is very important b. peer approval isn't yet a motivating power c. motivation comes from extrinsic rather than intrinsic sources d. feelings of inferiority or lack of worth can be derived from children themselves or from the environment

d. feelings of inferiority or lack of worth can be derived from children themselves or from the environment - all children aren't able to do all tasks well and the child must be prepared to accept some feeling of inferiority

superficial palpation of the abdomen is often perceived by the child as tickling. which measurement by the nurse is MOST likely to minimize this sensation and promote relaxation? a. palpating another area simultaneously b. asking the child not to laugh or move if it tickles c. beginning with deeper palpation and gradually progressing to superficial palpation d. having the child "help" with palpating by placing their hand over the palpating hand

d. having the child "help" with palpating by placing their hand over the palpating hand

the dx of cognitive impairment is based on the presence of: a. intelligence quotient (IQ) of 75 or less b. IQ of 70 or less c. subaverage intellectual functioning, deficits in adaptive skills, and onset at any age d. subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age

d. subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age - the onset must be before age 18 to meet the hx of cognitive impairment *IQ is only 1 component of the dx of cognitive impairment

superficial palpation of the abdomen is often perceived by the child as tickling. which measure by the nurse is MOST likely to minimize this sensation and promote relaxation? a. palpating another area simultaneously b. asking the child not to laugh or move if it tickles c. beginning with deeper palpation and gradually progression to superficial palpation d. having the child "help" with palpation by placing their hand over the palpating hand

d. having the child "help" with palpation by placing their hand over the palpating hand - this allows the nurse to perform the assessment while including the child in the care *a wouldn't promote relaxation and would make it more difficult to perform abdominal assessment *b may only contribute to the child's laughter or may prove frustrating to both the child and the nurse *deeper palpation enhances the "ticking" sensation, not lessen it

which of the following questions asked by the nurse isn't an example of collecting info in providing anticipatory guidance for a school-age child? a. how many hours does your child spend playing video games or watching TV? b. where does your child sit when they ride in the car? c. how much soda does your child drink in a week? d. how far away do you live from your child's school?

d. how far away do you live from your child's school? *asking about the child's level of activity and amount of soda consumed assesses the child's diet for excess calories and if dietary requirements are being met *likewise, asking where a child sits in the car assesses safety issues *finding out how far away the child's school is from home doesn't provide any info that could assist in providing anticipatory guidance for promoting and maintaining an optimal level of health >by definition, anticipatory guidance is a proactive developmentally based counseling technique that focuses on the needs of a child at each stage of life. by providing practical and contemporary health info to parents before significant physical, emotional and psychological milestones, parents will anticipate impending changes, maximize their child's developmental potential and identify their child's special needs

*ON QUIZ a child who is terminally ill with bone cancer is in severe pain. nursing interventions should be based on knowledge that: a. children tend to be overmedicated for pain b. giving large doses of opioids causes euthanasia c. narcotic addiction is common in terminally ill children d. large doses of opioids are justified when there are no other tx options

d. large doses of opioids are justified when there are no other tx options - continuing studies report that children are consistently undermedicated for pain. the dosage of opioids is titrated to relieve pain, not cause death. addiction refers to a psychologic dependence on the narcotic med, which doesn't occur in terminal care. large doses may be needed because the child has become physiologically tolerant to the drug, requiring higher doses to achieve the same degree of pain control

a 4 y/o female child is afraid of dogs. what should the nurse recommend to her parents to help her with this fear? a. keep her away from dogs b. buy her a stuffed dog toy c. force her to touch a dog briefly d. let her watch other children play with a dog

d. let her watch other children play with a dog - this way, the child can learn to adapt *forcing the child to interact with the dog may increase the level of fear

a mother brings her 6 month old to the clinic for a well-baby checkup. she comments, "I want to go back to work, but I don't want him to suffer because I'll have less time with him." the nurse's most appropriate answer is: a. I'm sure he'll be fine if you get a good babysitter b. you'll need to stay home until he starts school c. you should go back to work so he will get used to being with others d. let's talk about the child care options that will be best for him

d. let's talk about the child care options that will be best for him

the nurse needs to take the BP of a small child. of the cuffs available, 1 is too large and 1 is too small. the BEST nursing action is to: a. use the small cuff b. use the large cuff c. use either cuff, using palpation method d. locate the proper size cuff before taking the BP

d. locate the proper size cuff before taking the BP - to obtain an accurate BP reading, it's preferable to use the appropriate size cuff *the smaller cuff gives a falsely increased BP *the larger cuff, which may give a falsely lowered BP, is preferable to the smaller cuff but neither is the method of choice *auscultation is preferred to palpation

an important nursing intervention when caring for a child with myelomeningocele in the postoperative stage is to: a. place child on their side to decrease pressure on the spinal cord b. apply a heat lamp to facilitate drying and toughening of the sac c. keep skin clean and dry to prevent irritation from diarrheal stools d. measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus

d. measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus - hydrocephalus is frequently associated with myelomeningocele; assessment of the fontanels and daily measurements of head circumference will aid in early detection *before surgery teh child is kept in a prone position to decrease tension on the sac and reduce risk of trauma *the sac must be kept moist; sterile, moist, nonadherent dressings are placed over the sac *most infants don't have diarrheal stools

when assessing a preschooler's chest, the nurse would expect: a. respiratory movements to be chiefly thoracic b. the chest to be round in shape c. intercostal retractions on inspiration d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing

d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing

when assessing a preschooler's chest, the nurse would expect: a. respiratory movements to be chiefly thoracic b. anteroposterior diameter to be equal to the transverse diameter c. intercostal retractions on respiratory movement d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing

d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing - the preschool-age child should have symmetric chest movement bilaterally and a coordinated breathing pattern *at this age breathing is a coordinated function and is primarily abdominal or diaphragmatic *thoracic breathing occurs in older children, particularly girls *anteroposterior diameter is equal to transverse diameter in infants *as the child grows, the chest normally increases in the transverse direction; thus the anteroposterior diameter is less than the lateral diameter *intercostal retractions indicate respiratory distress

a 5 y/o male child has bilateral eye patches that were put in place after surgery yesterday morning. today he can be allowed to get out of bed. the MOST important nursing intervention is to: a. provide reassurance to the child and allow his parents to stay with him b. allow him to assist in feeding himself c. speak to him when entering the room d. orient him to his immediate surroundings

d. orient him to his immediate surroundings - the immediate safety concern for him is ensuring his familiarity with his immediate surroundings *reassurance in A should be provided throughout the hospitalization *he should be allowed to feed himself with assistance as needed *you should always speak to him when entering the room so the child can verify who it is

a 9 month old infant is seen in the ED after developing a urticaric rash with cough and wheezing. when collecting the hx of events before th sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." which food is the possible cause of this type of reaction in the infant? a. potatoes b. green beans c. spinach d. peanut butter

d. peanut butter - nuts of any type, including peanuts, have a high allergy index in children and infants; the infant has demonstrated the cutaneous and respiratory type of reaction after possible ingestion of PB

the nurse needs to take the BP of a preschool boy for the 1st time. which action would be BEST in gaining his cooperation? a. taking his BP when a parent is there to comfort him b. telling him that the procedure will help him get well faster c. explaining to him how the blood flows through the arm and why the BP is important d. permitting him to handle equipment and see the dial move before putting the cuff in place

d. permitting him to handle equipment and see the dial move before putting the cuff in place - this is the best approach for a preschooler; it allows the child to play out the experience ahead of time *the parent's presence will be helpful, but won't alleviate fear of the unknown *the child won't be able to understand the relationship between the BP and feeling better *the explanation would be too complex for this age group

when explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include: a. wearing safety belts snugly over the toddler's abdomen b. placing the car seat in the front passenger seat if there is an airbag c. using lap and shoulder belts when the child is over 3 years of age d. placing the care seat in the back seat of the car facing forward

d. placing the care seat in the back seat of the car facing forward - car seats are required for toddlers to prevent injury is case of a motor vehicle accident

the nurse is doing preop teaching with a child and his parents. the parents say that he's "dreading the shot" for premedication. the nurse's response should be based on the knowledge that: a. preanesthetic med can only be given IM b. in children the IM route is safer than the IV route c. the child will have no memory of the injection because of amnesia d. preanesthetic medication should to "atraumatic," using oral, existing IV, or rectal routes

d. preanesthetic medication should to "atraumatic," using oral, existing IV, or rectal routes *preanesthetic meds can be given in a variety of routes other than IM *IV route is preferrable

cerebral palsy may result from a variety of causes. it's now known that the most common cause is: a. birth asphyxia b. neonatal diseases c. cerebral trauma d. prenatal brain abnormalities

d. prenatal brain abnormalities - CP results from existing brain abnormalities during the prenatal period *the other issues were previously thought to be factors

a child is being seen in the ED with multiple facial abrasions and lacerations. the combination agent lidocaine, adrenaline, and tetracaine (LAT) is applied topically to the wounds. the purpose of this combination therapy is to: a. cleanse the wound b promote scab formation c. prevent infection of the wound d. provide anesthesia to the wound

d. provide anesthesia to the wound - provides anesthesia within 10-15 mins of application

EBP, a current health care trend, is best described as: a. gathering evidence of mortality and morbidity in children b. meeting physical and psychosocial needs of the child and family in all areas of practice c. using a professional code of ethics as a means for professional self-regulation d. questioning why something is effective and whether there is a better approach

d. questioning why something is effective and whether there is a better approach - focuses on measurable outcomes and the use of demonstrated, effective interventional and questions whether there's a better approach *a will assist the nurse in determining areas of concern and potential involvement *it's not possible to meet all the needs of the family and child in all areas of practice *the nurse is an advocate for the family, this is part of the professional role and licensure

a child's skeletal age is best determined by: a. assessment of dentition b. assessment of height over time c. facial bone development d. radiographs of the hand and wrist

d. radiographs of the hand and wrist - the most accurate measure of skeletal age is radiologic examination of the growth plates *these are epiphyseal cartilage plates. radiographs of the hand and wrist provide the most useful screening to determine skeletal age. age of tooth eruption varies considerably in children. it wouldn't be a good determinant of skeletal age. assessment of height over time will provide a record of the child's height, not skeletal age

which statement explains why it can be difficult to assess a child's dietary intake? a. no systematic assessment tool has been developed for this purpose b. biochemical analysis for assessing nutrition is expensive c. families usually don't understand much about nutrition d. recall of children's food consumption is frequently unreliable

d. recall of children's food consumption is frequently unreliable - it's difficult for parents to recall exactly what their child has eaten; concurrent food diaries are somewhat more reliable *systematic tools have been developed and are available *nutrients for different foods are known; it's the quantity and type of food consumed that are difficult to ascertain *the family doesn't need nutrition knowledge to describe what the child has eaten

the major goals of therapy for children with cerebral palsy include: a. reversing degenerative processes that have occurred b. curing underlying defect causing the DO c. preventing spread to individuals in close contact with the child d. recognizing the DO early and promoting optimal development

d. recognizing the DO early and promoting optimal development - since CP is currently a permanent DO, the goal of therapy is to promote optimal development; this is done through early recognition and beginning of therapy *it's very difficult to reverse degenerative processes *the underlying defect cannot be cured *CP isn't contagious

the most accurate method of determining the length of a child <12 months of age is: a. standing height b. estimation of length to the nearest cm or 1/2 inch c. recumbent length measured in the prone position d. recumbent length measured in the supine position

d. recumbent length measured in the supine position - the crown-heel length measurement is the most accurate in infants *infants are generally unable to stand to obtain a height measurement *measurement shouldn't be estimated since an accurate measurement is required to determine growth *the infant should be measured in the supine position, not prone

a nurse is caring for a 2 month old exclusively breastfed infant with an admitting dx of colic. based on the nurse's knowledge of breastfed infants, what type of stool is expected? a. dark brown and small hard pebbles b. loose with green mucus streaks c. forms and with white mucus d. semiformed, seedy, yellow

d. semi-formed, seedy, yellow

the role of the pediatric nurse is influenced by trends in health care. the greatest trend in health care is: a. primary focus on tx of disease or disability b. national health care planning on a distributive or episodic basis c. accountability to professional codes and international standards d. shift of focus to prevention of illness and maintenance of health

d. shift of focus to prevention of illness and maintenance of health - prevention is the current focus of health care, one in which nursing plays a major role

a toddler playing with sand and water would be participating in _______________ play a. skill b. dramatic c. social-affective d. social-pleasure

d. social-pleasure - this is characterized by nonsocial situations in which the child is stimulated by objects in the environment *infants engage is skill play when they persistently demonstrate and exercise newly acquired abilities *dramatic play is the predominant form of play in the preschool period *children pretend and fantasize *social-affective play is 1 of the first types of play in which infants engage; the infant responds to interactions with people

what is an important consideration r/t childhood stress? a. children should be protected from stress b. children don't have coping strategies c. parents cannot prepare children for stress d. some children are more vulnerable to stress than others

d. some children are more vulnerable to stress than others - children's age, temperament, life situation and state of health affect their vulnerability, reactions and ability to handle stress *it's not feasible to protect children from all stress *children can be taught coping strategies *adults need to recognize signs of stress before they become overwhelming

a neural tube defect that's not visible externally in the lubosacral area would be called: a. meningocele b. myelomeningocele c. spina bifida cystica d. spina bifida occulta

d. spina bifida occulta - completely closed and often won't be noticed *meningocele contains meninges and spinal fluid but no neural tissue; unless there are associated cutaneous findings, it's often not identified until later *myeloneningocele is a neural tube defect that contains meninges, spinal fluid and nerves *option C is a cystic formation with an external saclike protrusion

the nurse is interviewing the parents of a 4 month old male infant brought to the hospital ED. the infant is dead on arrival, and no attempt at resuscitation is made. the parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. they say he was "just fine" when they put him in his rib already asleep. the nurse should suspect his death was caused by: a. suffocation b. child abuse c. infantile apnea d. sudden infant death syndrome (SIDS)

d. sudden infant death syndrome (SIDS) - although the child was found under the blanket, the bloody fluid is consistent with SIDS, not suffocation

nursing interventions to help the siblings of a child with a complex or chronic condition cope include: a. explaining to the siblings that embarrassment is unhealthy b. providing info to the siblings about the child's condition only as they request it c. encouraging the parents not to expect siblings to help them care for the child with special needs d. suggesting to the parents ways of showing gratitude to the siblings who help care for the child with a disability or chronic condition

d. suggesting to the parents ways of showing gratitude to the siblings who help care for the child with a disability or chronic condition - showing gratitude includes things like increase in allowance, special privileges, and verbal praise *the presence of a child with special needs in a family will change the family dynamic *siblings may be asked to take on additional responsibilities to help the parents care for the child *embarrassment may be associated with having a sibling with a chronic illness or disability; parents must be able to respond in an appropriate manner without punishing the sibling *most siblings are positive about the extra responsibilities *siblings need to be informed about the child's condition before a non-family member does

in planning sex education and contraceptive teaching for adolescents, the nurse should consider which info? a. most teenagers today are knowledgeable about reproductive anatomy and physiology b. both sexual activity and contraception require planning c. most teenagers who become pregnant do so as an act of hostility, especially toward their parents d. teenagers need contraception education in both oral and written form

d. teenagers need contraception education in both oral and written form - info needs to be concrete and concise; oral presentations with visual demonstrations and written info and diagrams should be provided *contraception requires planning *most adolescents are sexually active for 6 months to 1 year before seeking contraceptive info

the nurse is assessing skin turgor in a child. the nurse grasps the skin on the abdomen between the thumb and index finger, pulls it taugt, and quickly releases it. the tissue remains suspended, or tented, for a few seconds, then slowly falls back on the abdomen. which evaluation can the nurse correctly assume? a. tissue shows normal elasticity b. the child is properly hydrated c. the assessment is done incorrectly d. the child has poor skin turgor

d. the child has poor skin turgor *in normal elasticity the skin would return immediately to its original position *if the child is properly hydrated, skin turgor would be elastic *"tenting" is the term for poor skin turgor

a woman who is 6 weeks' pregnant tells the nurse that she is worried that the baby might have spina bifida because of a family hx. the nurse's BEST response is: a. there's no genetic basis for the defect b. prenatal detection isn't possible yet c. chromosome studies dont on amniotic fluid can dx the defect prenatally d. the concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally

d. the concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally - fetal ultrasound and elevated concentrations of alpha-fetoprotein in amniotic fluid may indicate the presence of anencephaly or myelomeningocele *the origin of neural tube defects is unknown but it appears to have a multifactoral inheritance pattern *prenatal detection is possible through amniotic fluid or chronic villus sampling *there's no chromosome study at this time

a 5 y/o girl's sibling dies from SIDS. the parents are concerned because she showed more outward grief when her cat died than she is showing now. the nurse should explain that: a. this is suggestive of maladaptive coping and referral for counseling is needed b. the child isn't old enough to have a concept of death yet c. the child isn't old enough to have formed a significant attachment to her sibling d. the death may be so painful and threatening that the child must deny it for now

d. the death may be so painful and threatening that the child must deny it for now - a child at this age has limited defense mechanisms; often the child will react with more overt grief to a less significant loss than to the loss of a very significant person *the girl's actions show limited defense mechanisms not maladaptive coping *the child is beginning to understand the permanence of death *at 5 y/o, the child would've formed a relationship with the infant sibling

the genetic testing of a child with down syndrome (DS) showed that it was caused by translocation. the parents ask about further genetic testing. the nurse's BEST response for the parents is: a. no further genetic testing is indicated b. the child should be retested to confirm dx of DS c. the mother should be tested if she is over age 35 d. the parents can be tested themselves because the child's condition might be hereditary

d. the parents can be tested themselves because the child's condition might be hereditary - DS resulting from translocation may be inherited; this type of chromosome abnormality presents issues for future pregnancies *the child doesn't require further genetic testing, but parents and siblings do *retesting isn't necessary because it's been validated with chromosome testing *this type of chromosome abnormality occurs in children or parents of all ages

a 2 week old infant with down syndrome is being seen in the clinic. his mother tells the nurse that he's difficult to hold; that "he is like a rag doll. he doesn't cuddle up to me like my other babies did." the nurse's BEST interpretation of this lack of clinging or molding is that it is: a. a sign of maternal deprivation b. a sign of detachment and rejection c. suggestive of autism associated with down syndrome d. the result of the physical characteristics of down syndrome

d. the result of the physical characteristics of down syndrome - this lack of clinging is a result of the muscle hypotonicity and hyperextensibility of the joints associated with down syndrome *mothers have difficulty forming attachment to their children because of these characteristics of down syndrome *the nurse should recommends swaddling and wrapping the baby before picking them up *autism isn't associated with down syndrome

the parents of a 9 month old infant tell the nurse that they're worried about their baby's thumb-sucking. what is the nurse's BEST reply? a. a pacifier should be substituted for the thumb b. thumb-sucking should be discouraged by 12 months of age c. thumb-sucking should be discouraged when the teeth begin to erupt d. there's no need to restrain nonnutritive sucking during infancy

d. there's no need to restrain nonnutritive sucking during infancy - evidence is inconclusive regarding whether a pacifier or thumb is better for satisfying sucking needs. thumb sucking and the use of pacifiers should be stopped after 4 years of age. nonnutritive sucking reaches its peak at about 18-20 months of age

the nurse is caring for a an infant with a tacheostomy when accidental decannulation occurs. the nurse is unable to reinsert the tube. what should be the NEXT action by the nurse? a. notify the surgeon b. performing oral intubation c. trying to insert a larger-size tube d. trying to insert a smaller-size tube

d. trying to insert a smaller-size tube - a smaller size tube should be available, this will keep the stoma open until further action can be taken *notify the surgeon after the emergent situation is handled *oral intubation is done if a tube cannot be inserted *a larger tube would cause trauma to the trachea

which of the following play activities would be least appropriate to suggest to the mother for her 3 month old infant to promote auditory and tactile stimulation? a. placing toys out of infant's reach b. playing music and singing along c. using rattles d. using an infant swing

d. using an infant swing

the preferred site for IM injections in infants is: a. deltoid b. dorsogluteal c. rectus femoris d. vastus lateralis

d. vastus lateralis

a mother of a 12 month old asks what new gross motor skills her baby should be demonstrating when he returns for his next scheduled immunizations. the nurse's best response is: a. jump with both feet b. walk up and down stairs, one at a time c. catch a big ball d. walk on his own

d. walk on his own *the next scheduled immunizations occur at 15 months with the administration of DtaP *at 15 months, children are expected to walk on their own without support or assistance *jumping with both feet occurs at 30 months of age *walking up and down stairs, 1 step at a time occurs at 24 months *catching a ball is expected at 4 y/o

a parent has a 2 y/o in the clinic for a well-child check up. which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? a. we locked all meds in the bathroom cabinet b. we turned the thermostat down on our hot water heater c. we placed gates at the top and bottom of the basement steps d. we stopped using the car seat now that my child is older

d. we stopped using the car seat now that my child is older - a car seat should be used until the child weighs 40 lb at approximately 4 years of age

the nurse should expect to possibly incorporate which religious and cultural practices into the place of care when caring for a 35 y/o jewish mother who just gave birth to a healthy baby boy? (select all that apply) a. circumcision in hospital b. ordering house diet lunch tray of roasted pork with mashed potatoes c. allowing family, friends, and rabbi to visit pt often d. ask males to remove shawl and yarmulke while visiting e. ordering house diet with the exception of shellfish

ritual circumcision of male infants is custom on the 8th day and performed by a mohel. Jews generally are prohibited from eating pork or shellfish. family, friends, and rabbi should be allowed to visit. asking males to remove shawls or yarmulkes is not necessary while visiting