Growth and Development & Health Promotion (Ch. 3-7)

The nurse explains to parents of school-age children that according to Kohlberg's theory of moral development, their child is at the conventional stage of moral development. Which is the nurse's best explanation for the motivation for school-age children to follow rules? a. They follow rules out of a sense of being a "good person." b. They follow rules out of fear of being punished. c. They follow rules in order to receive praise from caretakers. d. They follow rules because it is in their nature to do so.

ANS: A During the school-age years, the child's sense of morality is constantly being developed. According to Kohlberg, the school-age child is at the conventional stage of moral development. The 7- to 10-year-old usually follows rules out of a sense of being a "good person." He or she wants to be a good person to his or her parents, friends, and teachers and to himself or herself.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior? a. The need for separation and control b. The need for love and belonging c. The need for safety and security d. The need for peer approval

ANS: A Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.

The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which best exemplifies a school-ager working toward accomplishing this developmental task? a. The child signs up for after-school activities. b. The child performs his bedtime preparations autonomously. c. The child becomes aware of the opposite sex. d. The child is developing a conscience.

ANS: A Erikson (1963) describes the task of the school-age years to be a sense of industry versus inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develop his or her cognitive and social skills. Achieving independence is a task of the preschooler who also is developing a conscience at that age. Awareness of the opposite sex occurs in, but is not the focus of, the school-age child.

After teaching a group of parents about language development in toddlers, what if stated by a member of the group indicates successful teaching? a. "When my 3-year-old asks 'why?' all the time, this is completely normal." b. "A 15-month-old should be able to point to his eyes when asked to do so." c. "At age 2 years, my son should be able to understand things like under or on." d. "An 18-month-old would most likely use words and gestures to communicate."

ANS: A Language development occurs rapidly in a toddler. By age 3 years, "why" and "what" questions dominate in the child's language. Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.

The parents of a 4-year-old who is a picky eater ask the nurse what foods to include in their child's diet to provide adequate iron consumption. Which food would the nurse recommend? a. Cooked lentils b. Whole milk c. Oranges d. Sweet potatoes

ANS: A Lentils are a good source of iron. Whole milk, oranges, and sweet potatoes are good sources of calcium.

When providing anticipatory guidance to parents about their preschool son who was caught in a lie, what would the nurse emphasize? a. "You need to determine the reason for lying before punishing the child." b. "Lying should never be tolerated and the child should be punished." c. "The misbehavior is usually more serious than the lying itself." d. "It is okay to become angry when dealing with the child's lying."

ANS: A Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which intervention is priority to promote adequate growth? a. Monitoring the child's weight and height b. Encouraging a more frequent feeding schedule c. Assessing the child's current feeding pattern d. Recommending higher-calorie solid foods

ANS: A Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. What would the nurse correctly include in this description? a. Myelination of the brain and spinal cord is complete at about 24 months. b. Alveoli reach adult numbers by 3 years of age. c. Urine output in a toddler typically averages approximately 30 mL/hour. d. Toddlers typically have strong abdominal muscles by the age of 2.

ANS: A Myelination of the brain and spinal cord continues to progress and is complete around 24 months of age. Alveoli reach adult numbers usually around the age of 7. Urine output in a toddler typically averages 1 mL/kg/hour. Abdominal musculature in a toddler is weak, resulting in a pot-bellied appearance.

The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem? a. Lack of social and emotional readiness for school b. Stuttering c. Speech and language delays d. Fine motor skills delay

ANS: A Risk factors for lack of social and emotional readiness for school include insecure attachment in the early years, maternal depression, parental substance abuse, and low socioeconomic status.

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening? a. Viewing her baby sister's illness as her fault b. Harming the baby c. Experiencing clinical depression d. Creating an imaginary friend to cope with the situation

ANS: A Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

The nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? a. "This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech." b. "This is considered a developmental delay in the 3-year-old and we should consult a speech therapist." c. "This is a condition known as echolalia and can be corrected if you work with your daughter on language skills." d. "This is a condition known as stuttering and it is a normal pattern of speech development in the toddler."

ANS: A Telegraphic speech is common in the 3-year-old. Telegraphic speech refers to speech that contains only the essential words to get the point across, much like a telegram. In telegraphic speech, the nouns and verbs are present and are verbalized in the appropriate order (Feigelman, 2016b). Echolalia (repetition of words and phrases without understanding) normally occurs in toddlers younger than 30 months of age. "Why" and "what" questions dominate the older toddler's language. Stuttering usually has its onset at between 2 and 4 years of age. It occurs more often in boys than in girls. About 75% of all cases of stuttering resolve within 1 to 2 years after they start.

The parents of a 1-year-old girl, both of whom have perfect teeth, are concerned about their child getting dental caries. Which is the best advice the nurse can provide? a. Tell the parents to limit the child's eating to meal and snack times. b. Urge the parents to take the child to a dentist for a check-up. c. Advise the parents to reduce carbohydrates in the child's diet. d. Advise the parents to use fluoride toothpaste.

ANS: A Telling the parents to limit eating to meal and snack times is the best advice for preventing dental caries. This reduces the amount of exposure the child's teeth have to food. Urging them to take the child to see a dentist is sound advice but doesn't suggest actions they can take now to prevent caries. Carbohydrates react with oral bacteria to cause caries, but they should not be reduced from the diet. Avoiding fluoridated toothpaste may help prevent fluorosis.

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. What is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? a. Reward the child for initiative in order to build self-esteem. b. Change the routine of the preschooler often to stimulate initiative. c. Do not set limits on the preschooler's behavior as this results in low self-esteem. d. As a parent, decide how and with whom the child will play.

ANS: A The building of self-esteem continues throughout the preschool period. It is of particular importance during these years, as the preschooler's developmental task is focused on the development of initiative rather than guilt. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. Routine and ritual continue to be important throughout the preschool years, as they help the child to develop a sense of time as well as provide the structure for the child to feel safe and secure. Also, consistent limits provide the preschooler with expectation and guidance. Giving children opportunities to decide how and with whom they want to play also helps them develop initiative.

The nurse is performing an annual check-up for an 8-year-old child. Compared to the previous assessment of this child, which characteristic would most likely be observed? a. Breathing is diaphragmatic. b. Pulse rate is increased. c. Secondary sex characteristics are present. d. Blood pressure has reached adult level.

ANS: A The child's respiratory system is maturing, so abdominal breathing has been replaced by diaphragmatic breathing. Pulse rate will decrease, rather than increase, during this time. Secondary sex characteristics will not appear until the late school-age years. Blood pressure will not reach the adult level until adolescence.

The nurse is caring for a 7-month-old girl during a well-child visit. Which intervention is most appropriate for this child? a. Discussing the type of sippy cup to use b. Advising about increased caloric needs c. Explaining how to prepare table meats d. Describing the tongue extrusion reflex

ANS: A The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months.

The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which topic would be most appropriate? a. Advising how to create a toddler-safe home b. Warning about small objects left on the floor c. Cautioning about putting the baby in a walker d. Telling about safety procedures during baths

ANS: A The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.

The nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth? a. Remove high-calorie, low-nutrient foods from the diet. b. Ensure 30 minutes of unstructured activity per day. c. Avoid sharing your snacks and candy with the child. d. Reduce the amount of high-fat food the child eats.

ANS: A The most effective intervention will be to remove high-calorie, low-nutrient foods from the diet in order to reduce the number of calories and increase the nutritional value. Exercise is also important, but a child this age should have 30 minutes of structured physical activity plus several hours of unstructured physical activity per day. The parents should set an example for good eating habits. Dietary fat should not be restricted for an 18-month-old child because it is necessary for nervous system development.

The nurse is caring for a 5-year-old girl posttonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process? a. Magical thinking b. Centration c. Transduction d. Animism

ANS: A The nurse understands that the girl is demonstrating magical thinking. Magical thinking is a normal part of preschool development. The preschool-age child believes her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as the basis for another situation whether or not they are truly causally linked. Animism is attributing life-like qualities to inanimate objects. Centration is focusing on one aspect of a situation while neglecting others.

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? a. A less discriminating sense of taste b. A lack of fully developed hearing c. Visual acuity that has not fully developed d. A less discriminating sense of touch

ANS: A The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

The parent of a 6-month-old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent? a. "Thumb sucking is a healthy self-comforting activity." b. "Thumb sucking leads to the need for orthodontic braces." c. "Caregivers should pay special attention to the thumb sucking to stop it." d. "Thumb sucking should be replaced with the use of a pacifier."

ANS: A Thumb sucking is a healthy self-comforting activity. Infants who suck their thumbs or pacifiers often are better able to soothe themselves than those who do not. Studies have not shown that sucking either thumbs or pacifiers leads to the need for orthodontic braces unless the sucking continues well beyond the early school-age period. The infant who has become attached to thumb sucking should not have additional attention drawn to the issue, as that may prolong thumb sucking. Pacifiers should not be used to replace thumb sucking as this habit will also need to be discouraged as the child grows.

The nurse is assessing the psychosocial development of a preschooler. What are normal activities characteristic of the preschooler? Select all that apply. a. Plans activities and makes up games. b. Initiates activities with others. c. Acts out roles of other people. d. Engages in parallel play with peers. e. Classifies or groups objects by their common elements. f. Understands relationships among objects.

ANS: A, B, C The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.

A new mother tells the nurse that she is having difficulty breastfeeding her baby. When observing the mother, which actions prompt the nurse to provide teaching about proper breastfeeding techniques? Select all that apply. a. The mother carefully washes her breasts prior to feeding the infant. b. The mother feeds the infant every hour. c. The mother supplements feedings with water. d. The mother holds her breast in the "C" position. e. The mother strokes the nipple against the infant's face.

ANS: A, B, C The mother should wash her hands prior to breastfeeding the infant. There is no need to wash the breasts in most circumstances. The best time to feed the infant is on demand rather than hourly, and there is no need to supplement breastfeeding with water. The "C" position and stroking the nipple against the infant's face promote effective breastfeeding.

The nurse is caring for preschoolers in a day care center. For this age group, of what developmental milestones should the nurse be aware? Select all that apply. a. Counting 10 or more objects b. Correctly naming at least four colors c. Understanding the concept of time d. Knowing everyday objects e. Understanding the differences of others f. Forming concepts as logical as an adult's

ANS: A, B, C, D The child in the intuitive phase can count 10 or more objects, correctly name at least four colors, and better understand the concept of time, and he or she knows about things that are used in everyday life, such as appliances, money, and food. The preschooler forms concepts that are not as complete or as logical as the adult's, and tolerates others' differences but doesn't understand them.

The school nurse providing school health screenings knows that the 7- to 11-year-old is in Piaget's stage of concrete operational thoughts. What should this age group accomplish when developing operations? Select all that apply. a. Ability to assimilate and coordinate information about the world from different dimensions b. Ability to see things from another person's point of view and think through an action c. Ability to use stored memories of past experiences to evaluate and interpret present situations d. Ability to think about a problem from all points of view, ranking the possible solutions while solving the problem e. Ability to think outside of the present and incorporate into thinking concepts that do exist as well as concepts that might exist f. Ability to understand the principle of conservation—that matter does not change when its form changes

ANS: A, B, C, F Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about the world from different dimensions. He or she is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. The school-age child is able to use stored memories of past experiences to evaluate and interpret present situations. Also, during concrete operational thinking, the school-age child develops an understanding of the principle of conservation—that matter does not change when its form changes. According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one in the formal operational period. During this period, the adolescent is able to think about a problem from all points of view, ranking the possible solutions while solving the problem. The adolescent also develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. His or her thinking becomes logical, organized, and consistent.

The nurse is assessing the infants in the nursery for the six stages of consciousness. The nurse becomes concerned when assessing which infants? Select all that apply. a. An infant rapidly moves from deep sleep to crying. b. An infant moves from active alert state to drowsiness. c. An infant progresses slowly from deep sleep to light sleep. d. An infant frequently skips the quiet alert state during the six stages of consciousness. e. An infant ends the stages of consciousness with crying.

ANS: A, B, D The nurse becomes concerned if the infant does not move slowly through six states of consciousness, which begin with deep sleep. The infant should then progress as follows: light sleep, drowsiness, quiet alert state, active alert state, and finally crying. States are not normally skipped.

The nurse is teaching the parents of a 4-year-old boy about the normal maturation of the child's organs during the preschool years and their effect on body functions. Which statements accurately describe these changes? Select all that apply. a. Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. b. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. c. Heart rate increases and blood pressure decreases slightly during the preschool years; an innocent heart murmur may be heard upon auscultation. d. The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. e. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. f. The urethra remains long in both boys and girls, making them more susceptible to urinary tract infections than adults.

ANS: A, B, D, E Most of the body systems have matured by the preschool years. Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. The bones continue to increase in length and the muscles continue to strengthen and mature. However, the musculoskeletal system is still not fully mature. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. The 4-year-old generally has adequate bowel control. Heart rate decreases and blood pressure increases slightly during the preschool years. An innocent heart murmur may be heard upon auscultation. The urethra remains short in both boys and girls, making them more susceptible to urinary tract infections than adults.

The school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all that apply. a. Preschoolers enjoy books with pictures that tell stories. b. Preschoolers like stories with repeated phrases as they help keep their attention. c. Preschoolers like stories that describe experiences different from their own. d. Preschoolers demonstrate early literacy skills by reciting stories or portions of books. e. Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. f. Preschoolers do not have enough focus and expanded attention to notice when a page is skipped during reading.

ANS: A, B, D, E Preschoolers enjoy books with pictures that tell stories. Stories with repeated phrases help to keep the child's attention. Also, children like stories that describe experiences similar to their own. The preschool child demonstrates early literacy skills by reciting stories or portions of books. He or she also may retell the story from the book, pretend to read books, and ask questions about the story. The preschool child has enough focus and expanded attention to notice when a page is skipped during reading and will call it to the parent's attention.

The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which statements accurately describe the typical infant's achievement of these milestones? Select all that apply. a. At 1 month, the infant lifts and turns the head to the side in the prone position. b. At 2 months, the infant rolls from supine to prone to back again. c. At 6 months, the infant pulls to stand up. d. At 7 months, the infant sits alone with some use of hands for support. e. At 9 months, the infant crawls with the abdomen off the floor. f. At 12 months, the infant walks independently.

ANS: A, D, E, F At 1 month, the infant lifts and turns the head to the side in the prone position. At 7 months, the infant sits alone with some use of hands for support. At 9 months, the infant crawls with the abdomen off the floor. At 12 months, the infant walks independently. At 4 months, the infant lifts the head and looks around. At 10 months, the infant pulls to stand up.

The nurse is assessing the respiratory system of a newborn. Which anatomic differences place the infant at risk for respiratory compromise? Select all that apply. a. The nasal passages are narrower. b. The trachea and chest wall are less compliant. c. The bronchi and bronchioles are shorter and wider. d. The larynx is more funnel shaped. e. The tongue is smaller. f. There are significantly fewer alveoli.

ANS: A, D, F In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.

Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned? a. Plantar grasp b. Step c. Babinski d. Neck righting

ANS: B Appropriate appearance and disappearance of primitive reflexes, along with the development of protective reflexes, indicates a healthy neurologic system. The step reflex is a primitive reflex that appears at birth and disappears at 4 to 8 weeks of age. The plantar grasp reflex is a primitive reflex that appears at birth and disappears at about the age of 9 months. The Babinski reflex is a primitive reflex that appears at birth and disappears around the age of 12 months. The neck righting reflex is a protective reflex that appears around the age of 4 to 6 months and persists.

The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which behaviors would the child also be expected to exhibit? a. Showing no interest in what the nurse sees in her ears b. Explaining what is right and what is wrong c. Demonstrating independence from her mother d. Showing no concern when the nurse hurts her own finger

ANS: B At this age, behavior is seen by the child as either completely right or wrong. The child will almost surely want to know why the nurse looks in her ears. The child depends heavily on parents for support and encouragement at this age. This is a time when children gain empathy, so the child would show concern for the nurse's injury.

The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? a. The mother is suffering from depression. b. The child is homeless and has no toys. c. The mother describes an inadequate diet. d. The child is unperturbed by a loud noise.

ANS: B Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.

The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? a. The child has trouble undressing himself. b. The child is unable to push a toy lawnmower. c. The child is unable to unscrew a jar lid. d. The child falls when he bends over.

ANS: B Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age.

During a health history, the nurse explores the sleeping habits of a 3-year-old boy by interviewing his parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group? a. "Our son sleeps through the night, and we insist that he takes two naps a day." b. "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." c. "Our son still sleeps in a crib because we feel it is the safest place for him at night." d. "Our son occasionally experiences night walking so we allow him to stay up later when this happens."

ANS: B Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.

The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which statement would indicate that the boy is having nightmares instead of night terrors? a. "It usually happens about an hour after he falls asleep." b. "He will tell us about what happened in his dream." c. "He is completely unaware that we are there." d. "When we try to comfort him, he screams even more."

ANS: B During a nightmare, a child will have a memory of the occurrence and may remember the dream and talk about it later. With night terrors, the child has no memory of the event. The other statements are indicative of night terrors.

The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erikson's theory of development, what would be an appropriate intervention for this child? a. Discourage solitary play; encourage playing with other children. b. Encourage the child to pick out his own clothes. c. Use "time-outs" whenever the child says "no" inappropriately. d. Encourage the child to take turns when playing games.

ANS: B Erikson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism and always saying "no" is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with "time-outs." The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.

The nurse is educating a first-time mother who has a 1-week-old boy. Which is the most accurate anticipatory guidance? a. Describing the effect of neonatal teeth on breastfeeding b. Explaining that the stomach holds less than 1 ounce c. Informing that fontanels will close by 6 months d. Telling that the step reflex persists until the child walks

ANS: B Explaining that the child's stomach holds less than 1 ounce gives the mother a reason for frequent, small feedings and is the most helpful and accurate anticipatory guidance. Telling that the step reflex persists until the child walks and informing that fontanels will close by 6 months are inaccurate. The step reflex disappears at about 2 months and fontanels close between 12 and 18 months. Neonatal teeth are highly unusual and need no explanation unless they occur.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? a. "I'll start with baby oatmeal cereal mixed with low-fat milk." b. "The cereal should be a fairly thin consistency at first." c. "I can puree the meat that we are eating to give to my baby." d. "Once he gets used to the cereal, then we'll try giving him a cup."

ANS: B Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer to prevent confrontations? a. "Respond in a calm but firm manner." b. "You need to adhere to various routines." c. "Put her in time-out when she misbehaves." d. "It's important to toddler-proof your home."

ANS: B Making expectations known through everyday routines helps to avoid confrontations. This helps the child know what to expect and how to behave. It is the best guidance to give these parents. Calm response and time-out are effective ways to discipline, but do not help to prevent confrontations. Toddler-proofing the house doesn't eliminate all the opportunities for confrontation.

When instructing the parents of a toddler about appropriate nutrition, what would the nurse recommend? a. About 12 to 16 ounces of fruit juice per day b. Approximately 16 to 24 ounces of milk per day c. Fat intake of 30% to 40% of total calories d. An average of 10 to 12 grams of fiber per day

ANS: B Milk intake should be limited to 16 to 24 ounces per day, with fruit juice limited to 4 to 6 ounces per day. A toddler's total fat intake should be 20% to 30% of total calories. The daily recommended fiber intake is 19 grams.

At which age would the nurse expect to find the beginning of object permanence? a. 1 month b. 6 months c. 9 months d. 12 months

ANS: B Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. What is a recommended guideline when dealing with this issue? a. Be prepared to thoroughly cover a topic before the child asks about it. b. Before answering questions, find out what the child thinks about the subject. c. Expand upon the topic when answering questions to prevent further confusion. d. Provide a less than honest response to shelter the child from knowledge that is too advanced.

ANS: B Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to answer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting.

A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? a. "This is a primitive reflex known as the plantar grasp." b. "This is a primitive reflex known as the palmar grasp." c. "This is a protective reflex known as rooting." d. "This is a protective reflex known as the Moro reflex."

ANS: B Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."

The nurse is counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother? a. Carrying the baby may increase the length of crying. b. Reducing stimulation may decrease the length of crying. c. Using vibration, white noise, or swaddling may increase crying. d. Using a swing or car ride may increase the incidence of crying episodes.

ANS: B Prolonged crying leads to increased stress among caregivers. Reducing stimulation may decrease the length of crying, and carrying the infant more may be helpful. Some infants respond to the motion of an infant swing or a car ride. Vibration, white noise, or swaddling may also help to decrease fussing in some infants. Parents should try one intervention at a time, taking care not to stimulate the infant excessively in the process of searching for solutions.

The nurse is caring for a 4-week-old girl and her mother. Which is the most appropriate subject for anticipatory guidance? a. Promoting the digestibility of breast milk b. Telling how and when to introduce rice cereal c. Describing root reflex and latching on d. Advising how to choose a good formula

ANS: B Telling the mother how to introduce rice cereal is the most appropriate subject for anticipatory guidance. Since this mother is already breast- or bottle-feeding her baby, educating her about these subjects would not inform her about what to expect in the next phase of development.

The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 in tall at her last examination at age 4. Which height measurement would be within the normal range of growth expected for a preschooler? a. 41 in b. 43 in c. 45 in d. 47 in

ANS: B The average preschool-age child will grow 2.5 to 3 in (6.5 to 7.8 cm) per year. The average 3-year-old is 37 in tall (96.2 cm), the average 4-year-old is 40.5 in tall (103.7 cm), and the average 5-year-old is 43 in tall (118.5 cm).

The nurse is assessing a 4-month-old boy during a scheduled visit. Which findings might suggest a developmental problem? a. The child does not babble. b. The child does not vocally respond to voices. c. The child never squeals or yells. d. The child does not say dada or mama.

ANS: B The fact that the child does not vocally respond to voices might suggest a developmental problem. At 4 to 5 months of age, most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child is too young to babble, squeal, yell, or say dada or mama.

The nurse is teaching good sleep habits for toddlers to the mother of a 3-year-old boy. Which response indicates the mother understands sleep requirements for her son? a. "I'll put him to bed at 7 PM, except Friday and Saturday." b. "He needs 12 hours of sleep per day including his nap." c. "I need to put the side down on the crib so he can get out." d. "His father can give him a horseback ride into his bed."

ANS: B The mother understands her child needs 12 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. However, a horseback ride to bed may cause problems because it may not provide a calming transition from play to sleep. A bath and reading a book would be better. If the child can climb out of a crib, he needs to be in a youth bed or regular bed to avoid injury.

The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond? a. "It is best to just ignore this and to not respond to his questions." b. "This is normal; children his age do not understand the permanence of death." c. "You have to keep repeating that his grandfather is never coming back." d. "He will eventually figure this out on his own."

ANS: B The nurse needs to remind the mother that preschoolers do not completely understand the concept of death or its permanence. Telling the mother that it is best to ignore the boy's questions or that the boy will eventually figure this out on his own does not teach. Repeating that the grandfather is not coming back does not consider the developmental stage of the child and is inappropriate.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which intervention would be appropriate advice? a. Allow the child to pick out his or her own foods for meals. b. Present the food matter-of-factly and allow the child to choose what to eat. c. Offer high-fat snacks if the child does not eat, to get them to eat something. d. Offer the child a special treat if he or she eats all the food on the plate.

ANS: B The parents should maintain a matter-of-fact approach, offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat. High-fat, nutrient-poor snacks should not be substituted for healthy foods just to coax the child to "eat something." If the preschooler is growing well, then the pickiness is not a cause for concern. A larger concern may be the negative relationship that can develop between the parent and child relating to mealtime. The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to try new foods or even eat the ones he or she likes that are served. The child should be offered a healthy diet, with foods from all groups over the course of the day as recommended by the U.S. Department of Agriculture.

The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse? a. "The preschooler has no sense of right and wrong." b. "The preschooler is developing a conscience." c. "The preschooler sees morality as internal to self." d. "The preschooler's morals are his or her own, right or wrong."

ANS: B The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own.

The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child? a. The newborn's eyes wander and occasionally are crossed. b. The newborn does not respond to a loud noise. c. The newborn's eyes focus on near objects. d. The newborn becomes more alert with stroking when drowsy.

ANS: B Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 in. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.

Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium? a. Spinach b. White beans c. Enriched bread d. Fortified cereal

ANS: B To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, enriched bread, and fortified cereal are good sources of iron.

The nurse observes an infant interacting with his parents. What are normal social behavioral developments for this age group? Select all that apply. a. Around 5 months, the infant may develop stranger anxiety. b. Around 2 months, the infant exhibits a first real smile. c. Around 3 months, the infant smiles widely and gurgles when interacting with the caregiver. d. Around 3 months, the infant will mimic the parent's facial movements, such as sticking out the tongue. e. Around 3 to 6 months of age, the infant may enjoy socially interactive games such as patty-cake and peek-a-boo. f. Separation anxiety may also start in the last few months of infancy.

ANS: B, C, D, F The infant exhibits a first real smile at age 2 months. By about 3 months of age, the infant will start an interaction with a caregiver by smiling widely and possibly gurgling. The 3- to 4-month-old will also mimic the parent's facial movements, such as widening the eyes and sticking out the tongue. Separation anxiety may also start in the last few months of infancy. Around the age of 8 months, the infant may develop stranger anxiety. At 6 to 8 months of age, the infant may enjoy socially interactive games such as patty-cake and peek-a-boo.

The pediatric nurse is aware of the maturation of organ systems in the school-age child. What accurately describes these changes? Select all that apply. a. The brain grows very slowly during the school-age years and growth is complete by the time the child is 12 years of age. b. Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. c. The school-age child's blood pressure increases and the pulse rate decreases, and the heart grows more slowly during the middle years. d. The school-age child experiences more gastrointestinal upsets compared with earlier years since the stomach capacity increases. e. Bladder capacity increases, but varies among individual children, and girls generally have a greater bladder capacity than boys. f. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics.

ANS: B, C, E, F Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. The school-age child's blood pressure increases and the pulse rate decreases. The heart grows more slowly during the middle years and is smaller in size in relation to the rest of the body than at any other development stage. Bladder capacity increases, but varies among individual children. Girls generally have a greater bladder capacity than boys. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. The brain and skull grow very slowly during the school-age years. Brain growth is complete by the time the child is 10 years of age. The school-age child experiences fewer gastrointestinal upsets compared with earlier years. Stomach capacity increases, which permits retention of food for longer periods of time.

The nurse is helping parents prepare a healthy meal plan for their toddler. Which guidelines for promoting nutrition should be followed when planning meals? Select all that apply. a. The child younger than 2 years of age should have his or her fat intake restricted. b. Extending breastfeeding into toddlerhood is believed to be beneficial to the child. c. Weaning from the bottle should occur by 6 to 12 months of age. d. Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. e. The toddler requires an average intake of 700 mg calcium per day. f. Toddlers tend to have the highest daily iron intake of any age group.

ANS: B, D, E Extending breastfeeding into toddlerhood is believed to be beneficial to the child as it is known to help prevent obesity. Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. The toddler requires an average intake of 500 mg calcium per day. The child younger than 2 years of age should not have his or her fat intake restricted, but this does not mean that unhealthy foods such as sweets should be eaten liberally. Weaning from the bottle should occur by 12 to 15 months of age. Prolonged bottle-feeding is associated with the development of dental caries. It is important for toddlers to consume adequate amounts of iron since they tend to have the lowest daily iron intake of any age group.

The parents of a preschooler ask the nurse to help them choose a preschool for their child. What are recommended guidelines and goals for choosing a preschool? Select all that apply. a. The main goal of preschool is to improve reading and writing skills and readiness for entering into grade school. b. When selecting a preschool, the parent may want to consider the accreditation of the school and the teachers' qualifications. c. The teachers should decide how focused on curriculum the school should be for each individual student. d. The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices. e. The type of discipline used in the school is also an important factor. Parents should choose a preschool that uses corporal punishment. f. The parent should observe the classroom to determine how the children interact with each other and how the teachers interact with the children.

ANS: B, D, F When selecting a preschool, the parent may want to consider the accreditation of the school, the teachers' qualifications, and recommendations of other parents. The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices, as well as how the children interact with each other and how the teachers interact with the children. The main goal of preschool is to foster the child's social skills and accustom him or her to the group environment. The parents must decide how focused on curriculum they want the school to be. The type of discipline used in the school is also an important factor. Parents should not choose a preschool that uses corporal punishment.

The pediatric nurse is planning quiet activities for a hospitalized 18-month-old. What would be an appropriate activity for a child of this age group? a. Painting by number b. Putting shapes into appropriate holes c. Stacking blocks d. Using crayons to color in a coloring book

ANS: C At 18 months, the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which is a recommended guideline that should be implemented? a. Wash the hands and breasts thoroughly prior to breastfeeding. b. Stroke the nipple against the baby's chin to stimulate wide opening of the baby's mouth. c. Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. d. When finished, the mother can break the suction by firmly pulling the baby's mouth away from the nipple.

ANS: C Before each breastfeeding session, mothers should wash their hands, but it is not necessary to wash the breast in most cases. The mother should then stroke the nipple against the baby's cheek to stimulate opening of the mouth and bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. When the infant is finished feeding, the mother can break the suction by inserting her finger into the baby's mouth.

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? a. Can copy a square on another piece of paper b. Can dress and undress herself without help c. Draws a person with three body parts d. Is beginning to tie her own shoelaces

ANS: C By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces.

The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up, the child weighed 80 lb. According to average growth for this age group, what would be his expected current weight? a. 81 lb b. 85 lb c. 87 lb d. 89 lb

ANS: C From 6 to 12 years of age, an increase of 7 lb (3 to 3.5 kg) per year in weight is expected.

The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. What might alert the nurse to a potential problem with the child's sensory development? a. The toddler places the nurse's stethoscope in his mouth. b. The toddler's vision tests at 20/50 in both eyes. c. The toddler does not respond to commands whispered in his ear. d. The toddler's taste discrimination is not at adult levels yet.

ANS: C Hearing should be at the adult level, as infants are ordinarily born with hearing intact. Therefore, the toddler should hear commands whispered in his ear. Toddlers examine new items by feeling them, looking at them, shaking them to hear what sound they make, smelling them, and placing them in their mouths. Toddler vision continues to progress and should be 20/50 to 20/40 in both eyes. Though taste discrimination is not completely developed, toddlers may exhibit preferences for certain flavors of foods.

The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. What is the priority intervention? a. Performing a developmental evaluation of the child b. Encouraging the parents to speak English to the child c. Asking the mother if the child uses Spanish words d. Referring the child to a developmental specialist

ANS: C Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.

The nurse is assessing a 3-year-old boy's development during a well-child visit. Which response by the child indicates the need for further assessment? a. He says a swear word when he hurts himself playing. b. He says "pew" when his sister has soiled her diaper. c. He laughs when his brother cries getting vaccinated. d. He constantly asks "why?" whenever he is told a fact.

ANS: C Laughing when his brother cries when being vaccinated indicates that the child hasn't yet developed a sense of empathy or that there may be psychosocial issues, such as sibling rivalry, that should be assessed. The child may repeat a word even if it is out of context. This is called echolalia. Older toddlers have a well-developed sense of smell and will comment if they don't like a smell. The incessant "why" is very common to toddlers' speech.

The nurse is performing a health assessment of a 3-month-old African-American boy. For what condition should this infant be monitored based on his race? a. Jaundice b. Iron deficiency c. Lactose intolerance d. Gastroesophageal reflux disease (GERD)

ANS: C Many dietary practices are affected by culture, both in the types of food eaten and in the approach to progression of infant feeding. Some ethnic groups tend to be lactose intolerant (particularly blacks, Native Americans, and Asians); therefore, alternative sources of calcium must be offered. Jaundice, iron deficiency, and GERD are not seen at a significantly higher rate in African-American infants.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. What is an appropriate response to this concern? a. Tell the child in a firm manner that this behavior is not acceptable. b. When the child displays this behavior, place him in a "time-out." c. Treat the action in a matter-of-fact manner emphasizing safety. d. Consult a psychotherapist to determine the reason for this behavior.

ANS: C Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, healthcare provider, or nurse checking to see when something is wrong.

A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother? a. "It is best to avoid the playground until she outgrows the fear." b. "She needs to face her fears head-on; take her to the park as much as possible." c. "Acknowledge her fear and help her develop a strategy for dealing with it." d. "Try to minimize her fears and insist that she go to the park."

ANS: C Preschoolers have vivid imaginations and experience a variety of fears. It is best to acknowledge the fear, rather than minimize it, and then collaborate with the child on strategies for dealing with the fear. Avoiding the playground will not address the child's fears. Forcing the child to face her fear without enlisting her input to help deal with the fear does not teach. It is also important for the mother to find out if an incident involving cats and dogs occurred without her knowledge.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week-old baby. Which recommended guideline might be included in the teaching plan? a. Place the baby on a soft mattress with a firm, flat pillow for the head. b. Place the head of the bed near the window to provide fresh air, weather permitting. c. Place the baby on his or her back when sleeping. d. If the baby sleeps through the night, wake him or her up for the night feeding.

ANS: C Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age, night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly? a. Telling the child to stop tearing pages from magazines b. Asking the child if he would please quit throwing toys c. Telling the child firmly that we don't scream in the office d. Saying, "Please come over here and sit in this chair. OK?"

ANS: C Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

The nurse is performing a physical assessment of a 3-year-old girl. What finding would be a concern for the nurse? a. The toddler gained 4 lb in weight since last year. b. The toddler gained 3 in in height since last year. c. The toddler's anterior fontanel is not fully closed. d. The circumference of the child's head increased 1 in since last year.

ANS: C The anterior fontanel should be closed by the time the child is 18 months old. The average toddler weight gain is 3 to 5 lb per year. Length/height increases by an average of 3 in per year. Head circumference increases about 1 in from when the child is between 1 and 2 years of age, then increases an average of a half inch per year until age 5.

The parents of a 5-year-old are concerned that their son is too short for his age. The nurse measures the child's height at 40 in (101.6 cm). How should the nurse respond? a. "Some children are short for their age during the preschool years but usually catch up during early childhood." b. "Are most of the adults in your family short? It may be hereditary that your child will be shorter than average." c. "The average height for a 5-year-old is 43 in tall (118.5 cm), so your son is within the normal range for height." d. "I am sure his height is a concern, but if you start choosing nutrient-dense foods, he will likely catch up to normal in height."

ANS: C The average preschool-age child will grow 2.5 to 3 in (6.5 to 7.8 cm) per year. The average 3-year-old is 37 in tall (96.2 cm), the average 4-year-old is 40.5 in tall (103.7 cm), and the average 5-year-old is 43 in tall (118.5 cm).

The nurse is examining a 10-month-old boy who was born 10 weeks early. Which finding is cause for concern? a. The child has doubled his birth weight. b. The child exhibits plantar grasp reflex. c. The child's head circumference is 49.53 cm. d. No primary teeth have erupted yet.

ANS: C The child's head size is large for his adjusted age (7.5 months), which would be cause for concern. The average head circumference of the full-term newborn is 35 cm (13.5 in). Head circumference increases about 10 cm from birth to 1 year (Levine, 2019). Birth weight doubles by about 4 months of age. Plantar grasp reflex does not disappear until 9 months adjusted age. Primary teeth may not erupt until 8 months adjusted age.

The nurse is using the formula for bladder capacity to measure the bladder capacity of a 9-year-old girl. What number would the nurse document for this measurement? a. 9 ounces b. 10 ounces c. 11 ounces d. 12 ounces

ANS: C The formula for bladder capacity is age in years plus 2 ounces. Therefore, the bladder capacity of the 9-year-old would be 11 ounces.

The nurse is supervising lunch time for children on a pediatric ward. Which observation, if noted by the nurse, would require further assessment? a. A child has a full set of primary teeth. b. A child has no difficulty chewing and swallowing meat. c. A child uses his fingers and refuses to use a fork. d. A child is a picky eater.

ANS: C The preschool child has learned to use utensils fairly effectively to feed himself or herself, has a full set of primary teeth, and is able to chew and swallow competently. Preschool children may be picky eaters. They may eat only a limited variety of foods or foods prepared in certain ways and may not be very willing to try new things.

The nurse is assessing the gross motor skills of an 8-year-old boy. Which interview question would facilitate this assessment? a. "Do you like to do puzzles?" b. "Do you play any instruments?" c. "Do you participate in any sports?" d. "Do you like to construct models?"

ANS: C To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

What activity would the nurse expect to find in an 18-month-old? a. Standing on tiptoes b. Pedaling a tricycle c. Climbing stairs with assistance d. Carrying a large toy while walking

ANS: C Toddlers continue to progress with motor skills. An 18-month-old should be able to climb stairs with assistance. A 24-month-old should be able to stand on his or her tiptoes and carry a large toy while walking. A 36-month-old would be able to pedal a tricycle.

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. What is a recommended intervention for this age group? a. Remove children's security blankets at this stage to help them assert their autonomy. b. Distract toddlers from exploring their own body parts, particularly their genitals. c. Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. d. Offer toddlers many choices to foster control over their environment.

ANS: C Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely on a security item to self-soothe as this is a function of autonomy and is viewed as a sign of a nurturing environment, rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 lb. What should the nurse instruct the parents to do? a. "Place her in a booster seat with lap and shoulder belts in the front seat." b. "Place her in the back seat with the lap and shoulder belts in place." c. "Place her in a forward-facing car seat with a harness and top tether." d. "Place her in a booster seat with lap and shoulder belts in the back seat."

ANS: D A child who weighs between 40 and 80 lb should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap/shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 lb.

A 6-month-old girl weighs 14.7 lb during a scheduled check-up. Her birth weight was 8 lb. What is the priority nursing intervention? a. Talking about solid food consumption b. Discouraging daily fruit juice intake c. Increasing the number of breastfeedings d. Discussing the child's feeding patterns

ANS: D Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.

The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond? a. "Is there a family history of diabetes?" b. "Suddenly having accidents can be a sign of diabetes." c. "That's normal; don't worry about it." d. "Tell me about the circumstances when this occurs."

ANS: D Bladder control is present in the 4- and 5-year-old child, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.

The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which is the most effective anticipatory guidance? a. Substituting cow's milk if breast milk is not available b. Advocating iron supplements with bottle-feeding c. Advising fluid intake per feeding of 5 or 6 ounces d. Discouraging the addition of fruit juice to the diet

ANS: D Discouraging the addition of fruit juice to the child's diet is the most effective anticipatory guidance. Fruit juice can displace important nutrients from breast milk or formula. Cow's milk is likely to result in an allergic reaction. If breast milk is not available, infant formula may be substituted. Advising fluid intake per feeding of 5 or 6 ounces is too much for this neonate, but is typical for an infant 4 to 6 months of age. Advocating iron supplements with bottle-feeding is unnecessary so long as the formula is fortified with iron.

The nurse is teaching the parents of a 2-year-old girl how to deal with common toddler situations. Which is the best advice? a. Discipline the child for regressive behavior. b. Scold the child for public thumb sucking. c. Tell the older sibling to not act like a baby. d. Have the child help clean up a bowel accident.

ANS: D Having the child help clean up a bowel accident is the best advice. Toddlers should never be punished for bowel or bladder "accidents," but gently reminded about toileting. Regressive behavior is best ignored, while appropriate behavior should be praised. Telling the older sibling to not act like a baby is a negative approach. It would be better to have the child be mother's helper. Calmly telling the child that thumb sucking is something that is done at home is better than scolding the child.

Which activity would the nurse least likely include as exemplifying the preconceptual phase of Piaget's preoperational stage? a. Displays of animism b. Use of active imaginations c. Understanding of opposites d. Beginning questioning of parents' values

ANS: D In the intuitive phase of Piaget's preoperational stage, the child begins to question parents' values. Animism, active imaginations, and an understanding of opposites would characterize the preconceptual phase of Piaget's preoperational stage.

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate? a. "Put the infant in an infant seat after eating." b. "Limit burping to once during a feeding." c. "Feed the same amount but space out the feedings." d. "Keep the baby sitting up for about 30 minutes afterward."

ANS: D Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended.

The neonatal nurse assesses newborns for iron deficiency anemia. Which newborn is at highest risk for this disorder? a. A postterm newborn b. A term newborn with jaundice c. A newborn born to a diabetic mother d. A premature newborn

ANS: D Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Infants born prematurely miss all or at least a portion of this iron store transfer, placing them at increased risk for iron deficiency anemia compared with term infants. An infant having jaundice, having been born to a mother with diabetes, or having been born postterm does not significantly place the infant at risk for iron deficiency anemia.

The nurse is providing discharge teaching regarding formula preparation for a new mother. Which guideline would the nurse include in the teaching plan? a. Always wash bottles and nipples in hot soapy water and rinse well; do not wash them in the dishwasher. b. Store tightly covered ready-to-feed formula can after opening in refrigerator for up to 24 hours. c. Warm bottle of formula by placing bottle in a container of hot water, or microwaving formula. d. Do not add cereal to the formula in the bottle or sweeten the formula with honey.

ANS: D Proper formula preparation includes the following: wash nipples and bottles in hot soapy water and rinse well or run nipples and bottles through the dishwasher; store tightly covered ready-to-feed formula can after opening in refrigerator for up to 48 hours; after mixing concentrate or powdered formula, store tightly covered in refrigerator for up to 48 hours; do not reheat and reuse partially used bottles; throw away the unused portion after each feeding; do not add cereal to the formula in the bottle; do not sweeten formula with honey; warm formula by placing bottle in a container of hot water; and do not microwave formula.

The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which safety intervention should the nurse address? a. Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. b. Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. c. Encourage parents to smoke only in designated rooms in the house or outside the house. d. Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the back seat of the car.

ANS: D Safety is of prime concern throughout the toddler period. The safest place for the toddler to ride is in the back seat of the car. Parents should use the appropriate size and style of car seat for the child's weight and age as required by the state. At a minimum, all children over 20 lb and up to 40 lb should be in a forward-facing car seat with harness straps and a clip. Parents who want to enroll a toddler in a swimming class should be aware that a water safety skills class would be most appropriate. However, even toddlers who have completed a swimming program still need constant supervision in the water. Pot handles on stoves should be turned inward to avoid accidental burn. Nurses should counsel parents to stop smoking (optimal), but if they continue smoking never to smoke inside the home or car with children present.

The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? a. Spanking in a child this age predisposes the child to a pro-violence attitude. b. The child will become resentful and angry, leading to more outbursts. c. Spanking demonstrates a poor model for problem-solving skills. d. There is an increased risk for physical injury in this age group.

ANS: D Spanking should never be used with toddlers younger than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount.

The nurse is performing a cognitive assessment of a 2-year-old. Which behavior would alert the nurse to a developmental delay in this area? a. The child cannot say name, age, and gender. b. The child cannot follow a series of two independent commands. c. The child has a vocabulary of 40 to 50 words. d. The child does not point to named body parts.

ANS: D The 2-year-old can point to named body parts and has a vocabulary of 40 to 50 words. At 30 months old, a child can follow a series of two independent commands and at 3 years old, a child can say name, age, and gender.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching? a. Telling them either one may demonstrate toilet use b. Assuring them that bladder control occurs first c. Telling them that curiosity is a sure sign of readiness d. Advising them to use praise, not scolding

ANS: D The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which behavior would warrant nursing intervention? a. The child pretends he is talking to an imaginary friend when the nurse addresses the child. b. The child states that her fairy godmother is going to come and take her home. c. The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. d. The child does not want to play games with other children on the hospital ward.

ANS: D The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses transduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which task would the nurse expect the toddler to be able to perform? a. Completing puzzles with four pieces b. Winding up a mechanical toy c. Playing make-believe with dolls d. Knowing which are his or her toys

ANS: D The toddler in Piaget's sensorimotor stage of cognitive development (18 to 24 months) understands requests, is capable of following simple directions, and has a sense of ownership (knowing which toys are his). The other tasks are accomplished by the child in the preoperational stage (2 to 7 years).

The nurse of a preschool child is helping parents develop a healthy meal plan for their child. What nutritional requirements for this age group should the nurse consider? a. The 3- to 5-year-old requires 300 to 500 mg calcium and 10 mg iron daily. b. The 3-year-old should consume 10 mg dietary fiber daily. c. The 4- to 8-year-old requires 15 mg dietary fiber per day. d. The typical preschooler requires about 85 kcal/kg of body weight.

ANS: D The typical preschooler requires about 85 kcal/kg of body weight. The 3- to 5-year-old requires 700 to 1,000 mg calcium and 10 mg iron daily. The 3-year-old should consume 19 mg dietary fiber daily, while the 4- to 8-year-old requires 25 mg dietary fiber per day.

The nurse is designing a nursing care plan for a toddler with lymphoma, who is hospitalized for treatment. What is a priority intervention that the nurse should include in this child's nursing plan? a. Limiting visitors to scheduled visiting hours b. Planning physical therapy for the child c. Introducing the toddler to other toddlers in the unit d. Monitoring the toddler for developmental delays

ANS: D When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays. Parents should be encouraged to stay with the toddler to avoid separation anxiety. Planning activities and socialization of the toddler is important, but the priority intervention is monitoring for, and addressing, developmental delays that may occur in the hospital.

The nurse is preparing a class for a group of adolescents about promoting safety. What would the nurse plan to include as the leading cause of adolescent injuries? a. Motor vehicles b. Firearms c. Water d. Fires

ANS: A Although firearms, water, and fires all pose a risk for injury for adolescents, most adolescent injuries are due to motor vehicle crashes.

The nurse is caring for a 7-year-old girl who is scheduled for a hernia repair and is very scared. Which fear would she also most likely have at this age? a. Fear of being kidnapped b. Fear of cutting her finger c. Fear of sudden loud noises d. Fear of the neighbor's dog

ANS: A At this age, the child will be fearful of being kidnapped. She should have outgrown her fears of harm to her body, noises, and dogs, all of which are typical preschooler fears.

After teaching the parents of a 9-year-old girl about safety, which statement indicates the need for additional teaching? a. "She can ride in the front seat of the car once she is 10 years old." b. "We need to buy her a helmet so she can ride her scooter." c. "She should ride her bike with the traffic on the side of the road." d. "We signed her up for swim lesions at the local community center."

ANS: A Children younger than 12 years of age must sit in the back seat of the car. Laws in most states require helmets for riding bicycles and scooters. When riding a bike, the child should ride on the side of the road traveling with the traffic. Children should know how to swim. If swimming skills are limited, the child must wear a life preserver at all times.

The mother of a 14-year-old girl reports to the nurse that her daughter is moody, shuts herself in her room, and fights with her younger sister. Which comment is most valuable to the mother? a. "Calmly talk to her about your concerns." b. "This is normal for her age." c. "She may be hanging with a bad crowd." d. "Set some rules for family etiquette."

ANS: A Getting the mother and daughter talking and sharing information is the most valuable advice. Telling the mother that this is normal does nothing for the family situation. Setting rules will alienate the child. Suggesting an underlying problem can cause a rift between the mother and daughter.

The mother of a 7-year-old girl tells the school nurse that her child is deathly afraid of going to school. What would be the best intervention the nurse could suggest in this situation? a. Return the child to school and investigate the cause of the fear. b. Have the child stay home from school until any issues causing this fear are resolved. c. Investigate a new school for the child to attend that the child will not be afraid of. d. Tell the child that privileges will be taken away if she does not return to school.

ANS: A It is important to investigate specific causes of school refusal/school phobia and take appropriate action. The parents should return the child to school, investigate the cause of the fear, support the child, collaborate with teachers, and praise success in school attendance. This is not a situation for punishment, and changing schools would not solve the child's school phobia.

The nurse is helping the parents and their underweight adolescent collaborate on planning a healthy menu. Of which nutritional requirement of adolescents should the nurse be aware? a. Teenagers have a need for increased calories, zinc, calcium, and iron for growth. b. Teenage girls who are active require about 1,800 calories per day. c. Teenage boys who are active require between 2,000 and 2,500 calories per day. d. Adolescents require about 1,000 to 1,200 mg of calcium each day.

ANS: A Teenagers have a need for increased calories, zinc, calcium, and iron for growth. However, the number of calories needed for adolescence depends on the teen's age and activity level as well as growth patterns. Teenage girls who are moderately active require about 2,000 calories per day. Teenage boys who are moderately active require between 2,200 and 2,800 calories per day. Adolescents require about 1,300 mg of calcium each day.

The nurse teaches parents of adolescents that adolescents need the support of parents and nurses to facilitate healthy lifestyles. What should be a priority focus of this guidance? a. Reducing risk-taking behavior b. Promoting adequate physical growth c. Maximizing learning potential d. Teaching personal hygiene routines

ANS: A The adolescent experiences drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. With this rapid growth during adolescence, the development of secondary sexual characteristics, and interest in the opposite sex, the adolescent needs the support and guidance of parents and nurses to facilitate healthy lifestyles and to reduce risk-taking behaviors. Promoting physical growth, maximizing learning potential, and teaching hygiene are secondary to reducing risky behavior.

During a health check-up without his parents, a 17-year-old tells the nurse he is gay. Which approach should the nurse take? a. "Tell me what makes you think you are gay." b. "This puts you in an at-risk category." c. "We need to talk about safe sex." d. "You're not gay; you're confused."

ANS: A The nurse needs to get more information from the teenager (assessment) before making any comment and then proceed in a sensitive and caring way. Comments about being at risk or needing to know about safe sex are negative and should be replaced with health promotion comments. Denying the statement shows the teenager that you are not an ally.

The nurse is performing a physical examination of an 11-year-old girl. What observations would be expected? a. The child has not gained weight since last year. b. The child has grown 2.5 in since last year. c. The child breathes abdominally. d. The child's third molars are about to erupt.

ANS: B From 6 to 12 years of age, children grow an average of 2.5 in (6 to 7 cm) per year, increasing their height by at least 1 foot. An increase of 7 lb (3 to 3.5 kg) per year in weight is expected. Abdominal breathing is typical of a preschooler and would have disappeared several years earlier. The third molars do not erupt until late adolescence.

A mother brings her 6-year-old son in for a check-up because the child is reporting stomachaches. It is the beginning of the school year. What might the mother also mention? a. The child cries before going to school. b. The child made friends the first day of school. c. The child fights with siblings more often. d. The child loves the crowds in the lunchroom.

ANS: A This child has a slow-to-warm-up temperament. The child may also be crying before going to school. Making friends the first day of school and enjoying the crowds in the lunchroom are typical of a child with an easy temperament. Irritability is typical of a child with a difficult temperament.

The nurse is performing a cognitive assessment on a 16-year-old client. Which behaviors demonstrated will the nurse identify as middle formal operational, according to Piaget's theory? Select all that apply. a. Reporting that he smokes marijuana occasionally. b. Wanting to make decisions about health care independently c. Being very concerned with implications of the Affordable Care Act regarding healthcare benefits d. Wanting their friends to visit them in the hospital more than their parents e. Difficulty understanding the implications their diagnosis might present

ANS: A, B, C During the middle years (age 14 to 17), Piaget recognizes that the adolescent has increased ability to think abstractly or in more idealistic terms, thinks he or she is invincible (leading to risky behaviors), and becomes involved/concerned with society and politics. In the early stages of formal operational reasoning, the adolescent's thinking is egocentric and lacks abstract thinking, as noted in the client being more concerned with peers than parents, and the adolescent does not understand the implications of his or her diagnosis.

When assessing adolescents for health risks, the nurse must keep in mind the factors related to the prevalence of adolescent injuries. What accurately describes these factors? Select all that apply. a. Increased physical growth b. Insufficient psychomotor coordination c. Tiredness, lack of energy d. Lack of impulsivity e. Peer pressure f. Inexperience

ANS: A, B, E, F Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes.

The school nurse is teaching parents risk factors for suicide in adolescents. What would the nurse discuss? Select all that apply. a. Mental health changes b. History of previous suicide attempt c. Higher socioeconomic status d. Greatly improved school performance e. Family disorganization f. Substance abuse

ANS: A, B, E, F Suicide is the third leading cause of death in adolescents 15 to 19 years of age. Risk factors for suicide include mental health changes, history of previous suicide attempt, family disorganization, and substance abuse. Other risk factors include poor school performance, crowded conditions/housing, low socioeconomic status, limited parental supervision, single-parent families/both parents in workforce, access to guns or cars, drug or alcohol use, low self-esteem, racism, peer or gang pressure, and aggression.

The school nurse is conducting a seminar for parents of adolescents on how to communicate with teenagers. Which guidelines might the nurse recommend? Select all that apply. a. Talk face to face and be aware of body language. b. Ask questions to see why he or she feels that way. c. Do not give praise unless the adolescent deserves it. d. Speak to your child as an authority figure, not an equal. e. Don't admit that you make mistakes. f. Don't pretend you know all the answers.

ANS: A, B, F In order to improve communication with teenagers, the parents should talk face to face and be aware of body language, ask questions to see why the teenager feels that way, not pretend they know all the answers, give praise and approval to the teenager often, speak to him or her as an equal (not talk down to him or her), and admit that they do make mistakes.

A 12-year-old girl is experiencing prepubescence, and tells the school nurse that she feels "very out of place" in her school. What would be acceptable responses by the nurse? Select all that apply. a. "It must be difficult for you. Why don't you sit down and we can talk about it." b. "I would suggest that you talk to your parents about your feelings. This isn't something that I can talk to you about." c. "All of the girls and boys will be going through the same thing as you so that should make you feel a little better." d. "Tell me how this makes you feel. Talking about your feelings may help you feel better about school." e. "I went through the same thing when I was in school. I know it doesn't feel like it now but I promise it will get easier."

ANS: A, D Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics, a period of rapid growth for girls, and a period of continued growth for boys. Acknowledging the student's feelings and encouraging her to talk about her feelings will likely help her to feel better about herself. She may not be comfortable with talking about her feelings with her parents at this point, and the nurse discussing this topic with the student is acceptable. Telling her that everyone goes through it and that it will "get easier" does not address the student's feelings and is nontherapeutic communication.

After assessing a 10-year-old girl, the nurse documents the appearance of breast buds, identifying this as what body change? a. Menarche b. Thelarche c. Puberty d. Tanner stage 5

ANS: B "Thelarche" is the term used to describe breast budding. Menarche refers to the first menstrual period. Puberty refers to the biologic changes that occur during adolescence. Tanner stage 5 involves maturation of the breast tissue to adult configuration.

Based on Erikson's developmental theory, what is the major developmental task of the adolescent? a. Gaining independence b. Finding an identity c. Coordinating information d. Mastering motor skills

ANS: B According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years, the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.

The school nurse is preparing a program on sexuality and birth control for a class of 14 to 16 year olds. Which behavior will have the most influence on how the information is presented? a. Teens are adjusting to new body images. b. Adolescents tend to take risks. c. Teenagers are able to think in the abstract. d. Adolescents understand that actions have consequences.

ANS: B Adolescents are risk takers. This tendency enables them to overcome common sense and their own better judgment. Although adolescents are capable of abstract thinking and understand that actions have consequences, they are not yet committed to these attributes. Changing body image would not have significant influence on the presentation.

When providing anticipatory guidance to a group of parents with school-age children, what would the nurse describe as the most important aspect of social interaction? a. School b. Peer relationships c. Family d. Temperament

ANS: B Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

The school nurse knows that dating is a milestone for adolescents. Which statement accurately describes a trend in teen dating? a. Most late adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. b. Most teens have been involved in at least one romantic relationship by late adolescence. c. Teens that date frequently report slightly lower levels of self-esteem and decreased autonomy. d. Homosexual behavior as a teen usually indicates that the adolescent will maintain a homosexual orientation.

ANS: B By age 18, 70% of adolescents report being in at least one romantic relationship in the past 18 months. Most early adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. Teens who date frequently report slightly higher levels of self-esteem and increased autonomy. Homosexual behavior as a teen does not necessarily indicate that the adolescent will maintain a homosexual orientation.

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which information would the nurse include in her teaching plan? a. Teachers are the most influential people in the development of the school-age child's social network. b. Continuous peer relationships provide the most important social interaction for school-age children. c. Parents should establish norms and standards that signify acceptance or rejection. d. A characteristic of school-age children is their formation of groups with no rules and values involved.

ANS: B Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

What finding would the nurse most likely discover in a 10-year-old child in the period of concrete operational thought? a. Participation in abstract thinking b. Ability to classify similar objects c. Problem solving via the scientific method d. Ability to make independent decisions

ANS: B During the period of concrete operational thought, children are able to classify or group objects based on their common elements. Abstract thinking, problem solving via the scientific method, and independent decision making are higher-level functions, typically seen in adolescents.

The nurse is teaching the parents of a 12-year-old boy about appropriate approaches when raising an adolescent. Which comment should be included in the discussion? a. "Find out if his friends are worthy of him." b. "Try to be open to his views." c. "Maintain a firm set of rules." d. "Remind him that he is still your little boy."

ANS: B It is most important to be open to the child's views. This will encourage the child to consider parental concerns and promote communication. Being judgmental about his friends will make the child defensive about his choice of friends. Rules need to be flexible so they can apply to new situations. Avoid condescension. The child will appreciate being treated like a young man.

The school nurse is performing a physical examination on a 13-year-old boy who is on the soccer team. What is a physical quality that develops during these early adolescent years? a. Coordination b. Endurance c. Speed d. Accuracy

ANS: B It is usually during early adolescence that teenagers begin to develop endurance. Their concentration has increased so they can follow complicated instructions. Coordination can be a problem because of the uneven growth spurts. During middle adolescence, speed and accuracy increase while coordination also improves.

The mother of a 12-year-old boy is talking with the school nurse about her son's clumsiness. She reports that he seems to fall a lot, his writing is horrible, and as much as he practices he can't play his guitar very well. How should the nurse respond to the mother? a. "Boys tend to take a bit longer than girls to mature." b. "Have you spoken with your pediatrician about your observations?" c. "Boys tend to refine their fine motor skills by this age." d. "I will make a note of your observations and talk to his teachers."

ANS: B Myelinization of the central nervous system is reflected by refinement of fine motor skills. The child between 10 and 12 years of age begins to exhibit manipulative skills comparable to adults. In order to determine if the child is delayed in fine motor skill development, the pediatrician should be made aware because further examination or testing may be warranted. Just stating the fact that his motor skills should be developed by this age, although true, does not address the mother's concerns. The teachers can be notified of the mother's observations, but the child should still be assessed by the pediatrician.

The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. What advice might be helpful for these parents? a. School-age children are not ready to absorb information that deals with drugs and alcohol. b. School-age children can think critically to interpret messages seen in advertising, media, and sports. c. Parents must prevent their child from being exposed to messages that are in conflict with their values. d. Discussions with children need to be based on facts and focused on the past and future.

ANS: B School-age children can be taught how to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities. School-age children are ready to absorb information that deals with drugs and alcohol and may be exposed to messages that are in conflict with their parents' values regarding smoking and alcohol. This may occur at school and cannot be prevented. Discussions with children need to be based on facts and focused on the present.

The school nurse is conducting vision screening for a 7-year-old girl and documents the condition "amblyopia." What would the nurse tell the parents about this condition? a. "Amblyopia is an uncorrected refractive error of the eye." b. "Amblyopia is reduced vision in an eye that has not been adequately used during early development." c. "Amblyopia is a malalignment of the eye, which occurs at birth." d. "Amblyopia is a clouding of the lens of the eye caused by trauma to the eye."

ANS: B Some problems frequently identified in school-age children include amblyopia (lazy eye), uncorrected refractive errors or other eye defects, and malalignment of the eyes (called strabismus). Amblyopia is reduced vision in an eye that has not been adequately used during early development. Inadequate use can result from conditions such as strabismus, being cross-eyed, or one eye being more nearsighted, farsighted, or astigmatic than the other eye. Amblyopia is the leading cause of visual impairment in children (National Eye Institute, 2008) and if untreated can result in vision loss.

The nurse knows that barriers to the adolescent's health and successful achievement of the tasks of adolescence exist. What is the major barrier to health for this population? a. Cultural b. Socioeconomic c. Marital status d. Racial

ANS: B The major barrier to the adolescent's health and successful achievement of the tasks of adolescence is socioeconomic status. Adolescents at a lower socioeconomic level are at higher risk for developing healthcare problems and risk-taking behaviors; this may be due to their inability to access health care and to obtain needed services. In caring for adolescents, the nurse should also recognize the influence of their culture, ethnicity, and race upon them.

The nurse assesses the spirituality of an adolescent. What are normal moral and spiritual milestones in this age group? Select all that apply. a. Adolescents will base their actions on the avoidance of punishment and the attainment of pleasure. b. Adolescents develop their own set of morals and values and question the status quo. c. Adolescents undergo the process of developing their own set of morals at different rates. d. Adolescents are more interested in the spiritualism of their religion than in the actual practices of their religion. e. Adolescents can understand the concepts of right and wrong and are developing a conscience. f. Adolescents are able to understand and incorporate into their behavior the concept of the "golden rule."

ANS: B, C, D It is during the adolescent years that teenagers develop their own set of values and morals at different rates. At the beginning of this stage, teenagers begin to question the status quo. The majority of their choices are based on emotions while they are questioning societal standards. Adolescents also begin to question their formal religious practices. As they progress through adolescence, teenagers become more interested in the spiritualism of their religion than in the actual practices of their religion. The toddler will base his or her actions on the avoidance of punishment and the attainment of pleasure. The preschool child can understand the concepts of right and wrong and is developing a conscience. The school-age child is able to understand and incorporate into his behavior the concept of the "golden rule."

The nurse is discussing ways to promote discipline with parents who are becoming increasingly frustrated with their teenager. What would the nurse identify as most important? a. Establish rules and expectations. b. Collaborate to determine consequence. c. Make your responses consistent. d. Explain the rules to the adolescent.

ANS: C Consistency and predictability are the cornerstones of discipline. Establishing rules and expectations, collaborating to determine the consequences, and explaining the rules are all important, but they are not as important as being consistent.

When describing the various changes that occur in organ systems during adolescence, what would the nurse include? a. Significant increase in brain size b. Ossification completed later in girls c. Decrease in heart rate d. Decrease in activity of sebaceous glands

ANS: C During adolescence, the heart rate decreases while the systolic blood pressure increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous gland activity increases during adolescence.

The nurse has seen a 15-year-old girl and a 16-year-old boy during health surveillance visits. Which physical characteristics would be seen in both teenagers? a. Decreased respiratory rates of 15 to 20 breaths per minute b. Eruption of the last four molars c. Increased shoulder, chest, and hip widths d. Fully functioning sweat and sebaceous glands

ANS: C Both teenagers are in the middle state of adolescence, which is marked by an increase in shoulder, chest, and hip widths. Decreased respiratory rate occurs in early adolescence, as do fully functioning sweat and sebaceous glands. Eruption of the last four molars occurs in late adolescence.

The nurse is promoting learning and school attendance to a 13-year-old girl. Which factor will affect the child's attitude most? a. Her parents' values and desires b. The dramatic changes to her body c. Peer group behaviors and attitudes d. Desire for attention from boys

ANS: C In this age group, children have a strong desire to conform to their peer group and to be accepted. It is important to know the peer group's attitude about school and learning. Early adolescence marks the beginning of separation from the family, including its values and desires. Physiologic changes and sexual attraction would not have significant or lasting influence in this matter.

During a health maintenance visit, a 15-year-old girl mentions that she is not happy with being overweight. Which approach is best for the nurse to take? a. "Good observation. Let's talk about diet and exercise." b. "Don't worry; you are within the weight and height guidelines." c. "What specifically have you been noticing?" d. "Tell me about your parents. Are they overweight?"

ANS: C It is best to find out what caused the teenager to make the comment so that you can work with her about the issue. This is an assessment and must be done first. Launching into a lecture on diet and exercise will be of no value if the teenager wants to talk about dealing with snide comments from her peers. Telling the teenager she is statistically in the normal range for weight and height may close the conversation prematurely. The focus is on the teenager, not her parents. Obtaining that information would be important, but not at this time.

The nurse is performing risk assessments on adolescents in the school setting. Which teen should the nurse screen for hypertension? a. An Asian female b. A white male c. An African-American male d. A Jewish male

ANS: C It is important for the nurse to recognize the ethnic background of each adolescent. Research has shown that certain ethnic groups are at higher risk for certain diseases. For example, adolescent African Americans are at higher risk for developing hypertension.

The school nurse is performing health assessments on students in middle school. Of what developmental milestone should the nurse be aware? a. Height in girls increases rapidly after menarche and usually ceases immediately after menarche. b. Boys' growth spurts usually begin between the ages of 8 and 14 years and end between the ages of and years. c. Peak height velocity (PHV) occurs at approximately 12 years of age in girls or about 6 to 12 months after menarche. d. Boys reach PHV and peak weight velocity (PWV) at about 16 years of age.

ANS: C PHV occurs at approximately 12 years of age in girls or about 6 to 12 months after menarche. Height in girls increases rapidly after menarche and usually ceases 2 to years after menarche. Boys' growth spurt occurs later than girls' and usually begins between the ages of and 16 years and ends sometime between the ages of and years. Boys reach PHV at about 14 years of age. PWV occurs about 6 months after menarche in girls and at about 14 years of age in boys.

The nurse is providing suggestions to a female adolescent about foods to help meet her nutritional requirements for iron. Which food would the nurse suggest as a good source of iron? a. Broccoli b. Yogurt c. Peanut butter d. White beans

ANS: C Peanut butter is a good source of iron. Broccoli, yogurt, and white beans are good sources of calcium.

The nurse is teaching parents to plan nutritional meals for their 7-year-old son who is overweight. Which guideline might the nurse include in the teaching plan? a. School-age children with an average body weight of 20 to 35 kg need approximately 90 calories per kilogram daily. b. The average water requirement for a school-age child per 24 hours ranges from 2,000 to 2,500 mL per day. c. The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. d. In the school-age child, calories needed to sustain weight increase, while the appetite decreases.

ANS: C The 4- to 8-year-old child needs 1,000 mg of calcium for maintenance of growth and good nutrition and 10% to 30% of calories should come from protein. School-age children with an average body weight of 20 to 35 kg need approximately 70 calories per kilogram daily (1,400 to 2,100 calories per day). The average water requirement per 24 hours ranges from 1,800 to 2,200 mL per day. Growth, body composition, and body shape remain constant during the late school-age years. Needed calories decrease while the appetite increases.

The nurse has determined that an 8-year-old girl is at risk for being overweight. Which intervention would be a priority prior to developing the care plan? a. Determining the need for additional caloric intake b. Asking the parents who they want to work with the child c. Interviewing the parents about their eating habits d. Discussing the influence of peers on the child's diet

ANS: C The nurse would need to find out what the parents' eating habits are like. It would not be necessary to determine the need for additional caloric intake. Developing a multidisciplinary plan is an intervention for a child with growth and development problems. Discussing the influence of peers is an intervention used for preventing injury.

The nurse is counseling the parents of a 10-year-old child who was caught stealing at school. Which topic should the nurse cover? a. Having the child return the property in front of his or her class b. Discussing ways for the child to save face c. Finding out what is currently going on at home d. Reminding the child daily that stealing is wrong

ANS: C The parents need to understand the child's behavior. The reason for stealing at age 10 may be that the child wants the item or is trying to impress peers, or it may be a sign of anxiety. More information is needed before the nurse can effectively work with the family. The parents should work together with the child to decide how the item will be returned. The child will lose face but gain integrity by returning the stolen item. Reminding the child about stealing on a daily basis may ruin the child's self-esteem.

The school nurse is teaching parents about the effects of bullying on school children. What accurately describes this developmental concern? a. Children who bully are those who report themselves as being lonely and having difficulty in forming friendships. b. Children with health issues, such as, disabilities, obesity, and food allergies, are at a decreased risk of being bullied. c. In general, about 20% of all children attending school are frightened and afraid most of the day. d. Both boys and girls are bullied; boys usually bully boys and use force more often.

ANS: D Both boys and girls are bullied and can bully others. Boys usually bully boys and use force more often, and boys are twice as likely to be victims of bullying. Bullied children are those who report themselves as being lonely and having difficulty in forming friendships. Children with health issues, such as disabilities, obesity, and food allergies, are at an increased risk of being bullied. In general, about 10% of all children attending school are bullied on a regular basis with approximately 50% of children reporting having been bullied at some point in their school-age years.

A 12-year-old boy reports to the nurse that he is one of the shortest kids in his class. He asks the nurse if he will ever grow. What response by the nurse is most appropriate? a. "At your age, you are largely done growing taller." b. "Since you are the shortest now, you will likely always be the shortest in the class." c. "Boys do not have their growth spurt until about age 17." d. "There is no way to know how tall you will grow because you are still well within the window for growth."

ANS: D Boys' growth spurt occurs later than girls' and usually begins between the ages of 10.5 and 16 years and ends sometime between the ages of 13.5 and 17.5 years.

Two working parents are discussing with the school nurse the possibility of their 12-year-old girl going home alone after school. What suggestion should the nurse make? a. Provide entertainment until the parents come home. b. Allow the child to go to a friend's house. c. Teach her how to take a message if someone calls. d. Purchase caller ID for the phone.

ANS: D Having caller ID allows the child to answer the phone if Mom or Dad calls while ignoring all other calls. Rather than entertaining the child, this would be a better time for homework, age-appropriate chores, and limited entertainment. If the child goes to a friend's house, it should be prearranged between the parents, not spur of the moment. It is safer if the child does not answer the phone instead of taking a message.

The nurse is promoting nutrition to a 13-year-old boy who is overweight. Which comment should the nurse expect to include in the discussion? a. "You need to go on a low-fat diet." b. "Eat what your parents eat." c. "Go out for a sport at school." d. "Keep a food diary."

ANS: D Having the boy keep a detailed food diary for 1 week will determine current patterns of eating. This can then be used to show him how to make small changes with results, especially if eating is done before periods of inactivity such as before going to bed or when he is bored. Speaking and thinking in terms of diet are negative and can lead to poor body image. If the parents have poor eating habits, telling the child to eat what his parents eat could be bad advice. The child could too easily choose the wrong sport or do poorly. It is best to offer solutions with more variety.

The school nurse knows that school-age children are developing metalinguistic awareness. Which is an example of this skill? a. The child enjoys reading books. b. The child enjoys conversations with peers. c. The child enjoys speaking on the phone. d. The child enjoys telling jokes.

ANS: D Language skills continue to accelerate during the school-age years. School-age children develop metalinguistic awareness—an ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles due to their understanding of double meanings and play on words and sounds.

The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which fact might the nurse include in the introduction? a. Children in the United States spend about 6 hours a day either watching TV or playing video games. b. A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. c. A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. d. Parents should limit television watching and video-game playing to 2 hours per day.

ANS: D Parents should limit television watching and video-game playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image.

During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? a. "The child's best friends will continue playing soccer." b. "The children will cheer for each other regardless of the sport being played." c. "Your child will rarely talk to you about his friends." d. "Acceptance by friends, especially of the same sex, is very important at this age."

ANS: D Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.

The adolescent continues to develop self-concept and self-esteem. What is most important to a teen's self-esteem? a. Strong authority figures b. Spirituality c. Morals and values d. Body image

ANS: D Self-concept and self-esteem are tied to body image many times. Adolescents who perceive their body as being different than peers or as less than ideal may view themselves negatively. Sexual characteristics are important to the adolescent's self-concept and body image. Authority figures, spirituality, and morals and values play a role in development of self-esteem, but body image is most influential in the development of self-concept/self-esteem.

The parents of an 8-year-old boy are interested in promoting learning through reading to their son. Which suggestion by the nurse would best promote this goal? a. Have the parents choose what he should read initially. b. Tell the child to read instead of watch TV with his parents. c. Tell the parents that reading is for the child to do by himself. d. Take the child to the library to check out some books.

ANS: D Taking the child to the library can be a positive start to the reading experience. It is best to let the librarian recommend books that will be appropriate for the child, but let the child choose from recommended materials. Set an example by reading instead of watching TV while the child is not in bed. Reading to the child is a valuable parent-child activity that can expose the child to classic works that are beyond the child's present reading ability.

The nurse is performing an assessment of the reproductive system of a 17-year-old girl. What would alert the nurse to a developmental delay in this girl? a. Areola and papilla separate from the contour of the breast b. Mature distribution and coarseness of pubic hair c. Developed breast tissue d. Absence of first menstrual period

ANS: D The first menstrual period usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately ages 9 to 11 years and is followed by the growth of pubic hair.

The nurse teaching safety to teens knows that which of these is the leading cause of death among adolescents? a. Drowning b. Poisoning c. Diseases d. Unintentional injuries

ANS: D Unintentional injuries are the leading cause of death in adolescents (Curtin, Heron, Miniño, & Warner, 2018). Motor vehicle accidents are the leading cause of injury death followed by poisoning, primarily due to drug overdose from opioids (Curtin et al., 2018). Males are more likely than females to die of any type of injury (Curtin et al., 2018).

The nurse is assessing the developmental milestones of an infant. The infant was born 8 weeks ago and was 4 weeks premature. The nurse anticipates that the infant will be meeting milestones for what age of child? Record your answer in weeks.

ANS: 4 To determine adjusted age, subtract the number of weeks that the infant was premature (4 weeks) from the infant's chronologic age (8 weeks).

The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which statement describes a developmental milestone occurring in infancy? a. By 6 months of age, the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. b. Most infants triple their birth weight by 4 to 6 months of age and quadruple their birth weight by the time they are 1 year old. c. The head circumference increases rapidly during the first 6 months: the average increase is about 1 in per month. d. The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

ANS: A By 6 months of age, the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. The head circumference increases rapidly during the first 6 months: the average increase is about 0.6 in (1.5 cm) per month. The heart doubles in size over the first year of life. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation? a. "This is normal behavior for infants unless the stool passed is hard and dry." b. "This is normal behavior for infants due to the immaturity of the gastrointestinal system." c. "This indicates a blockage in the intestine and must be reported to the healthcare provider." d. "This is normal behavior for infants unless the stool passed is black or green."

ANS: A Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.

When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? a. Parallel play b. Cooperative play c. Dramatic play d. Fantasy play

ANS: A Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.

The nurse is watching toddlers at play. Which normal behavior would the nurse observe? a. Toddlers engage in parallel play. b. Toddlers engage in solitary play. c. Toddlers engage in cooperative play. d. Toddlers do not engage in play outside the home.

ANS: A Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

The nurse is choosing foods for a toddler's diet that are high in vitamin A. What foods could be added to the menu? Select all that apply. a. Applesauce b. Avocados c. Broccoli d. Sweet potatoes e. Spinach f. Carrots

ANS: D, E, F Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in folate.