Hospitalized Child

A 2-year-old child brought to the clinic by her parents is uncooperative when the nurse tries to look in her ears. Which of the following should the nurse try first? 1) Ask another nurse to assist. 2) Allow a parent to assist. 3) Wait until the child calms down. 4) Restrain the child's arms.

2. Parents can be asked to assist when their child becomes uncooperative during a procedure. The child will feel more secure with a parent present.

The parents of a preschooler ask the nurse how to handle their child's temper tantrums. Which of the following should the nurse include in the teaching plan? Select all that apply. 1) Putting the child in "time-out." 2) Telling the child to go to his bedroom. 3) Ignoring the child. 4) Putting the child to bed. 5) Spanking the child. 6) Trying to reason with the child.

1, 3. Some parents find that putting the child in time-out until control is regained is very effective. Others find that ignoring the behaviors works just as well with their child.

A parents asks, "Can I get head lice too?" The nurse indicates that adults can also be infested with head lice but that pediculosis is more common among school children, primarily for which of the following reasons? 1) An immunity to pediculosis usually is established by adulthood. 2) School-age children tend to be more neglectful of frequent handwashing. 3) Pediculosis usually is spread by close contact with infested children. 4) The skin of adults is more capable of resisting the invasion of lice.

3. Lice are spread by close personal contact and by contact with infested clothing, bed and bathroom linens, and combs and brushes.

After teaching the parents about the cause of ringworm of the scalp (tinea capitis), which of the following, if stated by the father, indicates successful teaching? 1) It results from overexposure to the sun. 2) It's caused by infestation with a mite. 3) It's a fungal infection of the scalp. 4) It's an allergic reaction.

3. Ringworm of the scalp is caused by a fungus of dermatophyte group of the species.

A parent seems concerned about the fact that the infant's soft spot is still open. Which of the following should the nurse include when explaining about the usual age for closure of the soft spot near the front of the infant's head. 1) 2-4 months 2) 5-8 months 3) 9-11 months 4) 12-18 months

4. The anterior fontanel, the soft spot near the front of the infant's head, usually closes between 12-18 months.

Parents of a 15-year-old state that he is moody and rude. The nurse should advise his parents to: 1) Restrict his activities. 2) Discuss their feelings with their child. 3) Obtain family counseling. 4) Talk to other parents of adolescents.

2. Parents need to discuss with their adolescent how they perceive his behavior and how they feel about it.

A parent asks why it is recommended that the second dose of the measles, mumps, and rubella (MMR) vaccine be given at 4 to 6 years of age? The nurse should explain to the parent that the second dose is given at this age for what reason? 1) If the child reaches puberty and becomes pregnant when receiving the vaccine, the risks to the fetus are high. 2) The change of contracting the disease is much lower at this age. 3) The dangers associated with a strong reaction to the vaccine are increased at this age. 4) A serious complication from the vaccine is swelling of the joints.

1. After receiving the MMR vaccine, the person develops a mild form of the disease, stimulating the body to develop an immunity. Administration to a pregnant adolescent early in pregnancy puts the fetus at risk for deformity or spontaneous abortion.

The parents of a 9-month-old bring the infant to the clinic for a regular checkup. The infant has received no immunizations. Which of the following would be appropriate for the nurse to administer at this visit? 1) Diphtheria, tetanus, and acellular pertussis (DTaP); Haemophilus influenzae type B (Hib); inactivated poliomyelitis vaccine (IPV); and purified protein derivitive (PPD). 2) DTaP, Hib, oral polio vaccine (OPV), and measles, mumps, and rubella (MMR). 3) PPD, MMR, hepatitis B (hepB), and OPV 4) HepB, IPV, Hib, and varicella.

1. Infants that are delayed in receiving their immunizations or have not started their series by 9months of age begin with DTaP, Hib, IPV, and PPD.

A mother states that she thinks her 9-month-old "is developing slowly." When assessing the infant's development, the nurse is also concerned because the infant should be demonstrating which of the following characteristics? 1) Vocalizing single syllables. 2) Standing alone. 3) Building a tower of two cubes. 4) Drinking from a cup with little spilling.

1. Normally a 9-month-old infant should have been voicing single syllables since 6 months of age.

A mother has heard that several children have been diagnosed with mononucleosis. She asks the nurse what precautions should be taken to prevent this from occurring in her child. Which of the following should the nurse advise the mother to do? 1) Take no particular precautionary measures. 2) Sterilize the child's eating utensils before they are reused. 3) Wash the child's linens separately in hot, soapy water. 4) Wear masks when providing direct personal care.

1. The cause of infectious mononucleosis is thought to be the Epstein-Barr virus. It is believed to be spread only by direct intimate contact.

A nurse compares a child's height and weight with standard growth charts and finds the child to be in the 50th percentile for height and in the 45th percentile for weight. The nurse interprets these findings as indicating that the child is: 1) Average height and weight. 2) Overweight for height. 3) Underweight for height. 4) Abnormal in height.

1. The values of height and weight percentiles are usually similar for an individual child. Measurements between 5th and 95th percentiles are considered normal.

The mother of a preschooler reports that her child creates a scene every night at bedtime. The nurse and the mother decide that the best course of action would be to do which of the following? 1) Allow the child to stay up later one or two nights a week. 2) Establish a set bedtime and follow a routine. 3) Encourage active play before bedtime. 4) Give the child a cookie if bedtime is pleasant.

2. Bedtime is often a problem with preschoolers. Recommendations for reducing conflicts at bedtime include establishing a set bedtime, having a dependable routine, such as story reading; and conveying the expectation that the child will comply.

A 10-year-old child proudly tells the nurse that brushing and flossing her teeth is her responsibility. The nurse interprets this statement as indicating which of the following about the child? 1) She is too young to be given this responsibility. 2) She is most likely capable of this responsibility. 3) She should have assumed this responsibility much sooner. 4) She is probably just exaggerating the responsibility.

2. Children are capable of mastering the skills required for flossing when they reach 9 years of age. At this age, many children are able to assume responsibility for personal hygiene.

A father asks the nurse how he would know if his child had developed mononucleosis. The nurse explains that in addition to fatigue, which of the following would be most common? 1) Liver tenderness. 2) Enlarged lymph glands. 3) Persistent nonproductive cough. 4) A blush-like generalized skin rash.

2. Mononucleosis usually has an insidious onset with fatigue and the inability to maintain usual activity levels as the most common symptoms. The lymph nodes are typically enlarged and the spleen also may be enlarged.

The mother of a 4-year-old expresses concern that her child may be hyperactive. She describes the child as always in motion, constantly dropping and spilling things. Which of the following actions would be most appropriate at this time? 1) Determine whether there have been any changes at home. 2) Explain that this is not unusual behavior. 3) Explore the possibility that the child is being abused. 4) Suggest that the child be seen by a pediatric neurologist.

2. Preschool-age children have been described as powerhouses of gross motor activity who seem to have endless energy. A limitation of their motor ability is that in moving as quickly as they do, they are not always able to judge distances, nor are they able to estimate the amount of strength and balance needed for activities.

The school nurse develops a plan with an adolescent to provide relief of dysmenorrhea to aid in her development of which of the following? 1) Positive peer relations. 2) Positive self-identity. 3) A sense of autonomy. 4) A sense of independence.

2. Relieving dysmenorrhea in adolescence is crucial for the female's development of positive self-identity, of which positive body image and sexual identity are important components.

The mother tells the nurse that her 8--year-old child is continually telling jokes and riddles to the point of driving the other family members crazy. The nurse should explain this behavior is a sign of what? 1) Inadequate parental attention. 2) Mastery of language ambiguities. 3) Inappropriate peer influence. 4) Excessive television watching.

2. School-age children delight in riddles and jokes. Mastery of the ambiguities of language and of sentence structure allows the school-age child to manipulate words, and telling riddles and jokes is a way of practicing this skill.

A mother asks the nurse, "How did my children get pinworms?" The nurse explains that pinworms are most commonly spread by which of the following when contaminated? 1) Food. 2) Hands. 3) Animals. 4) Toilet seats.

2. The adult pinworm emerges from the rectum and colon at night onto the perianal area to lay its eggs. Itching and scratching introduces the eggs to the hands, from where they can easily reinfect the child or infect others.

The mother of a 6-month-old states that she has started her infant on 2% milk. which of the following should be the nurse's best response? 1) Your baby will probably be fine with this milk. 2) The baby should be switched to whole milk. 3) You need to keep the infant on formula. 4) You need to switch to formula right now.

2. The mother has already changed the infant from formula to cow's milk, so she probably will not change the infant back to formula. Therefore, the best the nurse can hope for is that the mother will switch to whole milk.

When planning a 15-month-old toddler's daily diet with the parents, which of the following amounts of milk should the nurse include? 1) 1/2 to 1 cup. 2) 2 to 3 cups. 3) 3 to 4 cups. 4) 4 to 5 cups.

2. Toddlers around the age of 15 months need 2 to 3 cups of milk per day to supply necessary nutrients such as calcium.

When assessing for pain in a toddler, which of the following methods should be the most appropriate? 1) Ask the child about the pain. 2) Observe the child for restlessness. 3) Use a numeric pain scale. 4) Assess for changes in vital signs.

2. Toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability, and crying.

An 8 month-old infant is seen in the well-child clinic for a routine checkup. The nurse should expect the infant to be able to do which of the following. Select all that apply. 1) Say "mama" and "dada" with specific meaning. 2) Feed self with spoon. 3) Play peek-a-boo. 4) Walk independently. 5) Stack two blocks. 6) Transfer object from hand to hand.

3, 6. Typically abilities demonstrated by 8-month-old infants include peek-a-boo and transferring objects from one hand to another.

When assessing a 2-year-old child brought by his mother to the clinic for a routine checkup, which of the following should the nurse expect the child to be able to do? 1) Ride a tricycle. 2) Tie his shoelaces. 3) Kick a ball forward. 4) Use blunt scissors.

3. A 2-year old child usually can kick a ball forward.

A 2-year-old tells his mother he is afraid to go to sleep because "the monsters will get him." The nurse should tell his mother to: 1) Allow him to sleep with his parents in their bed whenever he is afraid. 2) Increase his activity before he goes to bed, so he eventually falls asleep from being tired. 3) Read a story to him before bedtime and allow him to have a cuddly animal or a blanket. 4) Allow him to stay up an hour later with the family until he falls asleep.

3. Behavior problems related to sleep and rest are common in young children. Consistent rituals around bedtime help to create an easier transition from waking to sleep.

After teaching a group of parents of preschoolers attending a well-child clinic about oral hygiene and tooth brushing, the nurse determines that the teaching has been successful when the parents state that children can begin to brush their teeth without help at which of the following ages? 1) 3 years. 2) 5 years. 3) 7 years. 4) 9 years.

3. Children younger than 7 years of age do not have the manual dexterity needed for tooth brushing. Therefore, parents need to help with this task until that time.

A mother is concerned because her 5-year-old son seems prone to minor accidents such as skinning his elbows and knees and falling off his scooter. The nurse explains to the mother that childhood accidents are more likely to occur in which of the following situations? 1) The child is the sole child in the family. 2) The family has limited formal education. 3) The family is experiencing changes. 4) The child and family live in the suburbs.

3. Family changes and stresses (e.g. moving, having company, taking vacations, adding new members) can distract parental attention and contribute to accidents.

When discussing the onset of adolescence with parents, the nurse explains that it occurs at which of the following times? 1) Same age for both boys and girls. 2) 1 to 2 years earlier in boys than in girls. 3) 1 to 2 years earlier in girls than in boys. 4) 3 to 4 years later in boys than in girls.

3. Girls experience the onset of adolescence about 1 to 2 years earlier than boys.

Several high-school seniors are referred to the school nurse because of suspected alcohol misuse. When the nurse assesses the situation, what would be most important to determine? 1) What they know about the legal implications of drinking. 2) The type of alcohol they usually drink. 3) The reasons they choose to use alcohol. 4) When and with whom they use alcohol.

3. Information about why adolescents choose to use alcohol or other drugs can be used to determine whether they are becoming responsible users or problem users.

Which of the following is appropriate language development for an 8-month old? The child should be: 1) saying "dada" and "mama" specifically ("dada" to father and "mama" to mother). 2) saying three other words besides "mama" and "dada." 3) saying "dada" and "mama" nonspecifically. 4) saying "ball" when parents point to a ball.

3. It is important for the nurse to assist parents in assessing speech development in their child so that developmental delays can be identified early. At 8 months of age, the child should say "mama" and "dada" nonspecifically and imitate speech sounds.

When developing the teaching plan about illness for the mother of a preschooler, which of the following should the nurse include about how a preschooler perceives illness? 1) A necessary part of life. 2) A test of self-worth. 3) A punishment for wrong-doing. 4) The will of God.

3. Preschool-age children may view illness as punishment for their fantasies. At this age children do not have the cognitive ability to separate fantasies from reality and may expect to be punished for their "evil thoughts."

The mother asks the nurse about her 9-year-old child's apparent need for between-meal snacks, especially after school. When developing a sound nutritional plan for the child with the mother, which of the following should the nurse need to keep in mind? 1) The child does not need to eat between-meal snacks. 2) The child should eat the snacks the mother thinks are appropriate. 3) The child should help with preparing his or her own snacks. 4) The child will instinctively select nutritional snacks.

3. Snacks are necessary for school-age children because of their high energy level. School-age children are in a stage of cognitive development in which they can learn to categorize or classify and can also learn cause and effect.

A mother tells the nurse that one of her children has chickenpox and asks what she should do to care for that child. When teaching the mother, which of the following would be most important to prevent? 1) Acid-base imbalance. 2) Malnutrition. 3) Skin infection. 4) Respiratory infection.

3. The care of a child with chickenpox focuses primarily on preventing infection in the lesions. The lesions cause severe itching, and organisms are ordinarily introduced into the lesion through scratching.

Which of the following structures should be closed by the time the child is 2 months old? 1) Anterior fontanel 2) sagittal suture 3) Posterior fontanel 4) Frontal suture

3. The posterior fontanel should be closed by age 2 months. The anterior fontanel and sagittal and frontal sutures should be closed by age 18 months.

a 10-month old looks for objects that have been removed from his view. The nurse should instruct the parents that: 1) Neuromuscular development enables the child to reach out and grasp objects. 2) The child's curiosity has increased. 3) The child understands the permanence of objects even though the child cannot see them. 4) The child is now able to transfer objects from hand to hand.

3. Understanding object permanence means that the child is aware of the existence of objects that are covered or displaced.

In addition to immunizing for diphtheria, tetanus, and acellular pertussis (DTaP) during the first 6 months of life, the nurse should administer which of the following immunizations? 1) Mumps. 2) Measles. 3) Tuberculosis. 4) Hepatitis B.

4. A series of three injections of DTaP and a series of three injections of Hib vaccine are recommended during the first year of life. In addition the infant should receive three immunizations for hepatitis B.

The school nurse is invited to attend a meeting with several parents who express frustration with the amount of time their adolescents spend in front of the mirror and the length of time it takes them to get dressed. The nurse explains that this behavior indicates: 1) An abnormal narcissism. 2) A method of procrastination. 3) A way of testing the parents' limit-setting. 4) A result of developing self-concept.

4. An adolescent's body is undergoing rapid changes. Adolescence is a time of integrating these rapidly occuring physical changes into the self-concept to achieve the developmental task of a positive self-identity.

When observing the parent instilling prescribed ear drops ordered twice a day for a toddler, the nurse decides that the teaching about positioning of the pinna for instillation of the drops is effective when the parent pulls the toddler's pinna in which of the following directions? 1) Up and forward. 2) Up and backward. 3) Down and forward. 4) Down and backward.

4. In a child younger than 3 years of age, the pinna is pulled back and down, because the auditory canals are almost straight in children.

The nurse is teaching the parents of an 8-month-old about what the child should eat. The nurse should include which of the following points in the teaching plan? 1) Items from all four food groups should be introduced to the infant by the time the child is 10 months old. 2) Solid foods should not be introduced until the infant is 10 months old. 3) Iron deficiency rarely develops before 12 months of age, so iron-fortified cereals should not be introduced until the infant is 12 months old. 4) The infant's diet can be changed from formula to whole milk when the infant is 12 months old.

4. Infants should be kept on formula or breast milk until 1 year of age. the protein in cow's milk is harder to digest than that found in formula.

A nurse is assessing the growth and development of a 10-year old. What is the expected behavior of this child? 1) Enjoys physical demonstrations of affection. 2) Is selfish and insensitive to the welfare of others. 3) Is uncooperative in play and school. 4) Has a strong sense of justice and fair play.

4. School-age children are concerned about justice and fair play.

The mother asks the nurse for advice about discipline for her 18-month-old. Which of the following should the nurse suggest that the mother use first? 1) Structured interactions. 2) Spanking. 3) Reasoning. 4) Time-out.

4. Time out is the most appropriate discipline for toddlers. It helps to remove them from the situation and allows them to regain control.

Griseofulvin (Grisactin) was ordered to treat a child's ringworm of the scalp. The nurse instructs the parents to use the medication for several weeks for which of the following reasons? 1) A sensitivity to the drug is less likely if it is used over a period of time. 2) Fewer side effects occur as the body slowly adjusts to a new substance over time. 3) Fewer allergic reactions occur if the drug is maintained at the same level long-term. 4) The growth of the causative organism into new cells is prevented with long-term use.

4. Griseofulvin is an antifungal agent that acts by binding to the keratin that is deposited in the skin, hair and nails as they grow. This keratin is then resistant to the fungus. But as the keratin is normally shed, the fungus enters new, uninfected cells unless drug therapy continues.

Which development is necessary for toilet training readiness for a 2-year-old? Select all that apply. 1) Adequate neuromuscular development for sphincter control. 2) Appropriate chronological age. 3) Ability to communicate the need to use the toilet. 4) Desire to please the parent. 5) Ability to play with other 2-year-olds.

1, 3, 4. Readiness for toilet training is based on neurological, psychological, and physical developmental readiness. The nurse can introduce concepts of readiness for toilet training and encourage parents to look for adaptive and psychomotor signs such as the ability to walk well, balance, climb, sit in a chair, dress oneself, please the parent, and communicate awareness of the need to urinate or defecate.

The nurse is teaching an adolescent with asthma how to use an inhaler. In which order should the nurse instruct the client to follow the steps? 1) Inhale through an open mouth. 2) Breathe out through the mouth. 3) Hold the breath for 5 to 10 seconds. 4) Press the canister to release the medication.

2, 1, 4, 3.

A mother brings her 18-month-old to the clinic because the child "eats ashes, crayons, and paper." Which of the following information about the toddler should nurse assess first? 1) Evidence of eruption of large teeth. 2) Amount of attention from the mother. 3) Any changes in the home environment. 4) Intake of a soft, low-roughage diet.

3. A craving to eat nonfood substances is known as pica. Toddlers use oral gratification as a means to cope with anxiety. Therefore, the nurse should first asses whether the child is experiencing any change in the home environment that could cause anxiety.

The nurse discusses the eating habits of school-age children with their parents, explaining that these habits are most influenced by which of the following? 1) Food preferences of their peers. 2) Smell and appearance of foods offered. 3) Examples provided by parents at mealtimes. 4) Parental encouragement to eat nutritious foods.

3. Although children may be influenced by their peers and smell and appearance of foods may be important, children are most likely to be influenced by the example and atmosphere provided by their parents.

The mother of a 1-month-old infant states that she is curious as to whether her infant is developing normally. Which of the following developmental milestones should the nurse expect the infant to perform? 1) Smiling and laughing out loud. 2) Rolling from front to side. 3) Holding a rattle briefly. 4) Turning the head from side to side.

4. A 1-month-old infant usually is able to lift the head and turn it from side to side when lying prone.

The nurse should refer the parents of an 8-month-old child to a health care provider if the child is unable to: 1) stand momentarily without holding onto furniture. 2) Stand alone well for long periods of time 3) Stoop to recover an object. 4) Sit without support for long periods of time.

4. A child of 8 months should sit without support for ling periods of time. His muscles are not developed enough to support all his weight without assistance.

The nurse asks a 9-year-old child and her mother about the child's best friend to assess which of the following about the child? 1) Language development. 2) Motor development. 3) Neurologic development. 4) Social development.

4. During the school-age years, a child learns to socialize with children of the same age. Therefore, the nurse is assessing the child's social development.

Initiation of which of the following immunizations is recommended prior to the adolescent entering college? 1) Diphtheria, tetanus, and acellular pertussis (DTaP). 2) Varicella. 3) Meningococcal. 4) Pneumococcal conjugate vaccine (PCV).

3. Meningococcal vaccine should be administered before the adolescent enters college because outbreaks of this type of meningitis are likely when people live in close association, such as in college dorms.

A nurse working in the nursery identifies a goal for a mother of a newborn to demonstrate positive attachment behaviors upon discharge. Which intervention would be least effective in accomplishing this goal? 1) Provide opportunities for the mother to hold and examine the newborn. 2) Engage the mother in the newborn's care. 3) Create an environment that fosters privacy for the mother and newborn. 4) Identify strategies to prevent difficulties in parenting.

4. Identifying ways to prevent difficulties in parenting would be helpful in reducing the incidence of child abuse and reducing the stress of child rearing.

A parent asks the nurse about head lice (pediculosis capitis) infestation during a visit to the clinic. Which of the following symptoms should the nurse tell the parent is most common in a child infected with head lice? 1) Itching of the scalp. 2) Scaling of the scalp. 3) Serous weeping on the scalp surface. 4) Pinpoint hemorrhagic spots on the scalp surface.

1. The most common characteristic of head lice infestation is severe itching.

The nurse notes that an infant stares at an object placed in her hand and takes it to her mouth, coos and gurgles when talked to, and sustains part of her own weight when held in a standing position. The nurse correctly interprets these findings as characteristics of an infant at which of the following stages? 1) 2months 2) 4 months 3) 7 months 4) 9 months

2. Holding the head erect while sitting, staring at an object placed in the hand,taking the object to the mouth, cooing and gurgling, and sustaining part of her body weight when in a standing position are behaviors characteristic of a 4-month-old infant.

A nurse is assessing the growth and development of a 14-year-old boy. He reports that his 13-year-old sister is 2 inches taller than he is. The nurse should advise the boy that the growth spurt in adolescent boys, compared with the growth spurt of adolescent girls: 1) Occurs at the same time. 2) Occurs 2 years earlier. 3) Occurs 2 years later. 4) Occurs 1 year earlier.

3. Adolescent boys lag about 2 years behind adolescent girls in growth.

The mother of a 2-year-old is concerned because the child's right eye seems to turn in toward his nose when he is tired. The nurse should: 1) Assure the mother that this is a normal event when the child is tired. 2) Advise the mother to continue to watch his eyes closely and if the problem persists to call the clinic. 3) Test the child with the cover-uncover test and refer the mother and child to an ophthalmologist if the test is abnormal. 4) Explain to the mother that the child will probably outgrow the weakness and she need not be concerned.

3. Strabismus is diagnosed through observation and use of the corneal light reflex test. The cover-uncover test will reveal movement of the affected eye when the unaffected eye is covered, indicating abnormal fixation of the affected eye.

A 2-year-old always puts his teddy bear at the head of his bed before he goes to sleep. The parents ask the nurse if this behavior is normal. The nurse should explain to the parents that toddlers use ritualistic patterns to: 1) Establish a sense of identity. 2) Establish control over adults in their environment. 3) Establish sequenced patterns of learning behavior. 4)Establish a sense of security.

4. Toddlers establish ritualistic patterns to feel secure, despite inconsistencies in their environment.

An adolescent tells the school nurse that she would like to use tampons during her period. Which of the following would be most appropriate for the nurse to do? 1) Assess her usual menstrual flow pattern. 2) Determine whether she is sexually active. 3) Provide information about preventing toxic shock syndrome. 4) Refer her to a specialist in adolescent gynecology.

3. The nurse should provide the adolescent with information about toxic shock syndrome because of the identified relationship between tampon use and the syndrome's development.

A mother who brings her 4-month-old infant to the clinic for a regular checkup is concerned that her infant is not developing appropriately. When assessing the infant, which of the following should the nurse expect to find? 1) Sitting up with support. 2) Finger-to-thumb grasping. 3) Reaching for a toy. 4) Saying "mama" or "dada."

1. Typically a 4-month-old should be able to sit with support from a person holding the infant lightly in the area of the hips or lower chest.

To encourage autonomy in a 4 year-old, the nurse should instruct the mother to: 1) Discourage the child's choice of clothing. 2) Button the child's coat and blouse. 3) Praise the child's attempts to dress herself. 4) Tell the child when the combination of clothes is not appropriate.

3. At age 4, the child should be learning to dress without supervision. A child will feel more autonomous if allowed to try to take on tasks herself. Such attempts should be encouraged to increase self-esteem. Allowing choices encourages the child's capacity to control her behavior.

After teaching a group of parents about temper tantrums, the nurse knows the teaching has been effective when one of the parents states which of the following? 1) I will ignore the temper tantrum. 2) I should pick up the child during a tantrum. 3) I'll talk to my daughter during the tantrum. 4) I should put my child in time out.

1. Children who have temper tantrums should be ignored as longs as they are safe. They should not receive either positive or negative reinforcement to avoid perpetuating the behavior.

After having a blood sample drawn, a 5-year-old child insists that the site be covered with an adhesive bandage strip. When the mother tries to remove the bandage before leaving the office, the child screams that all the blood will come out. The nurse interprets this behavior as indicating a fear of which of the following? 1) Injury. 2) Compromised body integrity. 3) Pain. 4) Loss of control.

2. The preschool-age child does not have an accurate concept of skin integrity and can view medical and surgical treatments as hostile invasions that can destroy or damage the body. The child does not understand that exsanguination will not occur form an injection site.

Which of the following actions initiated by the parents of an 8 month-old indicates they need further teaching about preventing childhood accidents? 1) Placing a fire screen in front of the fireplace. 2) Placing a car seat in a front-seat, front-facing position. 3) Inspecting toys for loose parts. 4) Placing toxic substances out of reach or in a locked cabinet.

2. The recommended safety-sear arrangement for infants up to 200 lb and less than 1 year old is rear-facing with shoulder restraints.

A mother of a toilet-trained 3-year-old expresses concern over her child's bedwetting while hospitalized. The most appropriate response for the nurse to make is to tell the mother: 1) He was too immature to be toilet trained. In a few months he should be old enough. 2) Children are afraid in the hospital and frequently wet their bed. 3) It's very common for children to regress when they're in the hospital. 4) This is normal. He probably received too much fluid the night before.

3. A child will regress to a behavior used in an earlier stage of development in order to cope with a perceived threatening situation.

A mother calls the clinic to talk to the nurse. The mother states that a physician described her daughter as having 20/60 vision and she asks the nurse what this means. The nurse responds based on the interpretation that the child is experiencing which of the following? 1) A loss of approximately one-third of her visual acuity. 2) Ability to see at 60 feet what she should see at 20 feet. 3) Ability to see at 20 feet what she should see at 60 feet. 4) Visual acuity three times better than average.

3. A child with 20/60 vision sees at 20 feet what those with 20/20 vision see at 60 feet.

The nurse is discharging from the hospital an 8-month-old who weighs 15 lb. The parents have put the child in the back seat of the car with the car seat facing the front seat. The nurse should: 1) Ask the parents to wait while the nurse obtains the correct car seat. 2) Complete the discharge with the child facing the front seat. 3) Give the parents a manual on proper car seat placement. 4) Show the parents proper placement of the car seat facing the back seat.

4. The proper placement for a car seat for a child less than 20 lb and younger than 1 year is in the back seat, facing the rear of the car.