NURS 420 Exam 1

What is a common trigger for asthma attacks in children? a. Febrile episodes b. Dehydration c. Exercise d. Seizures

Answer: Exercise Rationale: Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. Febrile episodes are consistent with other problems, for example, seizures. Dehydration occurs as a result of diarrhea; it does not trigger asthma attacks. Viral infections are triggers for asthma. Seizures can result from a too-rapid intravenous infusion of theophyllinea therapy for asthma.

A parent asks the nurse about immunizing her 7-month-old daughter against the flu. Which response by the nurse would be most appropriate? A. "She really doesn't need the vaccine until she reaches 1 year of age." B. "She will probably receive it the next time she is to get her routine shots." C. "Since your daughter is older than 6 months, she should get the vaccine every year." D. "The vaccine has many side effects, so she wouldn't get it until she's ready to go to school."

"Since your daughter is older than 6 months, she should get the vaccine every year." Rationale: The current recommendations are for all children older than 6 months of age to be immunized yearly against influenza.

A group of nursing students are reviewing information about inflammatory bowel disease in preparation for a class discussion on the topic. The students demonstrate understanding of the material when they identify which characteristics of Crohn disease? Select all that apply. A) Distributed in a continuous fashion B) Most common between the ages of 10 and 20 years C) Elevated erythrocyte sedimentation rate D) Low serum iron levels E) Tenesmus F) Loss of haustra within bowel

-Most common between the ages of 10 and 20 years -Elevated erythrocyte sedimentation rate -Low serum iron levels Rationale: Crohn disease is most common between the ages of 10 and 20 years. Erythrocyte abirb.com/test sedimentation rate is elevated, and serum iron levels are low. Ulcerative colitis is distributed continuously distal to proximal, with tenesmus and loss of haustra within the bowel. Crohn disease is segmental, with disease-free skip areas common, and the bowel wall has a cobblestone appearance.

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. A) Tuna B) Salmon C) Tofu D) Cow's milk E) Dried fruits

-Tuna -Salmon - Tofu -Cow's milk -Dried fruits Rationale: Foods high in iron include red meats, tuna, salmon, eggs, tofu, enriched grains, abirb.com/test dried beans and peas, dried fruits, leafy green vegetables, and iron-fortified breakfast cereals.

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

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

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

Answer: Peer relationships Rationale: 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.

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

Answer: Thelarche Rationale: "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.

A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests what condition? a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

Answer: Asthma Rationale: Asthma may have these chronic signs and symptoms. Pneumonia appears with an acute onset, fever, and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea occurs with acute respiratory distress or failure and maybe stridor.

While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate? A. "Girls have a smaller bladder size than boys do." B. "A girl's urethra is closer to the rectal opening." C. "A girl's urethra is longer than a boy's urethra." D. "Her kidneys are less well protected."

Answer: "A girl's urethra is closer to the rectal opening." Rationale: In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination. Bladder size does not differ between boys and girls. The kidneys are less well protected in the abdomen, increasing the risk for injury but not UTIs.

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."

Answer: "Calmly talk to her about your concerns." Rationale: 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 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."

Answer: "Keep a food diary." Rationale: 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 nurse is caring for a 4-year-old with a suspected urinary tract infection. What would be most appropriate to say to the child when obtaining a urine specimen from him? A. "I will need a urine sample." B. "Let your mom help you tinkle in this cup." C. "Please tinkle in this cup right now." D. "Please void in this cup instead of the toilet."

Answer: "Let your mom help you tinkle in this cup." Rationale: The nurse needs to use familiar terms to explain to the child what is needed and to gain cooperation. The most positive approach would be to let the child's mother help rather than demanding that he tinkle right now. Using the terms "urine sample" or "void" is not appropriate for a 4-year-old.

The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A. "Let's put you in touch with some other girls who are also having the same body changes." abirb.com/test B. "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C. "Your real friends do not care about your appearance and just want you to get well." D. "You are beautiful in your own way; what matters is what is on the inside."

Answer: "Let's put you in touch with some other girls who are also having the same body changes." Rationale: Rationale: It is important to introduce the girl to other youngsters with chronic renal conditions so she does not feel so isolated. Adolescents need interaction with peers. Telling the girl that this is a temporary condition, her real friends don't care about her appearance, and she is beautiful in her own way dismisses the girl's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling her the condition is temporary also is inaccurate.

The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response by the client's parent will the nurse highlight for the primary health care provider as an indicator for this condition? A. "My child's has recently reported urinary frequency." B. "My child just got over a head cold with laryngitis." C. "My child's urine is pale yellow in color." D. "My child's eyes appear sunken to me."

Answer: "My child just got over a head cold with laryngitis." Rationale: Known risk factors include a recent episode of pharyngitis or other streptococcal infection, decreased urine output, rust or cola colored urine, and swelling around the eyes. Edema may occur in the abdomen, face, eyes, feet, ankles, hands, or generally.

The nurse is caring for a 4-year-old girl with vulvovaginitis. After instructing the girl's mother on how to help prevent subsequent episodes, which statement by the mother indicates a need for additional teaching? A. "She tells me she wipes from front to back." B. "I will make sure she changes her underwear every day." C. "She should avoid bubble baths." D. "I will help supervise her wiping after bowel movements." Answer:

Answer: "She tells me she wipes from front to back." Rationale: At the age of 4, the mother should not assume that the girl will wipe properly. The mother will need to supervise her wiping in order to train her properly. Making sure the child changes her underwear daily, avoiding bubble baths, and supervising her wiping after bowel movements indicate that the mother has understood the instructions.

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? A) "Parents commonly fear the worst; however, the factor will help your child lead a normal life." B) "There are risks with any treatment including using blood products, but these are very minor." C) "Although factor replacement is expensive, there's more financial abirb.com/test strain from missing work if he has a bleeding episode." D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

Answer: "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission." Rationale: The nurse needs to emphasize that since 1986, there have been no reports of virus abirb.com/test transmission from factor infusion since the inception of heat treatment of the factor. Telling the parents that there is a minor risk does not teach. Telling the parents that factor is expensive or that it is common to worry does not teach, nor does it address their concerns.

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."

Answer: "Try to be open to his views." Rationale: 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.

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?"

Answer: "What specifically have you been noticing?" Rationale: 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.

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? A) "Open your mouth so I can look inside your cheeks and lips." abirb.com/test B) "Do you have any bruises on your feet or shins?" C) "Will you show me how you walk across the room?" abirb.com/test D) "Let me see the palms of your hands and soles of your feet." abirb.com/test

Answer: "Will you show me how you walk across the room?" Rationale: Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit, stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the hands and feet provide information about signs of petechiae, purpura, or pallor.

When performing the physical examination of a child with cystic fibrosis, what would the nurse expect to assess? A. Dullness over the lung fields B. Increased diaphragmatic excursion C. Decreased tactile fremitus D. Hyperresonance over the liver

Answer: Decreased tactile fremitus Rationale: Examination of a child with cystic fibrosis typically reveals decreased tactile fremitus over areas of atelectasis, hyperresonance over the lung fields from air trapping, decreased diaphragmatic excursion, and dullness over the liver when enlarged.

The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include? A. Getting cervical radiographs between 3 and 5 years of age B. Adhering to the special dietary needs of the child C. Getting an echocardiogram before 3 months of age D. Monitoring for symptoms of respiratory infection

Answer: Adhering to the special dietary needs of the child Rationale: Children with Down syndrome do not require a special diet unless underlying gastrointestinal disease is present. However, a balanced, high-fiber diet and regular exercise are important. Getting cervical radiographs between 3 and 5 years of age is the screening method for atlantoaxial instability, which is seen in about 14% of children with Down syndrome. Evaluation by a pediatric cardiologist before 3 months of age, including an echocardiogram, is important since children with Down syndrome are at higher risk for heart disease. The child will be more susceptible to infectious diseases.

A child is in the emergency department with an asthma exaccerbation. Upon asucultation the nurse is unable to hear air movement in the lungs. What action should the nurse take first? A. Administer a beta-2 adrenergic agonist B. Administer oxygen C. Start a peripheral IV D. Administer corticosteroids

Answer: Administer a beta-2 adrenergic agonist Rationale: When lungs sounds are unable to be heard in a child with asthma, the child is very ill. This means there is severe airway obstruction. The air movement is so severe wheezes cannot be heard. The priority treatment is to administer an inhaled short term bronchodilator (beta-2 adrenergic agonist). The child may require numerous inhalations until bronchodilation occurs and air can pass through the bronchi. Oxygen can be started but until the brochi are dilated no oxygen can get through to the lung fields. In IV would need to be started and IV steroids administered to reduce the inflammation, but the priority is bronchodilation

A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A. Salmeterol B. Albuterol C. Ipratropium D. Cromolyn

Answer: Albuterol Rationale: Albuterol is a short-acting β2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting β2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to β2- adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, what would the nurse identify as potentially interfering with the accuracy of the results? A) Use of iron supplementation B) Blood transfusion 1 month ago C) Lack of fasting for 12 hours D) History of recent infection

Answer: Blood transfusion 1 month ago Rationale: Blood transfusion within the previous 12 weeks may alter the results of the hemoglobin electrophoresis. Iron supplements can increase serum ferritin levels. Children should fast for 12 hours before having a specimen obtained for iron levels. abirb.com/test A history of infection might interfere with the white blood cell count results, not hemoglobin electrophoresis.

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

Answer: Body image Rationale: 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.

A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which finding? A. Children's demand for oxygen is lower than that of adults. B. Children develop hypoxemia more rapidly than adults do. C. An increase in oxygen saturation leads to a much larger decrease in pO2. D. Children's bronchi are wider in diameter than those of an adult.

Answer: Children develop hypoxemia more rapidly than adults do. Rationale: Children develop hypoxemia more rapidly than adults do because they have a significantly higher metabolic rate and faster resting respiratory rates than adults do, which leads to a higher demand for oxygen. A smaller decrease in oxygen saturation reflects a disproportionately much larger decrease in pO2. The bronchi in children are narrower than in adults, placing them at higher risk for lower airway obstruction.

The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. What would the nurse include as a major congenital anomaly? A. Overlapping digits B. Polydactyly C. Umbilical hernia D. Cleft palate

Answer: Cleft palate Rationale: Cleft palate is considered a major congenital anomaly, one that creates a significant medical problem or requires surgical or medical management. Overlapping digits, polydactyly, and umbilical hernia are considered minor congenital anomalies because they do not cause an increase in morbidity in and of themselves.

The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? A. Hyperlipidemia B. Hypoalbuminemia C. Decreased blood urea nitrogen (BUN) D. Hypoproteinemia

Answer: Decreased blood urea nitrogen (BUN) Rationale: With nephrotic syndrome, proteinuria, hyperlipidemia, decreased serum protein levels (hypoproteinemia), and decreased serum albumin levels (hypoalbuminemia) are present. BUN typically becomes elevated.

The postoperative care plan for an infant with surgical repair of a cleft lip includes which intervention? a. A clear liquid diet for 72 hours b. Nasogastric feedings until the sutures are removed c. Elbow restraints to keep the infants fingers away from the mouth d. Rinsing the mouth after every feeding

Answer: Elbow restraints to keep the infants fingers away from the mouth Rationale: Keeping the infants hands away from the incision reduces potential complications at the surgical www.testbanktank.com site. The infants diet is advanced from clear liquid to soft foods within 48 hours of surgery. After surgery, the infant can resume preoperative feeding techniques. Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause? A. Klebsiella B. Escherichia coli C. Staphylococcus aureus D. Pseudomonas

Answer: Escherichia coli Rationale: E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus, and Pseudomonas.

The nurse is administering an IV infusion of albumin to a child with nephrotic syndrome. What is the primary concern for the nurse when administering this medication to the child? A. Fluid overload B. Electrolyte imbalance C. Increased blood pressure D. Urine output

Answer: Fluid overload Rationale: Many children with nephrotic syndrome develop hypoalbuminemia and require the administration of albumin. Albumin increases the intravascular pressure, causing the movement of fluid from the interstitial space to the intravascular space. As a result, fluid overload can occur. The treatment is to administer furosemide after the albumin infusion is complete. Furosemide is a diuretic that will help excrete the extra fluid from the vascular space, thus preventing fluid overload. Electrolyte imbalances would occur if the low albumin was not treated. The blood pressure and urine output should be assessed during the medication administration to determine renal function.

Which intervention is appropriate for the infant hospitalized with bronchiolitis? a. Position on the side with neck slightly flexed. b. Administer antibiotics as ordered. c. Restrict oral and parenteral fluids if tachypneic. d. Give cool, humidified oxygen.

Answer: Give cool, humidified oxygen. Rationale: Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. The etiology of bronchiolitis is viral. Antibiotics are given only if there is a secondary bacterial infection. Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration.

The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find? A) Sausage-shaped mass in the upper midabdomen abirb.com/test B) Hard, moveable, olive-shaped mass in the right upper quadrant C) Tenderness over the McBurney point in the right lower quadrant abirb.com/test D) Abdominal pain in the epigastric or umbilical region

Answer: Hard, moveable, olive-shaped mass in the right upper quadrant Rationale: With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would be palpated in the right upper quadrant. A sausage-shaped mass in the upper midabdomen would suggest intussusception. Tenderness over the McBurney point abirb.com/test would be associated with appendicitis. Epigastric or umbilical pain would be associated with peptic ulcer disease.

The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. What is the priority nursing diagnosis? A. Imbalanced nutrition, less than body requirements related to the effects of hypotonia B. Deficient knowledge related to the presence of a genetic disorder C. Delayed growth and development related to a cognitive impairment D. Impaired physical mobility related to poor muscle tone

Answer: Imbalanced nutrition, less than body requirements related to the effects of hypotonia Rationale: Children with Down syndrome may have difficulty sucking and feeding due to lack of muscle tone and the structure of their mouths and tongues. This can lead to poor nutritional intake and makes this the priority diagnosis. This also uses the strategy that physiologic needs have priority using Maslow's hierarchy of needs. Deficient knowledge due to lack of information about the disorder is a close second in priority, as the mother did not know of her daughter's condition before birth and has much to learn now. This child is at risk for a number of complications such as infection, heart disease, and leukemia and will require frequent assessment. Most children with Down syndrome experience some degree of intellectual disability, but early intervention will allow the child maximum development within the limits of the disease. Mobility is delayed but should not be a problem at this time.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? abirb.com/test A) Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. B) Use guided imagery and therapeutic touch. C) Administer meperidine as ordered. abirb.com/test D) Initiate pain assessment with a standardized pain scale. abirb.com/test

Answer: Initiate pain assessment with a standardized pain scale. Rationale: The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

What is a clinical finding that warrants further intervention for the child with acute poststreptococcal glomerulonephritis? a. Weight loss to within 1 pound of the preillness weight b. Urine output of 1 milliliter per kilogram per hour c. A normal blood pressure d. Inspiratory crackles

Answer: Inspiratory crackles Rationale: Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication. Weight loss to within 1 pound of the preillness weight is an indication that the child is responding to treatment. A urine output of 1 milliliter per kilogram per hour is an acceptable urine output and indicates that the child is responding to treatment. A normal blood pressure is also an indication that the child is responding to treatment.

A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. What would the nurse have most likely assessed? A. High fever B. Dysphagia C. Toxic appearance D. Inspiratory stridor

Answer: Inspiratory stridor Rationale: A child with croup typically develops a bark-like cough often at night. This may be accompanied by inspiratory stridor and suprasternal retractions. Temperature may be normal or slightly elevated. A high fever, dysphagia, and toxic appearance are associated with epiglottitis.

The nurse is educating the parents of a 7-year-old boy with asthma about the medications that have been prescribed. Which drug would the nurse identify as an adjunct to a β2-adrenergic agonist for treatment of bronchospasm? A. Ipratropium B. Montelukast C. Cromolyn D. Theophylline

Answer: Ipratropium Rationale: Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a β2-adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation. Question format: Multiple Choice abirb.com/test

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.

Answer: Make your responses consistent Rationale: 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.

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.

Answer: Most teens have been involved in at least one romantic relationship by late adolescence. Rationale: 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 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

Answer: Motor vehicles Rationale: 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 preparing to perform a physical examination of a child with asthma. Which technique would the nurse be least likely to perform? A. Inspection B. Palpation C. Percussion D. Auscultation

Answer: Palpation Rationale: When examining the child with asthma, the nurse would inspect, auscultate, and percuss. Palpation would not be used.

The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease? A) Normal growth patterns B) Perianal skin tags or fissures C) Poor growth patterns D) Abdominal tenderness

Answer: Perianal skin tags or fissures Rationale: Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poor growth patterns and abdominal tenderness are common to Crohn disease but are also seen with many other conditions. Normal growth patterns would not point to abirb.com/test Crohn disease because of problems with absorbing nutrients.

Which diagnostic finding is assessed by the nurse when a child has primary nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

Answer: Proteinuria Rationale: Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the livers inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned? A) WBC: 5.6 ×103/mm3 B) RBC: 2.8 × 106/mm3 C) Hemoglobin: 11.4 mg/dL D) Hematocrit: 35%

Answer: RBC: 2.8 × 106/mm3 Rationale: The RBC listed is below the normal range for a child between the ages of 6 and 16 years (4.0 to 5.2 × 106/mm3). The WBC count, hemoglobin, and hematocrit are within acceptable parameters for a child this age.

The nurse is examining a 5-year-old. Which sign or symptom is a reliable first indication of respiratory illness in children? A. Slow, irregular breathing B. A bluish tinge to the lips C. Increasing lethargy D. Rapid, shallow breathing

Answer: Rapid, shallow breathing Rationale: Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement.

A child requires supplemental oxygen therapy at 8 liters per minute. Which delivery device would the nurse most likely expect to be used? A. Simple mask B. Venturi mask C. Nasal cannula D. Oxygen hood

Answer: Simple mask Rationale: A simple mask would be used to deliver a flow rate of 8 liters per minute. A Venturi mask would be used to deliver a specific percentage of oxygen, from 24% to 50%. A nasal cannula would be used to deliver no more than 4 liters per minute. An oxygen hood requires a liter flow of 10 to 15 liters per minute.

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

Answer: Stacking blocks Rationale: 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 caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which action? A. Suctioning a tracheostomy tube B. Administering drugs with a nebulizer C. Providing tracheostomy care D. Suctioning with a bulb syringe

Answer: Suctioning a tracheostomy tube Rationale: Supplemental oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe does not require supplemental oxygen.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

Answer: Tea-colored urine Rationale: Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. In acute poststreptococcal glomerulonephritis, the urine output may be decreased and the blood pressure increased. Edema may be noted around the eyelids and ankles in patients with acute poststreptococcal glomerulonephritis; however, weight gain is associated with nephrotic syndrome.

When providing guidance to the parents of a child with Down syndrome, which interaction would be most appropriate? A. Encourage the parents to home-school the child. B. Advise the parents that the child will need monthly thyroid testing. C. Instruct them on the need for yearly dental visits. D. Teach the parents about the need for a high-fiber diet.

Answer: Teach the parents about the need for a high-fiber diet. Rationale: A high-fiber intake is important for children with Down syndrome because their lack of muscle tone may decrease peristalsis, leading to constipation. Early intervention programs with special education are important to promote growth and development. The child should be integrated into mainstream education whenever possible. Children with Down syndrome should undergo thyroid testing yearly and see the dentist every 6 months.

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.

Answer: Teenagers have a need for increased calories, zinc, calcium, and iron for growth. Rationale: 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.

Parents of a child admitted with respiratory distress are concerned because the child wont lie down and wants to sit in a chair leaning forward. Which response by the nurse is the most appropriate? 1. This helps the child feel in control of his situation. 2. The child needs to be encouraged to lie flat in bed. 3. This position helps keep the airway open. 4. This confirms the child has asthma.

Answer: This position helps keep the airway open. Rationale: Leaning forward helps keep the airway open. The child is not in control just because he is leaning forward. Lying flat in bed will increase the respiratory distress. This position does not confirm asthma.

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

Answer: Unintentional injuries Rationale: Unintentional injuries are the leading cause of death in adolescents. Motor vehicle accidents are the leading cause of injury death followed by poisoning, primarily due to drug overdose from opioids. Males are more likely than females to die of any type of injury.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. Urinary tract infection

Answer: Urinary tract infection Rationale: Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a urinary tract infection. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

Following parental teaching, the nurse is evaluating the parents understanding of environmental control for their childs asthma management. Which statement by the parents indicates appropriate understanding of the teaching? 1. We will replace the carpet in our childs bedroom with tile. 2. Were glad the dog can continue to sleep in our childs room. 3. Well be sure to use the fireplace often to keep the house warm in the winter. 4. Well keep the plants in our childs room dusted.

Answer: We will replace the carpet in our childs bedroom with tile. Rationale: Control of dust in the childs bedroom is an important aspect of environmental control for asthma management. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.

Which finding is expected when assessing a child hospitalized for asthma? a. Inspiratory stridor b. Harsh, barky cough c. Wheezing d. Rhinorrhea

Answer: Wheezing Rationale: Wheezing is a classic manifestation of asthma. Inspiratory stridor is a clinical manifestation of croup. A harsh, barky cough is characteristic of croup. Rhinorrhea is not associated with asthma.

The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). In educating the parents, the nurse would recommend that the child avoid: A. a liberal fluid intake. B. caffeine. C. cranberry juice. D. cotton underwear.

Answer: caffeine Rationale: Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation.

When teaching a class about trisomy 21, the instructor would identify the cause of this disorder as: A. nondisjunction. B. X-linked recessive inheritance. C. genomic imprinting. D. autosomal dominant inheritance.

Answer: nondisjunction Rationale: Trisomy 21 is an example of a genetic disorder involving an abnormality in chromosomal number due to nondisjunction. X-linked recessive inheritance disorders, such as hemophilia and Duchenne muscular dystrophy, involve altered genes on the X chromosome. Genomic imprinting disorders, such as Prader-Willi syndrome, involve expression of only the maternal or paternal allele, with the other being inactive. Autosomal dominant inheritance disorders, such as neurofibromatosis and achondroplasia, involve a single gene in the heterozygous state that is capable of producing the phenotype, thus overshadowing the normal gene.

The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, what would be least appropriate for the nurse to perform? A. Providing 100% oxygen B. Visualizing the throat C. Having the child sit forward D. Auscultating for lung sounds

Answer: visualizing the throat Rationale: The child is exhibiting signs and symptoms of epiglottitis, which can be life threatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in a the least invasive manner that is most acceptable to the child is a sound intervention, as is allowing the child to assume a position of sitting forward with the neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway.

What finding would lead the nurse to suspect that a child has Turner syndrome? A. Webbed neck B. Microcephaly C. Gynecomastia D. Cognitive delay

Answer: webbed neck Rationale: Manifestations of Turner syndrome include webbed neck, low posterior hairline, wide-spaced nipples, edema of the hands and feet, amenorrhea, and absence of secondary sex characteristics, along with short stature and slow growth. Microcephaly is commonly associated with trisomy 13. Gynecomastia and cognitive delay are associated with Klinefelter syndrome.

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply. a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teach parents to expect tea-colored urine

Answers -Daily weights -Salt-restricted diet -Frequent position changes Rationale: A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis, but not nephrotic syndrome. The urine in nephrotic syndrome is frothy indicating protein is being lost in the urine.

A child is hospitalized with acute poststreptococcal glomerulonephritis. What assessments should the nurse include in the plan of care for this child?? Select all that apply. A. Assess level of consciousness B. Assess pain C. Monitor blood pressure D. Auscultate lung sounds E. Inspect the urine

Answers: -Assess pain -Monitor blood pressure -Auscultate lung sounds -Inspect the urine Rationale: Acute poststreptococcal glomerulonephritis (APSGN) is an immune process that injures the renal glomeruli. Children come to the healthcare provider with fever, anorexia, headaches and abdominal pain. The focus of care is primarily on fluid volume and managing hypertension. The child would have edema so the nurse should assess thoroughly the lung sounds for crackles, and the work of breathing. Hypertension occurs from the damaged kidneys so the blood pressure should be assessed often and hypertension treated. Assessment of pain is necessary. The pain is abdominal in nature and should be treated appropriately. The urine will test have proteinuria and hematuria. It is tea colored from the gross blood in the urine. The level of consciousness is not affected by APSGN.

The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching? A. "Give your child high-calorie foods and snacks." B. "Feed your child foods that are high in protein." C. "Administer water-soluble vitamins." D. "Give pancreatic enzymes with meals." E. "Give your child foods high in fat."

Answers: - "Give your child high-calorie foods and snacks." -"Feed your child foods that are high in protein." - "Give pancreatic enzymes with meals." Rationale: Children with cystic fibrosis (CF) have trouble digesting and absorbing nutrients. They tend to be underweight. For optimal health, their diets should be high in calories and high test in protein, with the supplementation of fat soluble vitamins and pancreatic enzymes. This diet helps with growth and the optimal nutrients. The fat soluble vitamins (vitamins A, D, E and K) are needed, because children with CF have trouble absorbing fat and need the vitamin supplementation to aid in fat absorption. Water soluble vitamins (the B vitamins and vitamin C) do not aid in fat absorption. The child should not have a high-fat diet, because the extra fat is difficult to digest and be absorbed. Pancreatic enzymes are necessary because they are missing due to the disease process. They are necessary to aid in digestion. They should be ingested with meals.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply. a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

Answers: -Change in urine odor or color -Fever or hypothermia -Poor weight gain

A parent with a child who has cystic fibrosis asks the nurse how to determine if the child is receiving an adequate amount of pancreatic enzymes. How should the nurse respond? Select all that apply. A. "The dose is adequate when your child is only having 1 to 2 stools per day." B. "The dose is adequate when your child's weight is improving." C. "The dose prescribed is based on your child's pancreatic laboratory values so it should be correct." D. "When your child starts to eat more quantity of food you will need to adjust the amount of enzyme pills." E. "You will need to give your child less enzyme pills when high-fat foods are eaten."

Answers: -"The dose is adequate when your child is only having 1 to 2 stools per day." -"The dose is adequate when your child's weight is improving." -"When your child starts to eat more quantity of food you will need to adjust the amount of enzyme pills." Rationale: Pancreatic enzymes are required for the child with cystic fibrosis (CF) to help absorb nutrients from the diet and to aid in digestion. They are given with each meal and snack the child eats. The number of capsules required at each dose depends upon the diagnosis of how the pancreas is functioning and the amount of food needing to be digested. The pancreatic laboratory values may detemine a baseline for the number of pills to start with, but the dosage is adjusted abirb.com/test regularly. The dosage of pancreatic enzymes is adjusted until an adequate growth pattern is established and the child is having no more than 1 to 2 stools per day. The child should be given an increased number of enzyme pills when a meal with high-fat content is consumed, not fewer.

A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? Select all that apply. a. Observation of parentchild interactions b. Assignment of different nurses to care for the child from day to day c. Use of 28 calorie per ounce concentrated formulas d. Administration of daily multivitamin supplements e. Role-modeling appropriate adultchild interactions

Answers: -Observation of parent child interactions -Administration of daily multivitamin supplements - Role-modeling appropriate adult child interactions Rationale: The nurse should plan to assess parent-child interactions when a child is admitted for nonorganic failure to thrive. The observations should include how the child is held and fed, how eye contact is initiated and maintained, and the facial expressions of both the child and the caregiver during interaction

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

Answers: -Reporting that he smokes marijuana occasionally. -Wanting to make decisions about health care independently -Being very concerned with implications of the Affordable Care Act regarding healthcare benefits Rationale: 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

Answers: a. Increased physical growth b. Insufficient psychomotor coordination c. Tiredness, lack of energy d. Lack of impulsivity e. Peer pressure f. Inexperience Rationale: 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 nurse is caring for a 6-month-old with a cleft lip and palate. The mother of the child demonstrates understanding of the disorder with which statements? A) "My smoking during pregnancy didn't have anything to do with this disorder. Smoking primarily causes low birth weight." abirb.com/test B) "I know my baby takes a lot longer to feed than most children this age." abirb.com/test C) "It really worries me that my baby may have some other disorders that haven't been detected yet." abirb.com/test D) "I wonder if my baby will develop speech problems when language development begins?" E) "Thankfully there are healthcare providers that specialize in correcting this type of disorder."

B) "I know my baby takes a lot longer to feed than most children this age." abirb.com/test C) "It really worries me that my baby may have some other disorders that haven't been detected yet." abirb.com/test D) "I wonder if my baby will develop speech problems when language development begins?" E) "Thankfully there are healthcare providers that specialize in correcting Rationale: Feeding and speech are especially difficult for the child with cleft lip and palate until the defect is repaired. Cleft lip and palate occurs frequently in association with other anomalies and has been identified in more than 350 syndromes. Plastic surgeons or craniofacial specialists, oral surgeons, dentists or orthodontists, and prosthodontists are some of the healthcare providers that specialize in repair of this disorder. The mother is incorrect in stating that smoking is not associated with cleft abirb.com/test lip or palate. Maternal smoking during pregnancy is a major risk factor for the disorder.

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

Answer: Draws a person with three body parts Rationale: 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 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.

Answer: The child does not point to named body parts Rationale: 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.

An 18-year-old with a rash and itching in the groin area is concerned that he has contracted a sexually transmitted disease and does not want his parents to find out. The nurse's best response is: 1. "We will need to contact your parents to let them know." 2. "We will not contact your parents regarding this visit." 3. "Who would you like us to contact about your visit here today?" 4. "We cannot promise that the hospital will not contact your parents."

Answer: " We will not contact your parents regarding this visit." Rationale: An adolescent has every right to privacy as long as the situation is not life threatening

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

Answer: Discussing the child's feeding patterns Rationale: 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 an adolescent complains that he has had some recent behavioral changes. He comes home from school every day, closes his door, and refrains from interaction with his family. The nurse ' s best response to the mother is: 1. "You should speak with your son and ask him directly what is wrong with him." 2. "You should set limits with your son and tell him that this is unacceptable behavior." 3. "Your son ' s behavior is abnormal, and he is going to need a psychiatric referral." 4. "Your son ' s behavior is normal. You should listen to him without being judgmental."

Answer: " Your son's behavior is normal. You should listen to him without being judgemental." Rationale: The child's behavior is typical of a teen's response to developmental and psychosocial changes of adolescence.

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."

Answer: "Acceptance by friends, especially of the same sex, is very important at this age." Rationale: 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.

A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse ' s best response is: 1. "At 6 months, his weight should be approximately three times his birth weight." 2. "Each child gains weight at his or her own pace." 3. "At 6 months, his weight should be approximately twice his birth weight." 4. "At 6 months, a child should weigh about 10 lb more than his or her birth

Answer: "At 6 months, his weight should be approximately twice his birth weight." Rationale: Infants should double their birth weight by 4 to 6 months

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?"

Answer: "Do you participate in any sports?" Rationale: 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.

A 4-year-old boy has been hospitalized because he fell down the stairs. His mother is crying and states, "This is all my fault." Which is the nurse's best response? 1. "Accidents happen. You shouldn't t blame yourself." 2. "Falls are one of the most common injuries in this age-group." 3. "It may be a good idea to put a gate on the stairs." 4. "Your son should be proficient at walking down the stairs by now."

Answer: "Falls are one of the most common injuries in this age-group" Rationale: Falls are one of the most common injuries, and it may make the parent feel better to know that this is common.

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." 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.

Answer: "He needs 12 hours of sleep per day including his nap." Rationale: 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 an 11-month-old with iron-deficiency anemia tells the nurse that her infant is currently taking iron and a multivitamin. Which statement made by the mother should be of concern to the nurse? 1. "I give the iron and multivitamin at the same time each morning." 2. "I give the iron and multivitamin in the morning 6-oz bottle." 3. "I give the iron and multivitamin 2 hours before I feed the morning bottle." 4. "I give the iron and multivitamin in oral syringes toward the back of the cheek."

Answer: "I give the iron and multivitamin in the morning 6-oz bottle" Rationale: Medications should never be mixed in a large amount of food or formula because the parent cannot be sure that the child will take the entire feeding.

Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. "My child is able to stand but is not yet taking steps independently." 2. "My child has a vocabulary of approximately 15 words." 3. "My child is still sucking his thumb." 4. "My child seems to be quite wary of strangers."

Answer: "My child is able to stand but is not yet taking steps independently." Rationale: The child should be walking independently by 15 to 18 months.

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."

Answer: "This is normal behavior for infants unless the stool passed is hard and dry." Rationale: 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.

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."

Answer: "Place her in a booster seat with lap and shoulder belts in the back seat." Rationale: 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.

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."

Answer: "She can ride in the front seat of the car once she is 10 years old." Rationale: 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 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."

Answer: "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." Rationale: 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 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."

Answer: "The cereal should be a fairly thin consistency at first." Rationale: 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 mother of a newborn asks the nurse when the infant will receive the first hepatitis B immunization. Which is the nurse's best response? 1. "Babies receive the hepatitis B vaccine only if their mother is hepatitis B-positive." 2. "The first dose of the hepatitis B vaccine will be given prior to discharge today." 3. "The first dose of hepatitis B vaccine is given at 1 year of age." 4. "Babies receive their first hepatitis B vaccine at 6 months of age."

Answer: "The first dose of the hepatitis B vaccine will be given prior to discharge today." Rationale: The first dose of hepatitis B vaccine is recommended between birth and 2 months. In most hospitals, newborns are given the vaccine prior to discharge.

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."

Answer: "The preschooler is developing a conscience." Rationale: 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.

A 13-year-old tells the nurse that he is worried because his breasts are growing. They hurt, and he is embarrassed to take his shirt off during gym class. What should the nurse tell him? 1. "The pediatrician will draw some blood to fi nd out why your breasts are growing." 2. "It is just a slight hormonal imbalance that can be easily corrected with medication." 3. "This is a normal condition of puberty that will resolve within a year or two." 4. "This is a rare finding that occurs in about 5% of boys during puberty."

Answer: "This is a normal condition of puberty that will resolve within a year or two." Rationale: Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years.

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."

Answer: "This is a primitive reflex known as the palmar grasp." 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."

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."

Answer: "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." Rationale: 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.

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."

Answer: "When my 3-year old asks, why? all the time, this is completely normal." Rationale: 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 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."

Answer: "You need to adhere to various routines." Rationale: 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.

A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental milestones, what should the nurse caring for the child expect the current weight to be? 1. 16 lb 4 oz 2. 20 lb 5 oz 3. 24 lb 6 oz 4. 32 lb 8 oz

Answer: 241b 6oz Rationale: Children should triple their birth weight by 12 months of age

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

Answer: 6 months Rationale: 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 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.

Answer: A child uses his fingers and refuses to use a fork Rationale: 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.

What information should a school nurse include in a discussion on nutrition with a fourth-grade class? 1. The number of calories that a fourth-grade child should consume in a day. 2. A list of high-calorie foods that all fourth-graders should avoid. 3. How to read food labels so that children know which foods are good for them. 4. A list of nutritious foods with basic scientific information about how they affect the body organs and systems.

Answer: A list of nutritious foods with basic scientific information about how they affect the body organs and systems. Rationale: Reviewing nutritious choices keeps the lesson on a positive note, and school age children are very interested in how food affects their bodies

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

Answer: Absence of first menstrual period Rationale: 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 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.

Answer: Advise parents to use a forward-facing seat with harness straps, placed in the back seat of the car. Rationale: 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 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

Answer: Advising how to create a toddler-safe home Rationale: 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.

Which nursing action would help foster a hospitalized 3-year-old ' s sense of autonomy? 1. Let the child choose what time to take the oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of cephalexin (Keflex) via oral syringe. 4. Let the child watch age-appropriate videos.

Answer: Allow the child to administer her own dose of cephalexin (Keflex) via oral syringe Rationale: Allowing preschoolers to participate in actions of which they are capable is an excellent way to enhance their autonomy

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 Feedback: 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.

Answer: Approximately 16 to 24 ounces of milk per day Rationale: 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.

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

Answer: Asking the mother if the child uses Spanish words Rationale: 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.

Which should the nurse teach the parents is one of the most common causes of injury and death for a 9-month-old infant? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

Answer: Aspiration Rationale: Aspiration is a common cause of injury and death among children of this age. These children often find small objects lying on the floor and place them in their mouth.

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

Answer: Beginning questioning of parents' values Rationale: 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.

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

Answer: Climbing stairs with assistance Rationale: 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 parents of a newborn are asking the nurse how to use the infant car seat and where it should be placed in their vehicle. Which is the most appropriate action by the nurse? 1. Give the parents a pamphlet explaining how to install the car seat. 2. Accompany the parents to the car and show them how to install the car seat. 3. Contact the hospital's car-seat safety officer and ask the officer to accompany the parents to the car for car-seat installation. 4. Show the parents a video on car-seat installation and safety and ask if they are comfortable with the information.

Answer: Contact the hospital's car-seat safety officer and ask the officer to accompany the parents to the car for car-seat installation Rationale: The car-seat safety officer is the best choice as that individual would have the needed information and certification to help the family

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.

Answer: Continuous peer relationships provide the most important social interaction for school-age children. Rationale: 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.

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

Answer: Cooked lentils Rationale: Lentils are a good source of iron. Whole milk, oranges, and sweet potatoes are good sources of calcium.

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.

Answer: Encourage the child to pick out his own clothes. Rationale: 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.

A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. Which action taken by the nurse will most enhance his psychosocial development? 1. Fax the teen's teacher and have her send in his homework. 2. Encourage the teen's friends to visit him in the hospital. 3. Encourage the teen's grandparents to visit frequently. 4. Tell the teen he is free to use his phone to call or text friends.

Answer: Encourage the teen's friends to visit him in the hospital. Rationale: Teens are most concerned about being like their peers. Having the teen's friends visit will help him feel he is still part of the school and social environment.

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

Answer: Endurance Rationale: 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.

Which should the nurse do to prevent separation anxiety in a hospitalized toddler? 1. Assume the parental role when parents are not able to be at the bedside. 2. Encourage the parents to always remain at the bedside. 3. Establish a routine similar to that of the child ' s home. 4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

Answer: Establish a routine similar to that of the child's home Rationale: It is very important to maintain a child's home routine both when parents are present and when they have to leave the hospital. This will increase the child's sense of security and decrease anxiety.

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

Answer: Explaining that the stomach holds less than 1 ounce Rationale: 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.

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

Answer: Finding an identity Rationale: 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.

To obtain an adolescent's health information, the nurse should: 1. Interview the adolescent using direct questions. 2. Gather information during a casual conversation. 3. Interview the adolescent only in the presence of the parents. 4. Gather information only from the parents.

Answer: Gather information during a casual conversation Rationale: Frequently adolescents will share more information when it is gathered during a casual conversation.

During an adolescent ' s initial physical assessment, the nurse notes signs and symptoms of nutritional defi cit. Which assessment led the nurse to this initial conclusion? 1. Protein level within normal limits. 2. Blood pressure is 110/66. 3. Hair and nails are brittle and dry. 4. Teeth appear to be eroded.

Answer: Hair and nails are brittle and dry Rationale: Dry and brittle hair and nails are common among people who have a nutritional deficit.

The mother of a 13-year-old girl tells the nurse that she is concerned because her daughter has gained 10 lb since she began puberty. The child ' s mother asks the nurse for advice about what to do about her daughter ' s weight gain. Which should the nurse do? 1. Provide the child ' s mother with some pamphlets on nutrition and healthy eating. 2. Provide the child ' s mother with information about a new exercise program for teens. 3. Inform the child ' s mother that it is common for teen girls to gain weight during puberty. 4. Inform the child ' s mother that her daughter will likely gain another 5 to 10 lb in the next year.

Answer: Inform the child's mother that it is common for teen girls to gain weight during puberty. Rationale: The nurse should tell the child's mother that this is a normal finding in teenage girls as they enter puberty.

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

Answer: Interviewing the parents about their eating habits Rationale: 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 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

Answer: Knowing which are his or her toys Rationale: 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).

Which toy is the best choice for a 12-month-old? 1. Baby doll. 2. Musical rattle. 3. Board book. 4. Colorful beads.

Answer: Musical rattle Rationale: A musical rattle is the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation.

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

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

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.

Answer: Place the baby on his or her back when sleeping. Rationale: 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 mother of a child who is 2 years 6 months in age has arranged a play date with the neighbor and her child who is 2 years 9 months old. During the play date the two mothers should expect that the children will do which of the following? 1. Share and trade their toys while playing. 2. Play with one another with little or no conflict. 3. Play alongside one another but not actively with one another. 4. Only play with one or two items, ignoring most of the other toys.

Answer: Play alongside one another but not actively with one another Rationale: Toddlers engage in parallel play. They often play alongside another child but they rarely engage in activities with the other child

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.

Answer: Present the food matter-of-factly and allow the child to choose what to eat. Rationale: 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.

A 2-year-old admitted to the hospital 2 days ago has been crying and is inconsolable much of the time. The nurse's best response to the child's parents who are concerned about this behavior is that the child is in the: 1. Detachment phase of separation anxiety, which is normal for children during hospitalization. 2. Despair stage of separation anxiety, which is normal for children during hospitalization. 3. Bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. Protest stage of separation anxiety, which is normal for children during hospitalization.

Answer: Protest stage of separation anxiety, which is normal for children during hospitalization Rationale: During this protest stage, children are often inconsolable and often cry more than they do when they are at home

Which activity can the nurse provide for a 9-year-old to encourage a sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

Answer: Provide the child with the homework his teacher has sent Rationale: The school age child is focused on academic performance; therefore, the child can achieve a sense of industry by completing his homework and staying on track with his classmates

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.

Answer: Remove high-calorie, low-nutrient foods from the diet Rationale: 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 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.

Answer: Reward the child for initiative in order to build self-esteem. Rationale: 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 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.

Answer: School-age children can think critically to interpret messages seen in advertising, media, and sports. Rationale: 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.

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

Answer: Step Rationale: 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 mother of a 15-year-old is frustrated because he spends much of his weekend time sleeping. Which is the nurse ' s best response to the mother ' s frustration? 1. "Your son may be trying to catch up on the sleep missed during the week." 2. "Developmental theorists believe that teens require more sleep as they begin to integrate new roles into their lives." 3. "Teens require more sleep because of the rapid physical growth that is occurring." 4. "Teens require more sleep because of the increase in their social obligations."

Answer: Teens require more sleep because of the rapid physical growth that is occurring." Rationale: Teens require more sleep because of the rapid physical growth that occurs during adolescence

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

Answer: Telling how and when to introduce rice cereal Rationale: 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 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?"

Answer: Telling the child firmly that we don't scream in the office Rationale: 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 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.

Answer: Telling the parents to limit the child's eating to meal and snack times Rationale: 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.

Which reaction would a nurse expect when giving a preschooler immunizations? 1. The child remains silent and still. 2. The child cries and tells the nurse that it hurts. 3. The child tries to stall the nurse. 4. The child remains still while telling the nurse that she is hurting him.

Answer: The child cries and tells the nurse that it hurts Rationale: The common response of a 5 year old is to cry and protest during an immunization

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.

Answer: The child does not vocally respond to voices. Rationale: 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 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.

Answer: The child is homeless and has no toys Rationale: 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.

Answer: The child is unable to push a toy lawnmower. Rationale: 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.

According to developmental theories, which important event is essential to the development of the toddler? 1. The child learns to feed self. 2. The child develops friendships. 3. The child learns to walk. 4. The child participates in being potty-trained.

Answer: The child participates in being potty-trained Rationale: Developmental theories such as Erickson and Freud believe that toilet training is the essential event that must be mastered by the toddler

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.

Answer: The child signs up for after-school activities. Rationale: 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.

Which statement accurately describes the best method for assessing a 12-month-old? 1. The nurse should assess the child on the examining table. 2. The nurse should assess the child in a head-to-toe sequence. 3. The nurse should have the child's parent assist in holding her down. 4. The nurse should assess the child while she is in her parent's lap.

Answer: The nurse should assess the child while she is in her parent's lap Rationale: Infants are most secure when in proximity to the parent. The parent's lap is an excellent place to assess the child

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.

Answer: The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. Rationale: 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 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.

Answer: The typical preschooler requires about 85 kcal/kg of body weight. Rationale: 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.

A mother requests that her child receive the varicella vaccine at the 9-month well child checkup. The nurse tells the mother that: 1. Children who are vaccinated will likely develop a mild case of the disease. 2. The vaccine cannot be given at that visit. 3. The vaccine will be administered after the physician examines the child. 4. A booster vaccination will be needed at 18 months of age.

Answer: The vaccine cannot be given at that visit Rationale: The nurse should not give the vaccine. The varicella vaccine is not usually administered prior to 1 year of age unless they are extenuating circumstances

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.

Answer: There is an increased risk for physical injury in this age group. Rationale: 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 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."

Answer: This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech." Rationale: 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 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.

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

A 13-year-old boy is hospitalized for a femur fracture. He was hit by a car while he and his friends were racing bikes near a major intersection. The child ' s parents are concerned about his judgment. The nurse should tell the parents that the behavior is: 1. Typical of young teens. 2. Related to hormonal surges during adolescence. 3. An isolated incident and will not likely happen again. 4. Related to teen rebellion.

Answer: Typical of young teens Rationale: The brains of young teens are not completely developed, which often leads to poor judgment and impulse control.

Which method is the most effective way to present an educational program on abstinence to adolescents? 1. Use peer-led programs that emphasize the consequences of unprotected sexual contact. 2. Teach students methods to resist peer pressure. 3. Offer students the opportunity to care for a simulator infant for 1 week. 4. Offer statistics, pamphlets, and films discussing the consequences of unprotected sexual contact.

Answer: Use peer-led programs that emphasize the consequences of unprotected sexual contact Rationale: Adolescents are most concerned with what their peers think and feel. They are more receptive to information that comes from another adolescent.

Which should the nurse recommend to the parents of a 9-year-old hospitalized following a bicycle injury? To prevent future injury, their child should: 1. Wear safety equipment while riding bicycles. 2. Read educational material on bicycle safety. 3. Watch a video on bicycle safety. 4. Ride his bike in the presence of adults.

Answer: Wear safety equipment while riding bicycles Rationale: Safety equipment is essential for bicycling, skateboarding, and participating in contact sports. Most injuries occur during the school age years, when children are more active and participate in contact sports.

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

Answer: White beans Rationale: 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 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

Answer: magical thinking Rationale: 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 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

Answer: monitoring the child's weight and height

Which technique should the nurse suggest to the mother of an 8-year-old who does not want to complete her chores? 1. Grounding. 2. Time-out. 3. Reward system. 4. Spanking.

Answer: reward system Rationale: School-age children usually respond very well to a reward system and often enjoy the rewards so much that they will continue chores without continual reminders

Which statements by an infant's mother lead the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? Select all that apply. 1. "I will continue to breastfeed my son and will give him oatmeal cereal two times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 4 to 6 ounces of baby juice per day." 5. "I will make sure my son gets cereal three times a day."

Answers -"I will start my son on fruits and gradually introduce vegetables." - "I will not give my son any more than 4 to 6 ounces of baby juice per day." - "I will make sure my son gets cereal three times a day." Rationale: Infants should be started on vegetables prior to fruits. The sweetness of fruits may inhibit infants from taking vegetables. Infants can be given fruit juice by 6 months of age, but it is recommended not to exceed 4 to 6 ounces per day. Infants need another source of iron by 4 to 6 months of age, so cereal is introduced twice a day.

Which statements would indicate to the nurse that a school-age child is not developmentally on track for age? Select all that apply. 1. The child is able to follow a four- to five-step command. 2. The child started wetting the bed on admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister. 5. The child is not able to follow rules.

Answers -The child has an imaginary friend named Kelly - The child is not able to follow rules Rationale: Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age. Most school-age children like rules and understand the consequences of not obeying 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

Answers: -Ability to assimilate and coordinate information about the world from different dimensions -Ability to see things from another person's point of view and think through an action -Ability to use stored memories of past experiences to evaluate and interpret present situations -Ability to understand the principle of conservation—that matter does not change when its form changes Rationale: 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 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

Answers: -Counting 10 or more objects -Correctly naming at least four colors -Understanding the concept of time -Knowing everyday objects Rationale: 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 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.

Answers: -Extending breastfeeding into toddlerhood is believed to be beneficial to the child. -Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. - Toddlers tend to have the highest daily iron intake of any age group. Rationale: 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 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

Answers: -Sweet potatoes -Spinach -Carrots Rationale: 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.

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.

Answers: -The nasal passages are narrower -The larynx is more funnel-shaped -There are significantly fewer alveoli Rationale: 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.

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.

Answers: 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. f. Separation anxiety may also start in the last few months of infancy. Rationale: 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 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.

Answers: -Plans activities and makes up games -Initiates activities with others -Acts out roles of other people Rationale: 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.

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.

Answers: a. At 1 month, the infant lifts and turns the head to the side in the prone position. 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. Rationale: 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 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.

Answers: -Talk face to face and be aware of body language. -Ask questions to see why he or she feels that way. - Don't pretend you know all the answers. Rationale: 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.