Pedi Module 8

A nurse is assessing a 1-year-old's food intake over the past 3 days. What information from the parent leads the nurse to provide education on nutrition? a. Child drinks 2 cups of 1% milk each day. b. Child loves to snack on fruit throughout the day. c. Child gets one 4-ounce cup of juice with breakfast. d. Parent allows child to regulate own portions at meals.

ANS: A A child this age should not be drinking low-fat milk. Snacking on fruit, 4 ounces of juice, and not forcing the child to eat everything on the plate are appropriate activity and do not require education.

The nurse is assessing an infant's growth and development. The parents want education on how to stimulate this process. What action suggested by the nurse is inconsistent with knowledge of this topic? a. Have the family draw a three-generation family pedigree. b. Show the family how to coo and babble with their child. c. Encourage the parents to buy interactive toys for the child. d. Involve the child in activities that are outside the home.

ANS: A A family pedigree can help show relationships and health care problems but will not stimulate growth and development. Activities that are stimulating for a child include the consistent use of language by the parents, allowing play time with interactive toys (toys that make noises or do something in response to the baby's actions), and exposing the child to new sights and sounds.

A student nurse learns that according to Piaget, the adolescent is in the fourth stage of cognitive development, or period of what? a. Formal operations b. Concrete operations c. Conventional thought d. Postconventional thought

ANS: A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. Concrete operations usually develops between ages 7 and 11 years. Conventional and postconventional thought refer to Kohlberg's stages of moral development.

Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth.

ANS: A Development, a continuous and orderly process, provides the basis for increases in the child's function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is a. Erikson. b. Freud. c. Kohlberg. d. Piaget.

ANS: A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's.

A nurse wants to work to increase the number of immunized children. What action by the nurse would best meet this goal? a. Present a workshop to the local home-schooling parent support group. b. Volunteer for a mass "back to school" immunization clinic. c. Prepare welcome and information packets to college freshmen. d. Work with the health department to bring immunizations to day cares.

ANS: A Home-schooled children are often overlooked when it comes to immunizations, because they are not in immunization-friendly systems such as day care, schools, and colleges where immunizations are required. The best way for the nurse to help increase the number of immunized children is to reach out to the home-schooled group.

A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The parents ask the nurse if they should be concerned about this behavior. Which response by the nurse is best? a. This is normal because of increase in body mass during this time. b. This is abnormal and suggestive of possible future obesity. c. His caloric intake would have to be excessive for him to gain weight. d. He is substituting food for unfilled needs.

ANS: A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. It is not suggestive of possible future obesity or unmet psychosocial needs. It may be true that the teen would need to eat an enormous amount of food in order to gain weight, but that does not give the parents the information they are requesting.

A nurse is teaching parents to avoid environmental injury to their 2-year-old child. What information does the nurse include in teaching? a. Avoiding sun exposure, secondhand smoke, and lead b. Living in a middle-class neighborhood c. Avoiding smoking and alcohol intake during pregnancy d. Limiting breastfeeding to avoid toxins being passed through breast milk

ANS: A Lead can be present in the home and in toys made overseas. Environmental injury can also be the result of mercury, pesticides (flea and tick collars), radon, and exposure to the sun and secondhand smoke. It is important for the nurse to provide health teaching related to these factors. The nurse is unable to influence socioeconomic status, and the family may not want or be able to move. It is too late for the nurse to instruct the mother regarding smoking or alcohol intake during pregnancy. This should have been included in prenatal teaching. It is unlikely that a 2-year-old child will still be breastfeeding.

A nurse wants to volunteer for an organization that helps prevent death in older adolescents. What action by the nurse would have the most impact? a. Volunteer for a suicide hotline. b. Teach firework safety classes. c. Work on a poison control hot line. d. Educate teens on gun safety.

ANS: A Of the four causes of death listed, suicide ranks highest, being the second most common cause of death in the 15 to 24 age group. The nurse would make the biggest impact volunteering for a suicide hotline.

The parents of a preschool-aged child are in the clinic and report the child is seen playing with the genitals frequently. What response by the nurse is best? a. Reassure parents this is normal at this age. b. Teach parents about behavior modification. c. Refer parents and child to a psychologist. d. Ask the provider to speak to the parents.

ANS: A Preschool children are in the Phallic or Oedipal/Electra Stage of Freud's theory during which the genitals become the focus of curiosity and interest. The nurse should explain that this behavior is normal at this stage. Teaching about disciplinary techniques and referrals to psychotherapy are inappropriate. The nurse may well want the provider to speak to the parents, but the nurse is responsible for patient/parent teaching and should provide education him- or herself.

A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is a. testicular enlargement. b. facial hair. c. scrotal enlargement. d. voice deepens.

ANS: A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. During Tanner stages 4 and 5, facial hair appears at the corners of the upper lip and chin. As testosterone secretion increases, the penis, testes, and scrotum enlarge. During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen.

The nurse knows that measuring temperature is an integral part of assessment. Which concept is important for the nurse to know when taking a child's temperature? a. The method used should be consistent. b. Rectal temperatures should always be taken on infants. c. Oral temperatures can be taken on all children older than 5 years of age. d. Axillary temperatures should be taken at night.

ANS: A The method that is determined most appropriate for the child should be used consistently—the same site and device to maintain consistency and allow reliable comparison and tracking of temperatures over time. Because of the risk of rectal perforation and the intrusive nature of the procedure, rectal temperatures are measured only when no other route can be used or when it is necessary to obtain a core body temperature. Oral temperatures can be used on most children older than 6 years of age but may be inaccurate because of oral intake, oral surgery, oxygen therapy, nebulizer treatments, or crying. There is no time specification for when specific types of temperatures are taken.

The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse she wants her mother with her "like before." Which response by the nurse is most appropriate? a. Grant her request. b. Explain why this is not possible. c. Identify an appropriate substitute for her mother. d. Offer to provide support to her during the procedure.

ANS: A The parents' preferences for assisting, observing, or waiting outside the room should be assessed as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child are agreeable, then the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.

What is appropriate to include in the teaching plan for a family of a child with a tracheostomy? a. Suction the tracheostomy as needed. b. Apply powder around the stoma to decrease irritation. c. Limit suctioning time to 30 seconds. d. Provide showers and discourage baths.

ANS: A To maintain a patent airway in a child with a tracheostomy, assessing respiratory status and suctioning as needed using Standard Precautions is an important intervention to teach families. Talc powder should be avoided because of the risk of inhalation injury from breathing the powder particles. Catheter insertion for suctioning should be less than 5 seconds to prevent hypoxia. The family should be taught to avoid getting water in the tracheostomy during bath time. Showers should be discouraged.

What is critical for the nurse to know when using restraints on a child? a. Use the least restrictive type of restraint. b. Tie knots securely so they cannot be untied easily. c. Secure the ties to the mattress or side rails. d. Remove restraints every 4 hours to assess skin integrity.

ANS: A When restraints are necessary, the nurse should institute the least restrictive type of restraint possible to meet goals. Knots must be tied so that they can be easily undone for quick access to the child. The ties are never tied to the mattress or side rails. They should be secured to a stable device, such as the bed frame. Restraints are removed every 2 hours to allow for range of motion, position changes, and assessment of skin integrity.

A 2-month-old child has not had any immunizations. Which ones should the nurse prepare to give? (Select all that apply.) a. Hib b. HepB c. MCV d. V aricella e. HPV

ANS: A,B,C,D Hib, HepB, MCV, and varicella are all appropriate vaccinations for this child. HPV is for adolescents.

The school nurse is evaluating the school's athletic programs for safety. What factors should the nurse assess? (Select all that apply.) a. Students get adequate rest periods. b. Equipment is in good condition. c. Practices are appropriate for students. d. Post-game concussion assessment if needed e. Adequate fluids are available at all times.

ANS: A,B,C,E A safe athletic program has several features including adequate rest periods, good quality equipment, appropriate practice schedules and regimes, and adequate fluids. Concussion testing if warranted, should occur immediately as the student is withdrawn from the game, and not wait until after the game is over.

A nurse works for an organization that seeks to limit adolescent violence. In talking with donors, which risk factors for violence may lead to programming decisions? (Select all that apply.) a. Drug or alcohol use/abuse b. Poverty c. Hopelessness about the future d. Narcissism e. Lack of supervision

ANS: A,B,C,E Drug and alcohol use/abuse, poverty, hopelessness, and lack of supervision all are risk factors for violence. Narcissism is not.

The nurse preparing to administer the Denver Developmental Screening Test II (DDST-II) should understand that it assesses which functional areas? (Select all that apply.) a. Personal-functional b. Fine motor c. Intelligence d. Language e. Gross motor

ANS: A,B,D,E The four functional areas assessed by this tool are personal-functional, fine motor, language, and gross motor. It is not an intelligence test.

The nurse is discussing contraceptive choices with an adolescent girl who wants to become sexually active. Which factors are important to consider? (Select all that apply.) a. Motivation b. Cognitive development c. Chronological age d. Parental opinions e. Frequency of intercourse

ANS: A,B,E Motivation, cognitive development, and planned frequency of intercourse are some of the factors to consider when counseling an adolescent about birth control choices. Chronological age is not as important as developmental state. Parents generally do not need to give consent or be informed when a teen seeks contraception.

A parent calls the emergency department (ED) reporting a front tooth completely knocked out of an adolescent's mouth while playing soccer. What information should the nurse provide? (Select all that apply.) a. Rinse the tooth in lukewarm tap water. b. Place the tooth in saline, milk, or water. c. Scrub the tooth with a disinfectant. d. Come to the ED within 1 hour. e. Prognosis is best if they are seen within 30 minutes.

ANS: A,B,E The parent should be advised to rinse the tooth in lukewarm tap water and to place it in saline, milk, or a commercial tooth preservative. Prognosis is best if the tooth can be re-implanted within 30 minutes. The tooth should not be scrubbed.

Which factors contribute to early adolescents engaging in risk-taking behaviors? (Select all that apply.) a. Peer pressure b. A desire to master their environment c. Trying to separate from their parents d. A belief that they are invulnerable e. Impulsivity

ANS: A,D,E Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability ("It can't happen to me") are evident in adolescence. Impulsivity places adolescents in unsafe situations. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training.

Which nursing action is the most appropriate when applying a face mask to a child for oxygen therapy? a. The oxygen flow rate should be less than 6 L/min. b. Make sure the mask fits properly. c. Keep the child warm. d. Remove the mask for 5 minutes every hour.

ANS: B A properly fitting face mask is essential for adequate oxygen delivery. The oxygen flow rate should be greater than 6 L/min to prevent rebreathing of exhaled carbon dioxide. Oxygen delivery through a face mask does not affect body temperature. A face mask used for oxygen therapy is not routinely removed.

Many adolescents decide to follow a vegetarian diet during their teen years. The nurse can advise the adolescent and his or her parents that a. this diet will not meet the nutritional requirements of growing teens. b. a vegetarian diet can be healthy for this population. c. an adolescent on a vegetarian diet is less likely to eat high-fat foods. d. a vegetarian diet requires little extra meal planning.

ANS: B A vegetarian diet is healthy for this population, and the low-fat aspect of the diet can prevent future cardiovascular problems. Several dietary organizations have suggested that a vegetarian diet, if correctly followed, is healthy for this population. As with any adolescent, nurses need to advise teens who follow a vegetarian eating plan to avoid low-nutrient, high-fat foods. The nurse can assist with planning food choices that will provide sufficient calories and necessary nutrients. The focus is on obtaining enough calories for growth and energy from a variety of fruits and vegetables, whole grains, nuts, and soymilk.

Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain

ANS: B All children can be frightened by hospitalization. However, toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. Young infants are not as likely to be as frightened as toddlers by hospitalization because they are not as aware of the environment. The 9-year-old child's cognitive ability is sufficient for the child to understand the reason for hospitalization. The 15-year-old adolescent has the cognitive ability to interpret the reason for hospitalization.

Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious? a. "You need to be stricter so that your teen stops trying to test the limits." b. "Try to collaborate to set limits that are perceived as being reasonable." c. "Increasing your teen's involvement with her peers will improve her behavior." d. "Allow your teenager to choose the type of discipline that is used in your home."

ANS: B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process. Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. Increasing peer involvement does not typically improve behavior. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

Which action by the nurse indicates that the correct procedure has been used to measure vital signs in a toddler? a. Measuring oral temperature for 5 minutes b. Counting apical heart rate for 60 seconds c. Observing chest movement for respiratory rate d. Recording blood pressure as P/80

ANS: B Apical pulse measurement when the child is quiet for 1 full minute is the preferred method for measuring vital signs in infants and children ages 2 years and younger. A child younger than 6 years may not be able to hold a thermometer under the tongue. The respiratory rate should be auscultated on the quiet infant or young child for 1 full minute. The nurse should be able to auscultate the blood pressure of a toddler, so this would not be the correct way to document it.

Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence.

ANS: B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being "self-centered or lazy." The peer group validates acceptable behavior during adolescence. Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. Conformity becomes less important in late adolescence.

A nurse uses Erikson's theory to guide nursing practice. What action by a hospitalized 4-year-old child would the nurse evaluate as developmentally appropriate? a. Dressed and fed by the parents b. Independently ask for play materials or other personal needs c. Verbalizes an understanding of the reason for the hospitalization d. Asks for a parent stay in the room at all times

ANS: B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is not a developmental outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include a. planning for a short teaching session of about 30 minutes. b. telling the child that procedures are never a form of punishment. c. keeping equipment out of the child's view. d. using correct scientific and medical terminology in explanations.

ANS: B Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment. Teaching sessions for this age-group should be much shorter in length. Demonstrate the use of equipment, and allow the child to play with miniature or actual equipment. Explain the procedure in simple terms and how it affects the child.

In preparing to give enemas to a 4-year-old child, what action by the nurse is best? a. Use tap water. b. Only use normal saline. c. Insert the tip of the tube at least 3 inches. d. Instill 120 to 240 mL of solution.

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause fluid and electrolyte disturbances. The tip of the tubing should be inserted 3 inches (7.5 cm) maximum. 240 to 360 mL is appropriate for this age group.

A parent wants to know why acetaminophen should only be given for 2 days for a fever without checking with the provider. What response by the nurse is best? a. Acetaminophen is a dangerous drug with bad side effects. b. Long-term acetaminophen use can cause liver damage. c. There may be better fever relievers you could use. d. What if there were something seriously wrong with your child?

ANS: B Long-term use of acetaminophen can lead to liver damage. It is not a particularly dangerous drug and, like all drugs, has side effects. The provider needs to see the child to determine if something is more seriously wrong, but this statement sounds like a threat. There may be other medications the parent could try, but the main concern is liver damage.

A nurse wants to assess a chronically ill child's feelings regarding a lengthy hospitalization and treatments. What action by the nurse is best? a. Ask direct questions of the child as to feelings. b. Watch the child play on several occasions. c. Discuss the situation with the parents. d. Refer the child to the child life specialist for assessment.

ANS: B Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments. The nurse can best decipher the child's emotional state by observing this activity. Children often are threatened by direct questions, especially if the questioner is not well known to the child. The nurse may want to discuss the situation with the parents or enlist the help of the child life specialist, but these will not give the nurse the rich data that can be obtained through watching the child play.

What does the nurse learn that predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity d. Typical lack of ambition

ANS: B Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue in this population. It is not due to dietary factors, decreased activity, or lack of ambition.

Which is assessed with Tanner staging? a. Hormone levels b. Secondary sex characteristics c. Growth hormone secretion d. Hyperthyroidism

ANS: B Tanner stages are used to assess staging of secondary sex characteristics at puberty. Hormone levels are assessed by their concentration in the blood. Growth hormone secretion tests are not associated with Tanner staging. Tanner stages are not associated with hyperthyroidism.

A student nurse is preparing to administer an Hib vaccination to an infant. What action by the student requires the registered nurse to intervene? a. Gives the vaccine information statement prior to administering the vaccine b. Wipes the dorsal gluteal area with alcohol prior to injection c. Obtains written informed consent before giving the vaccine d. Assesses the family's beliefs and values about vaccinations

ANS: B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants. When the student prepares the wrong site, the registered nurse should intervene. Federal law requires parents be given vaccine information statements and sign informed consent prior to the nurse's administering vaccinations. The nurse should also assess the family's beliefs and values related to vaccination, which can help dispel myths and guide teaching.

An important nursing consideration when performing a bladder catheterization on a young child is to a. use clean technique, not Standard Precautions. b. insert 2% lidocaine lubricant into the urethra. c. lubricate catheter with water-soluble lubricant such as K-Y Jelly. d. delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

ANS: B The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparation of the child and parents, by selection of the correct catheter, and by appropriate technique of insertion. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure.

A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development b. Moral development c. Psychosocial development d. Psychosexual development

ANS: B The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment. Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. Although a task during adolescence is the development of a sexual identity, the teenager's dependence on the parents' sanctioning of right or wrong behavior is more appropriately related to moral development.

A parent calls the pediatrician's office because her 1-year-old child has a 100° F temperature. What is the most appropriate initial nursing response to make to the parent? a. "Did you feel your child's forehead?" b. "Does your child appear to be uncomfortable?" c. "Has anyone in your home been sick lately?" d. "Don't worry if the temperature is less than 101° F."

ANS: B The child's comfort is the primary concern in treating a fever in a normally healthy child. The nurse asks about the child's comfort level before giving further information. Feeling a child's forehead can give clues related to whether the child's temperature should be measured; if it has already been measured, this is unnecessary because it does not give accurate information about the child's body temperature. Asking about other ill family members is important, but not as the initial response, which should be to get more data about the child. Although the height of the temperature is not an indication of the seriousness of the child's illness, it is incorrect to tell a parent to be unconcerned about temperatures less than 101° F.

What is the most appropriate statement for the nurse to make to a 5-year-old child who is undergoing a venipuncture? a. "You must hold still or I'll have someone hold you down. This is not going to hurt." b. "This will hurt like a pinch. I'll get someone to help hold your arm still so it will be over fast and hurt less." c. "Be a big boy and hold still. This will be over in just a second." d. "I'm sending your mother out so she won't be scared. You are big, so hold still and this will be over soon."

ANS: B The nurse can help minimize the pain and stress of the venipuncture by having someone help the child maintain control during the procedure. Threatening the child with having someone hold him or her down is likely to produce less cooperation and frighten the child. Telling a child to be a "big boy" does not acknowledge the child's developmental stage. Parents should be allowed to stay during procedures when possible.

A nurse is teaching parents how to care for a child's gastrostomy tube at home. What information should the nurse include? a. Bring the child to the clinic for cleaning b. Clean around the insertion site daily with soap and water. c. Expect some leakage around the button. d. Remove the tube for cleaning once a week.

ANS: B The skin around the tube insertion site should be cleaned with soap and water once or twice daily. Parents must be able to clean the site; the child is not taken to the clinic for this. Leakage around the tube should be reported to the physician. A gastrostomy tube is placed surgically. It is not removed for cleaning.

A student nurse learns that according to Erikson, the psychosocial task of adolescence is to develop a. intimacy. b. identity. c. initiative. d. independence.

ANS: B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Initiative is the developmental stage for early childhood. Independence is not one of Erikson's developmental stages.

A preschool aged child is in the clinic for a well-child checkup. Which statement identifies an appropriate level of language development in this child? (Select all that apply.) a. Vocabulary of 300 words b. Relates elaborate tales c. Uses correct grammar in sentences d. Able to pronounce consonants clearly e. Expresses abstract thought

ANS: B,C The 4-year-old child is able to use correct grammar in sentence structure and can tell elaborate tales and stories. A vocabulary of 300 words is appropriate for a 2-year-old. The 4-year-old child typically has difficulty in pronouncing consonants. The use of language to express abstract thought is developmentally appropriate for the adolescent.

The school nurse is presenting information on some risks of tattoos. What information should the nurse provide? (Select all that apply.) a. Amateur tattoos are difficult to remove. b. Tattoos pose a risk for bloodborne and skin infections. c. A tattoo may keep you from getting an MRI. d. Tattoo dyes may cause allergic reactions. e. Tattoo parlors are well regulated.

ANS: B,C,D Tattoos carry the risk for contracting bloodborne diseases such as hepatitis B and HIV. Infection, allergic reaction to the dye, scarring, or keloid formation can occur. Should an MRI ever be required, it is important to notify the health care professionals, because the dyes can contain iron and other metals. Amateur tattoos are easily removed; however, studio tattoos made with red and green dye are extremely difficult to remove. Very little regulation exists in the tattoo industry; therefore, the cleanliness of each tattoo parlor varies. Teens should be counseled to avoid making an impulsive decision to get a tattoo.

A nurse is planning for a sports pre-participation physical exam day. What goals for this event does the nurse set? (Select all that apply.) a. Comprehensive physical examination b. Assess general health c. Identify limiting conditions d. Provide wellness counseling e. Adhere to insurance requirements

ANS: B,C,D,E In a pre-participation sports examination, goals are to identify the teen's general health, identify any condition that would limit participation, provide wellness counseling, and ensure that participants meet insurance guidelines for participation. It is not meant to be a comprehensive physical examination.

Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? (Select all that apply.) a. Plans to try out for the debate team at school b. Skipping classes to go to the mall c. Hanging out with friends they have had since childhood d. Unexplained source of money e. Fear of the police

ANS: B,D,E Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is also a sign. A change in attitude toward participating in activities is another sign of gang involvement. Plans to become more involved in school activities and hanging around old friends are not signs.

Which action by the nurse is appropriate when preparing a child for a procedure? a. Discourage the child from crying during the procedure. b. Use professional terms so the child will understand what is happening. c. Give the child choices whenever possible. d. Discourage the parents from staying in the room during the procedure.

ANS: C Allowing children to make choices gives them a sense of control. Children (and adults) should be given permission to cry. Age-appropriate language should always be used. Parents should be encouraged to stay in the room and give support to the child.

Which nursing diagnosis is appropriate for the 5-year-old child in isolation because of immunosuppression? a. Spiritual distress b. Social isolation c. Deficient diversional activity d. Sleep deprivation

ANS: C Children in isolation need extra attention to avoid boredom. A 5-year-old child is not developmentally advanced enough to feel spiritual distress. The main social system for a 5-year-old child is the family, who should be allowed liberal visitation. Sleep deprivation may occur during hospitalization but is not specific to isolation.

According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the __________ period of cognitive development. a. sensorimotor b. formal operations c. concrete operations d. preoperational

ANS: C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant's world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. The preoperational stage is a period of egocentrism in which the child's judgments are illogical and dominated by magical thinking and animism.

Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

ANS: C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier those delays in development are discovered and intervention initiated, the less dramatic their effect will be. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development is orderly and proceeds in a predictable pattern based on each individual's abilities and potentials

The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. "Your teenager needs clearer and stricter limits about her behavior." b. "Your teenager needs more responsibility at home." c. "During adolescence this behavior is not unusual." d. "The behavior is abnormal and needs further investigation."

ANS: C Egocentric and narcissistic behavior, such as staring at oneself in the mirror, is normal during this period of development. The teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal development. More responsibility at home is not an appropriate response for this situation. The behavior is normal and needs no further investigation.

The nurse wore gloves during a dressing change. When the gloves are removed, the nurse should a. wash hands thoroughly. b. check the gloves for leaks. c. use an alcohol-based hand rub. d. apply new gloves before touching the next patient.

ANS: C Evidence-based research has demonstrated that alcohol-based rubs are more effective for eliminating organisms. If the nurse's hands are clean, alcohol-based hand rubs are most appropriate. If hands are soiled, then soap and water are used. Gloves should be disposed of after use. Hands should be thoroughly cleaned before new gloves are applied.

A nurse must do a venipuncture on a 6-year-old child. An important consideration in providing atraumatic care is to a. use an 18-gauge needle if possible. b. wait 10 minutes after applying EMLA cream. c. restrain child only as needed to perform venipuncture safely. d. have the parents choose the child's favorite bandage afterward.

ANS: C Restrain child only as needed to perform the procedure safely. Smaller needles are used. After applying EMLA cream, the nurse must wait a minimum of 60 minutes. Allow the child to choose a favorite bandage.

What nursing action is appropriate for specimen collection? a. Follow sterile technique for specimen collection. b. Sterile gloves are worn if the nurse plans to touch the specimen. c. Use Standard Precautions when handling body fluids. d. Avoid wearing gloves in front of the child and family.

ANS: C Standard Precautions should always be used when handling body fluids. Sterile gloves may be needed for some specimens, but Standard Precautions are important for all. The child and family should be educated in the purpose of glove use, including the fact that gloves are used with every patient, so that they will not be offended or frightened.

Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide? a. "Tell your friend to come to the clinic immediately." b. "You need to gather details about your friend's suicide plan." c. "Your friend's threat needs to be taken seriously and he needs immediate help." d. "If your friend mentions suicide again get your friend some help."

ANS: C Suicide is the second most common cause of death among American adolescents and young adults aged 15 to 24. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. The teen should not be responsible for getting more information from the friend. Waiting until the teen discusses suicide a second time may be too late.

The nurse is explaining Tanner staging to an adolescent and mother. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronologic age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics

ANS: C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. The puberty stage in girls begins with breast development. Puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the basis of Tanner staging.

What should the nurse consider when having consent forms signed for surgery and procedures on children? a. Only a parent or legal guardian can give consent. b. The person giving consent must be at least 18 years old. c. The risks and benefits of a procedure are part of the consent process. d. A mental age of 7 years or older is required for a consent to be considered "informed."

ANS: C The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances, such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

A student nurse in the emergency department is preparing to obtain a throat culture on a child with suspected epiglottis secondary to a strep infection. What action by the registered nurse is best? a. Remind the student to wear personal protective equipment. b. Tell the student to get the child to say "ahhh." c. Consult with the provider prior to obtaining the culture. d. Inform the parents and child that a throat culture is needed.

ANS: C The nurse never obtains a throat culture on a child in whom epiglottitis is suspected because it may precipitate sudden airway obstruction. The nurse consults with the provider about this issue. Wearing personal protective equipment, having the child say "ahhh," and informing the child and parents of the needed culture would all be appropriate when obtaining it.

A student nurse asks the faculty why peer relationships become more important during adolescence. Which of the following is the nurse's best response? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C The peer group serves as a strong support to teenagers, providing them with a sense of belonging (versus individuality) and a sense of strength and power. During adolescence, the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. This does not mean teens do not like their parents who continue to play an important role in their personal and health-related decisions.

Which nursing action is most appropriate when treating a child who has a fever of 102.5° F (39.1° C)? a. Restrict fluid intake. b. Administer an aspirin. c. Administer acetaminophen. d. Bathe the child in tepid water.

ANS: C Treatment of a fever can include administration of an antipyretic such as acetaminophen. Dehydration can occur from insensible water loss. Offer the child fluids frequently and evaluate the need for IV therapy. Aspirin is avoided because of the potential association with Reye syndrome. A sponge or tub bath with tepid water to reduce fever can cause shivering and ultimately increase the child's temperature.

Which action is appropriate to promote a toddler's nutrition during hospitalization? a. Allow the child to walk around during meals. b. Require the child to empty his or her plate. c. Ask the child's parents to bring a cup and utensils from home. d. Select new foods for the child from the menu.

ANS: C Using familiar items during mealtimes increases the toddler's sense of security and control and may encourage eating. For safety reasons, "roaming" while eating should not be permitted. The child should be seated during meals. Toddlers often use food as a source of control. Forcing a toddler to eat only increases the child's sense of powerlessness. Toddlers also experience food jags, a normal phenomenon when they will only eat certain foods. Hospitalization is a stressful experience for the toddler. It is not the time to introduce the child to new foods.

A nurse is planning to teach about injury prevention to a group of parents. What action by the nurse would best ensure a successful event? a. Have handouts listing community resources. b. Provide free safety gear like bike helmets. c. Group parents by child's developmental stage. d. Present the material in an interactive way.

ANS: C When providing anticipatory guidance to prevent injury, the most important thing for the nurse to know and understand is developmental levels of the children involved. Grouping parents by their child's developmental level allows the nurse to know this information about the group and to provide teaching specific to the group. The other options will help but are not as important as tailoring teaching to the specific needs of the children.

A parent asked, "When should I start dental care for my child?" What response by the nurse is best? a. "The recommendation is for children to have a dental examination no later than 2.5 years." b. "Children should see a dentist at least one time before kindergarten." c. "The recommendation is for children to have a dental examination before first grade." d. "A dental examination by 1 year of age is the current recommendation."

ANS: D Children should see a dentist by 1 year of age.

What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby? a. "Have you talked with your parents about this?" b. "Do you have plans to continue school?" c. "Will you be able to support the baby?" d. "Can you tell me how your life will be if you have an infant?"

ANS: D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen's perception and reality orientation. Asking the teenager whether she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. A direct question about continuing school will not facilitate communication. Open-ended questions encourage communication. Asking the teenager about how she will support the child will not facilitate communication. Open-ended questions encourage communication.

In girls, the initial indication of puberty is a. menarche. b. growth spurt. c. growth of pubic hair. d. breast development.

ANS: D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth

When counseling parents and children about the importance of increased physical activity, the nurse will emphasize which of the following? a. Anaerobic exercise should comprise a major component of the child's daily exercise. b. All children should be physically active for at least 2 hours per day. c. It is not necessary to participate in physical education classes at school if a student is taking part in other activities. d. Make exercise a fun and habitual activity.

ANS: D It is important to make exercise a fun and habitual activity. Encourage parents to investigate their community's different activity programs. This includes recreation centers, parks, and the YMCA. Aerobic exercise should comprise a major component of children's daily exercise; however, physical activity should also include muscle- and bone-strengthening activities. Children and adolescents should be physically active for at least 1 hour daily. Encourage all students to participate fully in any physical education classes.

Which immunizations should be used with caution in children with an allergy to eggs? a. HepB b. DTaP c. Hib d. MMR

ANS: D Live measles vaccine is produced by using chick embryo cell culture, so there is a remote possibility of anaphylactic hypersensitivity in children with egg allergies. Most reactions are actually the result of other components in the vaccine. The other vaccines are safe for children with an egg allergy.

When planning care for adolescents, the nurse should a. teach parents first, and they, in turn, will teach the teenager. b. provide information for long-term health needs. c. provide explanations for treatment and procedures to the parents only. d. give information privately to adolescents on specific problems that they identify.

ANS: D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider. Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. Teenagers are more interested in immediate health care needs than in long-term needs. Teenagers are at the developmental level that allows them to receive explanations about health care directly from the nurse.

The nurse is preparing for the admission of an infant who will have several procedures performed. In which situations is informed consent required? (Select all that apply.) a. Catheterized urine collection b. IV line insertion c. Oxygen administration d. Lumbar puncture e. Bone marrow aspiration

ANS: D, E Informed consent is required for invasive procedures that involve a risk to a child such as lumbar puncture and bone marrow aspiration. Informed consent is not required for procedures that are covered under the general consent to treat that is signed at admission by a parent or a guardian. These include catheterized urine collection, IV insertion, and oxygen administration.

An immunocompromised child is in the clinic for immunizations. Which vaccine prescriptions should the nurse question? (Select all that apply.) a. DTaP b. HepA c. IPV d. V aricella e. MMR

ANS: D,E Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children. DTaP, HepA, and IPV can be given safely.