Pediatrics

The mother of a 3-year-old child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother? a. a. The child probably is very shy but will outgrow this tendency with repeated exposure to other children. b. b. The toddler may have a language delay that interferes with socialization with other children. c. c. Toddlers may be interested in other children but usually do not engage in interactive play. d. d. Toddlers need more structured play to encourage interaction and socialization with others.

Toddlers may be interested in other children but usually do not engage in interactive play.

The nurse has just started assessing a young child who is febrile and appears very ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. The most appropriate action is to: a. Refer for immediate medical evaluation. b. Continue the assessment to determine the cause of neck pain. c. Ask the parent when the child's neck was injured. d. Record "head lag" on the assessment record and continue the assessment of the child.

a. Refer for immediate medical evaluation. These symptoms indicate meningeal irritation and need immediate evaluation. Continuing the assessment is not necessary. No indication of injury is present. This is not descriptive of head lag.

*In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in a crude pincer grasp. c. Hold a crayon and make a mark on paper. d. Release cubes into a cup.

a. Transfer objects from one hand to the other. By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The infant can scribble spontaneously at age 15 months. At age 12 months, the infant can release cubes into a cup.

The nurse caring for the newborn should be aware that the sensory system least mature at the time of birth is: a. Vision. c. Smell. b. Hearing. d. Taste.

a. Vision. The visual system continues to develop for the first 6 months. As soon as the amniotic fluid drains from the ear (minutes), the infant's hearing is similar to that of an adult. Newborns have a highly developed sense of smell. The newborn can distinguish and react to various tastes.

The nurse has determined the rate of both the child's radial pulse and heart. When comparing the two rates, the nurse should expect that normally they: a. are the same. b. differ, with heart rate faster. c. differ, with radial pulse faster. d. differ, depending on quality and intensity.

a. are the same. Pulses are the fluid wave through the blood vessel as a result of each heartbeat. Therefore, they should be the same.

The nurse is teaching a caregiver to select activities that will develop hand-eye-mouth coordination in a preschooler. Which of the following activities would indicate that this caregiver had learned to select well? a. bubbles and stickers c. swimming b. horseback riding d. hide-and-seek

a. bubbles and stickers The nurse teaches the caregiver to select activities that will develop hand-eye-mouth coordination in a preschooler, and includes coloring, scissors, stickers and bubbles.

The term cruising is best described by which of the following statements? a. deliberate steps while holding onto something b. going as fast as possible at this age c. looking for something to get into while moving d. moving while in a battery-powered child's vehicle

a. deliberate steps while holding onto something The term cruising is best described as deliberate steps while holding onto something.

The school nurse is forking with male and female adolescents who fall into two subgroups. One group is having difficulty with maturation and the other group is on a different schedule from the majority of their class. Which of the following groups of adolescents would the nurse anticipate having more risk for engaging in delinquent behavior, being more vulnerable to eating disorders and depression, and being teased more by peers? a. early maturing females c. late maturing females b. early maturing males d. late maturing males

a. early maturing females The group of early maturing females is more at risk for engaging in delinquent behavior, being more vulnerable to eating disorders and depression, and being teased more by peers.

During adolescence, estrogen causes which of the following changes in the female? a. epiphyseal maturation, which in turn inhibits long bone growth b. the greatest widening of the hips she will experience in her lifetime c. the greatest peaking of sexual interest in preparation for sexual life d. nesting instinct, with a desire to find a life mate and have a family

a. epiphyseal maturation, which in turn inhibits long bone growth Estrogen promotes epiphyseal maturation, which in turn inhibits long bone growth. Estrogen is not associated with the widening of the hips, a peak of sexual interest, or a nesting instinct.

Using your knowledge of the Freudian stages of psychosexual development when caring for a child between the ages of 1 and 3 years, it would be most important for you to ask the caregivers about: a. fords and rituals used for elimination b. use of pacifiers c. pet names for grandparents d. whether or not the child has a tendency to bite others

a. fords and rituals used for elimination The anal stage (1-3 years) is about toilet training, hence it is most appropriate to ask the caregivers about words and rituals used for elimination.

Cephalocaudal development proceeds in which direction? a. head downward b. foot to midsection, followed by head to midsection c. toe to head d. extremities in toward the tailbone section of the body

a. head downward Cephalocaudal development proceeds from the head downward.

The most rapid growth period in a person's life is during which of the following periods? a. infancy c. latency b. early childhood d. adolescence

a. infancy The most rapid growth period in a person's life is during infancy.

The assumptions about human nature that Jean Jacques Rousseau (1712-1778) proposed include a belief that children are: a. inherently good and born without a sense of right and wrong b. little adults and have all the reasoning abilities of adults c. bad and must be taught, corrected, and saved from evil ways d. neither good nor bad but are taken over by God or the devil

a. inherently good and born without a sense of right and wrong The assumptions about human nature that Jean Jacques Rousseau (1712-1778) proposed include a belief that children are inherently good and born without a sense of right and wrong.

Which of the following behaviors by a child is an example of positive self-esteem? a. initiating a conversation c. working on the computer b. playing quietly by oneself d. combing one's hair

a. initiating a conversation Examples of positive self-esteem include the ability to express an opinion, work cooperatively with others, and initiate a conversation.

The mother asks the nurse to describe the common reactions to immunizations. The nurse tells the mother that they usually consist of redness, swelling, and tenderness at the injection site, along with: a. low-grade fever b. chills c. fever of 38.3-38.9 degrees C (101-102 degrees F) d. seizures

a. low-grade fever The nurse tells the mother that the common reactions to immunizations are redness, swelling and tenderness at the injection site along with a low grade fever.

An adolescent boy has developed gynecomastia. The nurse would share with the adolescent that this condition: a. may occur normally in adolescence and the elderly male and is normally temporary b. often causes a loss of sexual desire and an inability to perform sexually c. is frequently precancerous and he will need to have a mammogram d. is associated with weak male chromosomal makeup and strong female chromosomes

a. may occur normally in adolescence and the elderly male and is normally temporary Sixty percent of males experience transient breast enlargement (gynecomastia), and is temporary.

The behavioral theorists believe which of the following factors most influence behavior? a. rewards and punishment c. confrontation b. genetic inheritance d. presentation of reality

a. rewards and punishment The behavioral theorists believe children randomly respond to the environment consistent with developmental capabilities, and rewards and punishment influence behavior.

The nurse observes the mother of a newborn and four other children feeding the newborn in the infant seat with the bottle propped. The nurse would need to: a. tactfully teach the mother the importance of holding and cuddling in the attachment process b. congratulate the mother for finding a safe place for the baby to take the bottle c. tell the mother that this procedure encourages independence in the newborn d. suggest that the mother let the older children hold the bottle for the baby in the infant seat

a. tactfully teach the mother the importance of holding and cuddling in the attachment process Feeding time is crucial to the development of the caregiver-newborn attachment, since it is time for the newborn and caregiver to interact and learn about each other. If the newborn remains in the crib or in an infant seat with the bottle propped, the attachment process can be delayed.

The caregivers of a toddler are concerned that their child does not play nicely with other children. The caregivers describe the child as frequently taking toys away from others and not being willing to share toys. The nurse working with these caregivers would explain that: a. toddlers most often play alongside other children and not with them, and this behavior is typical at this age b. caregivers need to teach children how to play nicely by role-modeling this behavior for the child c. this child may need an older playmate who can teach him or her about proper play d. some children are more aggressive than others, and this aggression needs to be punished

a. toddlers most often play alongside other children and not with them, and this behavior is typical at this age The nurse working with these caregivers would explain that toddlers most often play alongside other children and not with them, and this behavior is typical at this age.

The primary care pediatric nurse practitioner is preparing to conduct a well child assessment of an 8- year-old child. How will the nurse practitioner begin the exam? a. Ask the child about school, friends, home activities, and sports b. Discuss the purpose of the visit and explain the procedures that will be performed c. Offer age-appropriate information about usual developmental tasks d. Provide information about healthy nutrition and physical activities

a. Ask the child about school, friends, home activities, and sports To build rapport with the child and parent, the PNP will begin by asking direct questions to the child, encouraging the child to share information about daily routines. The other answers list aspects of the well child visit that can be introduced after the initial conversation.

What nursing action will the nurse implement for a preterm infant who is being gavage fed and has a bloody stool? a. Assess for abdominal distention. b. Decrease the amount of the next feeding. c. Institute enteric precautions. d. Get a culture of the next stool.

a. Assess for abdominal distention. Bloody stools, abdominal distention, diarrhea, and bilious vomitus are signs of necrotizing enterocolitis. Specific nursing responsibilities include measuring the abdomen and listening to bowel sounds.

The nurse is talking with a parent about tooth eruption. What teeth will the nurse explain are the first deciduous teeth to erupt? a. Lower central incisors b. Upper central incisors c. Lower lateral incisors d. Upper lateral incisors

a. Lower central incisors The first teeth to erupt, usually at about 7 months, are the lower central incisors.

The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk? a. Three-generation pedigree b. Review of systems c. Genogram d. Ecomap

a. Three-generation pedigree The three-generation pedigree is used to map out risks for genetic diseases in families, as well as conditions with modifiable risk factors. The review of systems is used to evaluate the history of the child's body systems. The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The ecomap is used to identify relationships in the family and community that are supportive or harmful.

The caregiver of an adolescent remarks to the nurse that her child seems to have fatigue and not get enough oxygen. The physical examination and other tests are normal. Which of the following explanations by the nurse will be most helpful? a. "The tests may have missed a cardiac or respiratory problem and the health care practitioner will probably want to repeat them later." b. "As the heart becomes larger in adolescence, the pumping mechanism is somewhat inefficient for a while and the lungs have not yet fully matured." c. "Adolescents fake tiredness to get out of doing chores or associating with people they consider to be boring." d. "I suggest you take him to one of the better and larger clinics there they have more sophisticated equipment."

b. "As the heart becomes larger in adolescence, the pumping mechanism is somewhat inefficient for a while and the lungs have not yet fully matured. The nurse will best explain the reported fatigue and lack of oxygen by saying: "As the heart becomes larger in adolescence, the pumping mechanism is somewhat inefficient for a while and the lungs have not yet fully matured."

Operant conditioning is a term originated by which of the following theorists? a. Albert Ellis b. B. F. Skinner c. Victor Frankl d. Urie Bronfenbrenner

b. B. F. Skinner Operant conditioning, a term originated by B. F. Skinner (1904-1990), involves behavioral changes due to either negative (punishment) or positive (reinforcers) consequences rather than just the occurrence of a stimuli.

A nurse is performing an otoscopic exam on a school-age child. Which direction should the nurse pull the pinna for this age of child? a. Up and back b. Down and back c. Straight back d. Straight up

b. Down and back With older children, usually those older than 3 years of age, the canal curves downward and forward. Therefore, pull the pinna up and back during otoscopic examinations. In infants, the canal curves upward. Therefore, pull the pinna down and back to straighten the canal. Pulling the pinna straight back or straight up will not open the inner ear canal.

To initiate the milk ejection reflex (MER), the mother should be advised to: a. Wear a firm-fitting bra. c. Place the infant to the breast. b. Drink plenty of fluids. d. Apply cool packs to her breast.

c. Place the infant to the breast. Oxytocin, which causes the MER reflex, increases in response to nipple stimulation. A firm bra is important to support the breast; however, will not initiate the MER reflex. Drinking plenty of fluids is necessary for adequate milk production, but this alone will not initiate the MER reflex. Cool packs to the breast will decrease the MER reflex.

Where in the health history should the nurse describe all details related to the chief complaint? a. Past history c. Present illness b. Chief complaint d. Review of systems

c. Present illness The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the child's health, not to the current problem. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system.

A nurse is assigned to four children of different ages. In which age group should the nurse understand that body integrity is a concern? a. Toddler b. Preschooler c. School-age child d. Adolescent

c. School-age child School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are oversensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to toddlers, preschoolers, or adolescents.

According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase? a. Use of reflexes c. Secondary circular reactions b. Primary circular reactions d. Coordination of secondary schemata

c. Secondary circular reactions Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. For example, shaking of a rattle is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. The primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

What term is used to describe breath sounds that are produced as air passes through narrowed passageways? a. Rubs c. Wheezes b. Rattles d. Crackles

c. Wheezes Wheezes are produced as air passes through narrowed passageways. The sound is similar when the narrowing is caused by exudates, inflammation, spasm, or tumor. Rubs are the sound created by the friction of one surface rubbing over another. Pleural friction rub is caused by inflammation of the pleural space. Rattles is the term formerly used for crackles. Crackles are the sounds made when air passes through fluid or moisture.

The nurse will assess the newborn for passage of stool and will expect the newborn to pass which of the following stools: a. a pasty yellow stool by 24 hours c. a meconium stool by 24 hours b. firm, pale yellow stool by 18 hours d. a meconium stool by 72 hours

c. a meconium stool by 24 hours The nurse will assess the newborn for passage of stool and will expect the newborn to pass a meconium stool within 24-48 hours of birth.

Erikson has theorized that young people are better able to commit themselves intimately to another person then they have: a. higher level thinking skills c. achieved a sense of identity b. completed college d. conquered their fear of closeness

c. achieved a sense of identity Erikson has theorized that young people are better able to commit themselves intimately to another person then they have achieved a sense of identity.

According to Freud, toddlers are in which stage of development? a. oral c. anal b. phallic d. cerebral

c. anal Infants are in the oral stage (birth to 1 year). Toddlers are in the anal stage of development (1-3 years of age). Children from 3-6 years are in the phallic stage.

Which hormone causes breast changes, including enlargement and darkening of the nipple? a. progesterone c. estrogen b. luteinizing hormone d. adrenocorticotropic hormone (ACTH)

c. estrogen Estrogen causes breast changes, such as the enlargement and darkening of the nipple.

In fetal circulation, most blood will bypass the fetal lungs via the: a. inferior vena cava c. foramen ovale b. ductus venosus d. ductus arteriosus

c. foramen ovale In fetal circulation, most blood will bypass the fetal lungs via the foramen ovale, an opening between the right and left atria of the fetal heart.

Erikson's psychosocial theory of development differed from Freud's ideas of development in that Erikson viewed: a. children as being controlled by caregivers and society with little room for exploring the environment on their own b. children as being controlled by the superego and being afraid to displease the caregivers c. humans as rational creatures with the ego-rather than the id, superego, or conflicts-controlling thoughts, feelings, and actions d. children as having no sexual interests or conflicts of any kind, with this issue not arising until young adulthood

c. humans as rational creatures with the ego-rather than the id, superego, or conflicts-controlling thoughts, feelings, and actions Erikson assumes humans are rational creatures whose actions, feelings and thoughts are controlled primarily by the ego instead of the id, superego, or conflicts between the three components of personality.

The nurse applying knowledge of Sullivan's interpersonal theory of development would most likely encourage which of the following activities for school-aged children and adolescents who are hospitalized? a. extra homework c. interactions with same-aged children b. television and computer game time d. visits from extended family

c. interactions with same-aged children When children of any age are ill it is important to meet their basic needs and provide an opportunity for school-aged children and adolescents to interact with others their same age.

The nurse is working with a newborn who has elevated bilirubin levels that are fast approaching the toxic level. The nurse is most concerned about which of the following conditions? a. ketolysis c. kernicterus b. bilharziasis d. biliverdin

c. kernicterus Kernicterus is the chronic and permanent accumulation of bilirubin in central nervous system tissues.

When children learn new developmental skills, the new skills: a. take longer to learn than earlier skills c. predominate over older skills b. cause the child anxiety d. are a minor focus compared to old skills

c. predominate over older skills When children learn new developmental skills, the new skills predominate over older skills. This occurs because of the strong drive to practice and perfect new abilities, especially early in life, when the child is not capable of coping well with several new skills simultaneously.

Infant head control is judged by the: a. amount of neck wrinkling c. presence or absence of head lag b. ability to hold head without support d. rigidity of the neck and head

c. presence or absence of head lag Infant head control is judged by the presence or absence of head lag.

Freud believed that the most important life instinct was which of the following instincts? a. protector c. sex b. hunter d. comfort

c. sex Freud believed that the most important life instinct was sex.

The nurse administering phototherapy ordered by the primary care provider must take special safety precautions and: a. check the baby's blood glucose before therapy b. cover the baby with a sheet during therapy c. shield the baby's eyes and protect the gonads d. apply a special sunscreen prior to the treatment

c. shield the baby's eyes and protect the gonads Special safety precautions when administering phototherapy requires the nurse to shield the baby's eyes (prevent retinal damage) and protect the gonads since maximum exposure is accomplished when the newborn is unclothed.

Freud developed the theory that the source of psychic energy that drives human behavior is: a. sexual need c. the id, ego, and superego b. work need d. the preconscious mind

c. the id, ego, and superego Freud developed the theory that the source of psychic energy that drives human behavior has three components: the id, ego, and superego.

full-term newborn weighs 3600 grams at birth. What would the nurse expect the newborn to weigh in grams 3 days later? a. 2900 b. 3100 c. 3300 d. 3800

c. 3300 In the first 3 to 4 days of life, a newborn generally loses 5% to 10% of his or her birth weight.

The parent of a 5-year-old child who has just begun kindergarten expresses concern that the child will have difficulty adjusting to the birth of a sibling. What will the primary care pediatric nurse practitioner recommend? a. Allowing the child opportunities to discuss feelings about the baby b. Giving the child specific baby care tasks to promote sibling bonding c. Having snack time with the child each day to discuss the school day d. Providing reassurance that the sibling will not replace the child

c. Having snack time with the child each day to discuss the school day Family routines provide support to children and help them self-regulate, especially during times of change, and serve as a buffer during times of change and transition. This child has two major changes, so setting aside regular time to spend with the child will help stabilize these changes. The other options may be useful as well, but routines and special activities are most important.

Which region globally has the highest infant mortality rate? a. Indonesia b. Southern Asia c. Sub-Saharan Africa d. Syria

c. Sub-Saharan Africa Although Sub-Saharan Africa and Southern Asia together account for 81% of the infant mortality rate globally, Sub-Saharan Africa has the highest infant mortality rate in the world.

The parent of a 10-year-old boy tells the primary care pediatric nurse practitioner that the child doesn't appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child's sexual identity. The nurse practitioner will tell the parent a. children at this age who prefer interactions with same-gender peers usually have a homosexual orientation. b. children experiment with sexuality at this age as a means of deciding later sexual orientation. c. this attachment to other same-gender children is how the child learns to interact with others. d. to encourage mixed-gender interactions in order to promote development of sexual values.

c. this attachment to other same-gender children is how the child learns to interact with others. At age 10, children usually develop an intense same-gender relationship with a peer. This is how the child learns to expand the self, shares feelings, and learns how others manage problems. It does not indicate later sexual orientation and is not a characteristic of experimentation with sexuality. It is not necessary to encourage mixed-gender interactions.

Which of the following statements might a preschool child most likely make when questioned as to why something is right or wrong? a. "Because my mother says so." b. "Because there are rules about this." c. "Because it's in the Ten Commandments." d. "I just know it is so."

a. "Because my mother says so." The preschooler has little understanding of why something is right or wrong, and if questioned, will often say, "Because my mother says so."

Most common reactions to immunizations last how many days? a. 1 to 2 c. 5 to 6 b. 3 to 4 d. 7 to 8

a. 1 to 2 Most common reactions to immunizations last 1 to 2 days.

The stomach capacity of the newborn is approximately how many mL? a. 30 c. 60 b. 40 d. 80

c. 60 The stomach capacity of the newborn is approximately 60 mL

The stage at which children have a chum, according to Sullivan's stages of interpersonal development, is which of the following stages? a. early childhood c. late childhood b. preadolescence d. adolescence

b. preadolescence The stage at which children have a chum, according to Sullivan's stages of interpersonal development, is preadolescence (9-12 years).

A first-time mother reports that she is experiencing difficulty breastfeeding her newborn. Which neonatal reflex would the nurse teach the mother to elicit to facilitate breastfeeding? a. Sucking b. Rooting c. Grasping d. Tonic neck

b. Rooting The rooting reflex causes the infant's head to turn in the direction of anything that touches the cheek in anticipation of food.

Toddlers achieve bladder and bowel control during this stage and can typically retain urine up to how many hours before they have to void? a. 1 c. 4 b. 2 d. 6

c. 4 Toddlers achieve bladder and bowel control during this stage and can typically retain urine up to four hours before they have to void

The primary care pediatric nurse practitioner performs a developmental assessment on a 32-month-old child. The child's parent reports that about 70% of the child's speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing "t," "d," "k," and "g" sounds. Which action is correct? a. a. Evaluate the child's cognitive abilities. b. b. Obtain a hearing evaluation. c. c. Reassure the parent that this is normal. d. d. Refer the child to a speech therapist.

Reassure the parent that this is normal. Intelligibility of speech reaches about 66% between the ages of 24 and 36 months. Tongue- contact sounds are more intelligible by age 5 years. This child exhibits normal speech for age. It is not necessary to perform a cognitive assessment based on these findings. Referrals for hearing and speech evaluations are not indicated, since these findings are within normal limits.

When a preschooler is watching a new show or a new video, the caregivers need to: a. watch the new show or video with the child b. allow extra time or play the video more than once c. invite other children to watch this presentation in a group d. limit viewing time to 20 minutes

a. watch the new show or video with the child When a preschooler is watching a new show or a new video, the caregivers need to watch the new show or video with the child.

Formula-fed newborns compared to breastfeeding newborns: a. will go longer between feedings b. will feed at about the same intervals c. will require more frequent feedings d. are unpredictable in how they will compare

a. will go longer between feedings Formula is digested more slowly and usually establishes a pattern of feeding every 3-4 hours, whereas a breastfed newborn may nurse every 1 1/2 - 3 hours.

The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement would indicate that the mother needs additional teaching? a. "I can store my breast milk in the refrigerator for 3 months." b. "I can store my breast milk in the freezer for 3 months." c. "I can store my breast milk at room temperature for 8 hours." d. "I can store my breast milk in the refrigerator for 3 to 5 days."

a. "I can store my breast milk in the refrigerator for 3 months." If the mother states that she can store her breast milk in the refrigerator for 3 months, she needs additional teaching about safe storage. Breast milk can be stored at room temperature for 8 hours, in the refrigerator for 3 to 5 days, in the freezer for 3 months, or in a deep freezer for 6 to 12 months. It is accurate and does not require additional teaching if the mother states that she can store her breast milk in the freezer for 3 months, at room temperature for 8 hours, and in the refrigerator for 3 to 5 days.

The parents are interviewing people who have applied to their advertisement for a caregiver for their 6-week-old baby in preparation for the mother's return to work. In addition to asking about the applicant's experience, which of the following questions by the parents would most help them assess an applicant's ability to provide a trusting environment? a. "If the baby is fussy, what will you do?" b. "How many children have you cared for at a time?" c. "What is your training in child care?" d. "What was your childhood like?"

a. "If the baby is fussy, what will you do?" If the baby is fussy, what will you do?" is the question asked by parents that would most help them assess an applicant's ability to provide a trusting environment.

A caregiver asks the nurse to explain what happens if the time-out is too long. The best reply by the nurse is which of the following? a. "If the child is kept in time-out beyond the time it takes to calm down, he or she has enough time to become resentful." b. "The child will begin to think up new bad behaviors if given enough time in time-out." c. "Too much time-out will exhaust the child, and he or she will have difficulty thinking." d. "Time-out will stop having any effect on the child at all as he or she designs ways to amuse him- or herself."

a. "If the child is kept in time-out beyond the time it takes to calm down, he or she has enough time to become resentful." If a child remains in a time-out longer than this recommended time, it can lead to resentment.

A 2-week-old baby's caregivers seek help from the nurse in understanding the baby's recent unexplained episodes of crying and inability to be consoled, no matter what they try. The nurse explains that this is probably colic. The caregivers ask: "What causes colic? Have we been doing something wrong?" The nurse's best response is: a. "In most cases we don't really know what causes colic, so don't blame yourselves. We will do some checking to see if it might be an infection." b. "I don't know if you have been doing something wrong or not. Let's look at what routines you have and your parenting practices." c. "Do you think you have been doing anything wrong?" d. "What have you been feeding this baby, and how much at a time?"

a. "In most cases we don't really know what causes colic, so don't blame yourselves. We will do some checking to see if it might be an infection." When the caregivers ask: "What causes colic? Have we been doing something wrong?" The nurse's best response is: "In most cases we don't really know what causes colic, so don't blame yourselves. We will do some checking to see if it might be an infection."

The pediatrician has been speaking with a mother about the "prepubescent period." Later the mother asks the nurse, "What does prepubescence mean?" Which of the following is the nurse's best response? a. "It is the 2 years before puberty with puberty being when secondary sex characteristics start to develop and girls begin menstruation." b. "It is the period of time from birth until the time when the individual has the ability to reproduce." c. "It is the months in which the child is developing secondary sexual characteristics up until sexual development is sufficient for reproduction." d. "It is the time period starting with interest in a sexual partner to the time of the first sexual mating."

a. "It is the 2 years before puberty with puberty being when secondary sex characteristics start to develop and girls begin menstruation." The last years of the school-age period are called prepubescence, meaning the 2 years before puberty.

The nurse is teaching a group of caregivers about reverse attention. Which of the following statements by a caregiver 2 weeks later would indicate that this caregiver was following the instructions of the nurse? a. "My child was coloring quietly, and I gave him a compliment on his good behavior." b. "Our child was coloring the walls with crayons, and I put him in time-out." c. "When our daughter took crayons away from a playmate, I put all the crayons up until she could agree to share." d. "I had my child gift wrap the crayons and give them to a playmate."

a. "My child was coloring quietly, and I gave him a compliment on his good behavior." Reverse attention has been deemed an effective tool for teaching appropriate behavior. Rather than acknowledging only bad behavior, good behavior is also acknowledged. Therefore, for the child who is coloring quietly, it is important for the caregiver to recognize the child's actions.

A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents? a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide." b. "The drug keeps your baby from requiring too much sedation." c. "Surfactant is used to reduce episodes of periodic apnea." d. "Your baby needs this medication to fight a possible respiratory tract infection."

a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide." Surfactant can be administered as an adjunct to oxygen and ventilation therapy. With administration of artificial surfactant, respiratory compliance is improved until the infant can generate enough surfactant on his or her own. Surfactant has no bearing on the sedation needs of the infant. Surfactant is used to improve respiratory compliance, including the exchange of oxygen and carbon dioxide. The goal of surfactant therapy in an infant with respiratory distress syndrome (RDS) is to stimulate production of surfactant in the type 2 cells of the alveoli. The clinical presentation of RDS and neonatal pneumonia may be similar. The infant may be started on broad-spectrum antibiotics to treat infection.

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, "What is this black, sticky stuff in her diaper?" The nurse's best response is: a. "That's meconium, which is your baby's first stool. It's normal." b. "That's transitional stool." c. "That means your baby is bleeding internally." d. "Oh, don't worry about that. It's okay."

a. "That's meconium, which is your baby's first stool. It's normal." "That's meconium, which is your baby's first stool. It's normal" is an accurate statement and the most appropriate response. Transitional stool is greenish brown to yellowish brown and usually appears by the third day after initiation of feeding. "That means your baby is bleeding internally" is not accurate. "Oh, don't worry about that. It's okay" is not an appropriate statement. It is belittling to the father and does not educate him about the normal stool patterns of his daughter.

An adolescent tells his caregivers that he is not going to school on a particular day because he doesn't have anything appropriate to wear and there is a zit (skin eruption) on his face. This behavior exemplifies which of the following concepts? a. Elkind's concept of imaginary audience c. adolescent instability of emotions b. extreme and diagnosable narcissism d. disrespect for the school system

a. Elkind's concept of imaginary audience An adolescent telling his caregivers that he is not going to school on a particular day because he doesn't have anything appropriate to wear and there is a zit (skin eruption) on his face is displaying Elkind's concept of imaginary audience.

A mother notices that her 6-month-old child grasps things such as a spoon in her palms. This mother asks when her daughter will be able grasp a spoon between the thumb and fingers. She has been trying to teach the child this skill without success. The best response by the nurse would be: a. "The pincer grasp will be mastered at about 8 months. It would be best to let the child grasp the spoon with the palm, as it is too early for the pincer grasp." b. "Have your child play with an older child who uses the pincer grasp, and your baby will likely pick up the skill from the other child in a short while." c. "Keep working and teaching. The baby will soon pick this skill up if you just keep pushing." d. "Let's do some developmental testing to see in what other areas your baby is behind in development."

a. "The pincer grasp will be mastered at about 8 months. It would be best to let the child grasp the spoon with the palm, as it is too early for the pincer grasp." As the infant's fine motor development progresses, the palmar reflex is replaced with a thumb and finger pincer grasp at approximately 8 months of age.

A parent asks the nurse why his school-aged child, who was ill so often during the preschool years, is now healthy and seldom ill. Which of the following is the nurse's best response? a. "The production of antibodies is at a peak by age 7 with the increase in body size and the maturity of the immune system." b. "School-aged children usually eat a healthier diet, sleep better, and are less stressed than younger children." c. "The school-aged child is exposed to the same people every day and has little exposure to new pathogens." d. "School-aged children have had all their vaccinations and have had most health problems corrected by this time."

a. "The production of antibodies is at a peak by age 7 with the increase in body size and the maturity of the immune system." The school-age years are often among the healthiest phases of life. Antibodies are produced by the lymphatic system and reach their peak by age 7 years. Because of the increase in body size and maturity of the immune system, the school-age child is able to respond to illnesses similar to adults.

A caregiver is upset that her 34-month-old girl has begun to wet the bed and suck her thumb after being admitted to the hospital. This caregiver asks the nurse to explain why this is happening. The nurse's best response is which of the following? a. "This behavior is a defense mechanism when normal routines are changed." b. "Your daughter probably does not like the primary nurse who has been assigned." c. "Your toddler is angry, and this is her way of letting us know that she is unhappy." d. "Bed-wetting and thumb sucking are just a way of getting even with you for abandoning her."

a. "This behavior is a defense mechanism when normal routines are changed." The nurse's best response is "This behavior is a defense mechanism when normal routines are changed." If a child's rituals are disrupted because of hospitalization, the child experiences stress and frequently regresses to earlier, safer, more familiar behavior.

A caregiver asks the nurse why her preschooler grinds her teeth at night. The best response by the nurse is which of the following statements? a. "This is a common practice during the preschool years; it may be a way she releases tension and calms herself so she can fall asleep." b. "This is the time when permanent teeth are trying to grow, and the pain causes grinding at night." c. "Loss of baby teeth will cause the mouth to get out of adjustment, and this causes grinding at night." d. "You are probably keeping your child up too late at night and not making sure the child gets a nap."

a. "This is a common practice during the preschool years; it may be a way she releases tension and calms herself so she can fall asleep." "This is a common practice during the preschool years; it may be a way she releases tension and calms herself so she can fall asleep" is the best response the nurse can give to the caregiver asking why her preschooler grinds her teeth at night.

The nurse is working with a family who describes a great deal of frustration because their child is overturning every bucket in the house, including mop buckets with dirty water and paint buckets when they paint, as well as the sand pail in the sandbox. Which of the following statements by the nurse would be best in this situation? a. "Toddlers do think of every bucket as the same. So if you can turn over one, you can turn them all over." b. "Perhaps you could explain this to your child a number of times, and this will increase the chances he will understand." c. "If you pour a bucket of water on the child when he empties your bucket, this will most likely cause him to stop and think." d. "Print the child's name on the sand bucket and your name on the other buckets to indicate that only the sand bucket is the child's bucket."

a. "Toddlers do think of every bucket as the same. So if you can turn over one, you can turn them all over." The following statement by the nurse "Toddlers do think of every bucket as the same. So if you can turn over one, you can turn them all over" would be best in this situation. In the mind of a toddler, all objects that look alike have the same function and are therefore treated equally.

A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on "high." The nurse instructs the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. The nurse's best response is: a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." b. "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." c. "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." d. "Your baby will get cold stressed easily and needs to be bundled up at all times."

a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him" is an accurate statement. Conduction is the loss of heat from the body surface to cooler surfaces, not air, in direct contact with the newborn. Evaporation is loss of heat that occurs when a liquid is converted into a vapor. In the newborn heat loss by evaporation occurs as a result of vaporization of moisture from the skin. Cold stress may occur from excessive heat loss, but this does not imply that the infant will become stressed if not bundled at all times. Furthermore, excessive bundling may result in a rise in the infant's temperature.

The American Academy of Pediatrics suggests that caregivers do which of the following things in regard to physical activities for preschoolers? a. Encourage a variety of physical activities in a noncompetitive environment. b. Keep physical activities to a minimum until the child is in grade school. c. Have the child engage in competitive sports to see there they excel. d. Push the child to practice sports activities while they are more flexible.

a. Encourage a variety of physical activities in a noncompetitive environment. The American Academy of Pediatrics suggests that caregivers encourage a variety of physical activities in a noncompetitive environment in regard to physical activities for preschoolers.

During a prenatal examination, the woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. When the woman asks why, the nurse's best response would be: a. "Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child." b. "You and your baby can be exposed to the human immunodeficiency virus (HIV) in your cats' feces." c. "It's just gross. You should make your husband clean the litter boxes." d. "Cat feces are known to carry Escherichia coli, which can cause a severe infection in both you and your baby."

a. "Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child." Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite, commonly found in cats, dogs, pigs, sheep, and cattle. About 30% of women who contract toxoplasmosis during gestation transmit the disease to their children. Clinical features ascribed to toxoplasmosis include hydrocephalus or microcephaly, chorioretinitis, seizures, or cerebral calcifications. HIV is not transmitted by cats. Although suggesting that the woman's husband clean the litter boxes may be a valid statement, it is not appropriate, does not answer the client's question, and is not the nurse's best response. E. coli is found in normal human fecal flora. It is not transmitted by cats.

The nurse is doing an assessment with a preschooler and her caregivers. The caregivers reveal that their child watches an average of 8 hours of television each day. The nurse will share with the caregivers that the American Academy of Pediatrics recommends which of the following number of hours of television a day for a preschooler? a. 1 to 2 c. 5 to 6 b. 3 to 4 d. 7 to 8

a. 1 to 2 The American Academy of Pediatrics recommends 1 to 2 hours of television a day for a preschooler.

A father asks when the baby will have to go see the pediatrician. From her reading in the baby book as well as instructions from the nurse, his wife tells him that these visits are normally scheduled at which of the following ages? a. 2 weeks, and 2, 4, 6, 9, and 12 months b. every month for 1 year c. every 2 weeks for 2 months, when monthly d. 3, 5, 7, and 9 months

a. 2 weeks, and 2, 4, 6, 9, and 12 months In the first year, health screening or well-child visits are usually scheduled when the infant is 2 weeks, and 2, 4, 6, 9 and 12 months.

Newborns have which of the following visual acuities? a. 20/100-20/200 c. 20/60-20/200 b. 20/90-20/220 d. 20/20-20/100

a. 20/100-20/200 Research has shown that even newborns have full visual array with acuity of 20/100 to 20/200.

The nurse is teaching the caregivers about the care of their uncircumcised son. The nurse tells the caregivers that the foreskin may not be retractable in some children until around how many years of age? a. 3 c. 6 b. 4 d. 8

a. 3 The foreskin of the uncircumcised son may not be retractable until age 3.

The timing of the eruption of teeth may vary, but it usually begins around which of the following ages? a. 3 to 4 months c. 1 year b. 6 to 8 months d. 1-1/2 years

a. 3 to 4 months The eruption of teeth varies among children, but the teething process typically begins around 3-4 months of age.

By what age does the posterior fontanel usually close? a. 6 to 8 weeks c. 4 to 6 months b. 10 to 12 weeks d. 8 to 10 months

a. 6 to 8 weeks The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks. Ten weeks or longer is too late.

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is: a. A normal finding. b. An abnormal finding; the child needs referral to an ophthalmologist. c. A sign of a possible visual defect; the child needs vision screening. d. A sign of small hemorrhages, which usually resolve spontaneously.

a. A normal finding. A brilliant, uniform red reflex is an important normal and expected finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as: a. A normal finding. b. A questionable finding—the infant should be rechecked in 1 month. c. An abnormal finding—indicates the need for immediate referral to a practitioner. d. An abnormal finding—indicates the need for developmental assessment.

a. A normal finding. Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid? a. A premature infant more easily digests breast milk than formula. b. A glass of wine just before pumping will help reduce stress and anxiety. c. The mother should pump only as much as the infant can drink. d. The mother should pump every 2 to 3 hours, including during the night.

a. A premature infant more easily digests breast milk than formula. Human milk is the ideal food for preterm infants, with benefits that are unique in addition to those received by term, healthy infants. Greater physiologic stability occurs with breastfeeding compared with formula feeding. Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mother's milk ejection reflex. To establish an optimal milk supply, the mother should be instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast.

Part of the health assessment of a newborn is observing the infant's breathing pattern. A full-term newborn's breathing pattern is predominantly: a. Abdominal with synchronous chest movements. b. Chest breathing with nasal flaring. c. Diaphragmatic with chest retraction. d. Deep with a regular rhythm.

a. Abdominal with synchronous chest movements. In normal infant respiration the chest and abdomen rise synchronously, and breaths are shallow and irregular. Breathing with nasal flaring is a sign of respiratory distress. Diaphragmatic breathing with chest retraction is a sign of respiratory distress. Infant breaths are not deep with a regular rhythm.

The cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating is called: a. Vernix caseosa. c. Caput succedaneum. b. Surfactant. d. Acrocyanosis.

a. Vernix caseosa. This protection, vernix caseosa, is needed because the infant's skin is so thin. Surfactant is a protein that lines the alveoli of the infant's lungs. Caput succedaneum is the swelling of the tissue over the presenting part of the fetal head. Acrocyanosis is cyanosis of the hands and feet that results in a blue coloring.

A new mother states that her infant must be cold because the baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called: a. Acrocyanosis. c. Harlequin color. b. Erythema neonatorum. d. Vernix caseosa.

a. Acrocyanosis. Acrocyanosis, or the appearance of slightly cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level. Acrocyanosis is normal and appears intermittently over the first 7 to 10 days. Erythema toxicum (also called erythema neonatorum) is a transient newborn rash that resembles flea bites. The harlequin sign is a benign, transient color change in newborns. Half of the body is pale, and the other half is ruddy or bluish red with a line of demarcation. Vernix caseosa is a cheeselike, whitish substance that serves as a protective covering.

The nurse is taking vital signs on adolescents and keeps in mind which of the following facts about baseline vital signs? a. Adolescent females have a slightly lower systolic blood pressure and a slightly higher pulse and body temperature than males. b. The pulse of the adolescent female is often slightly irregular compared to the regular pulse of the male. c. It is not unusual to find a pathological murmur in the male and a physiological murmur in the female. d. The male body temperature, pulse, and blood pressure are usually higher than the female's.

a. Adolescent females have a slightly lower systolic blood pressure and a slightly higher pulse and body temperature than males. When taking vital signs on adolescents, the nurse keeps in mind the fact that adolescent females have a slightly lower systolic blood pressure and a slightly higher pulse and body temperature than males.

The abuse of which of the following substances during pregnancy is the leading cause of cognitive impairment in the United States? a. Alcohol c. Marijuana b. Tobacco d. Heroin

a. Alcohol Alcohol abuse during pregnancy is recognized as one of the leading causes of cognitive impairment in the United States.

A pregnant woman presents in labor at term, having had no prenatal care. After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. On the basis of her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy? a. Alcohol c. Heroin b. Cocaine d. Marijuana

a. Alcohol The description of the infant suggests fetal alcohol syndrome, which is consistent with maternal alcohol consumption during pregnancy. Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestions. Heroin use in pregnancy frequently results in intrauterine growth restriction. The infant may have a shrill cry and sleep cycle disturbances and present with poor feeding, tachypnea, vomiting, diarrhea, hypothermia or hyperthermia, and sweating. Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.

The best play activity to provide tactile stimulation for a 6-month-old infant is to: a. Allow to splash in bath. c. Play music box, tapes, or CDs. b. Give various colored blocks. d. Use infant swing or stroller.

a. Allow to splash in bath. The feel of the water while the infant is splashing provides tactile stimulation. Various colored blocks provide visual stimulation for a 4- to 6-month-old infant. A music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation.

A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers

a. Appropriate use of car seat restraints Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year; therefore, the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over the appropriate use of car seat restraints.

A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant's parents should be based on the knowledge that petechiae: a. Are benign if they disappear within 48 hours of birth. b. Result from increased blood volume. c. Should always be further investigated. d. Usually occur with forceps delivery.

a. Are benign if they disappear within 48 hours of birth. Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of the trunk and face. These lesions are benign if they disappear within 2 days of birth and no new lesions appear. Petechiae may result from decreased platelet formation. In this situation the presence of petechiae is most likely a soft-tissue injury resulting from the nuchal cord at birth. Unless they do not dissipate in 2 days, there is no reason to alarm the family. Petechiae usually occur with a breech presentation vaginal birth.

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

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

Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include: a. Avoidance of eye contact. b. An associated malabsorption defect. c. Weight that falls below the 15th percentile. d. Normal achievement of developmental landmarks.

a. Avoidance of eye contact. One of the clinical manifestations of nonorganic failure to thrive is the child's avoidance of eye contact with the health professional. A malabsorption defect would result in a physiologic problem, not behavioral. Weight (but not height) below the 5th percentile is indicative of failure to thrive. Developmental delays, including social, motor, adaptive, and language, exist.

Which would be best for the nurse to use when determining the temperature of a preterm infant under a radiant heater? a. Axillary sensor b. Tympanic membrane sensor c. Rectal mercury glass thermometer d. Rectal electronic thermometer

a. Axillary sensor The axillary sensor measures the infrared heat energy radiating from the axilla. It can be used on wet skin, in incubators, or under radiant warmers. Ear thermometry does not show sufficient correlation with established methods of measurement. It should not be used when body temperature must be assessed with precision. Mercury thermometers should never be used. The release of mercury, should the thermometer be broken, can cause harmful vapors. Rectal temperatures should be avoided unless no other suitable way exists for the temperature to be measured.

The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which heading? a. Birth history c. Chief complaint b. Present illness d. Review of systems

a. Birth history The birth history refers to information that relates to previous aspects of the child's health, not to the current problem. The mother's difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth. Sequelae such as pulmonary dysfunction would be included.

The nurse providing couplet care should understand that nipple confusion results when: a. Breastfeeding babies receive supplementary bottle feedings. b. The baby is weaned too abruptly. c. Pacifiers are used before breastfeeding is established. d. Twins are breastfed together.

a. Breastfeeding babies receive supplementary bottle feedings. Nipple confusion can result when babies go back and forth between bottles and breasts, especially before breastfeeding is established in 3 to 4 weeks, because the two require different skills. Abrupt weaning can be distressing to mother and/or baby but should not lead to nipple confusion. Pacifiers used before breastfeeding is established can be disruptive, but this does not lead to nipple confusion. Breastfeeding twins requires some logistical adaptations, but this should not lead to nipple confusion.

The nurse is doing some teaching about oral hygiene with a group of caregivers of toddlers. The nurse would most likely include which of the following statements in this teaching? a. Caretakers need to physically assume some responsibility for effective teeth cleaning. b. Children often do not like the taste of toothpaste, so allow them to use just water if they prefer. c. Provide the child with a firm toothbrush with pointed bristles and floss. d. Children do not need to see a dentist until they are around 5 years of age.

a. Caretakers need to physically assume some responsibility for effective teeth cleaning. The nurse would most likely include the statement that caretakers need to physically assume some responsibility for effective teeth cleaning.

The head-to-tail direction of growth is referred to as: a. Cephalocaudal. c. Mass to specific. b. Proximodistal. d. Sequential.

a. Cephalocaudal. The first pattern of development is the head-to-tail, or cephalocaudal, direction. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near-to-far, is the second pattern of development. Limb buds develop before fingers and toes. Postnatally the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.

The nurse working on the pediatric unit checks the apical pulse of a school-aged child and finds a rate of 95 beats per minute while the child is lying in bed. The best action on the part of the nurse is to: a. Chart the apical pulse of 95 as it is in the normal range. b. Recheck the apical pulse for a full minute, as it is somewhat high. c. Call the pediatrician. d. Have another nurse recheck the apical pulse.

a. Chart the apical pulse of 95 as it is in the normal range. The average apical rate for the school-aged child is 90-95 beats per minute. Therefore, the nurse should chart the apical pulse of 95 as it is within the normal range.

Which of the following statements best demonstrates social learning theory applied in a health care setting? a. Children cooperate with a procedure if they see other children or adults cooperating for the same or similar procedure. b. The nurse shows the child the equipment and lets the child play with it until the procedure takes place. c. The respiratory therapist shows the child how to use a nasal inhaler and lets the child then demonstrate the use of the inhaler. d. Children play with peers in a playroom rather than staying in bed in the acute care hospital.

a. Children cooperate with a procedure if they see other children or adults cooperating for the same or similar procedure. Social learning theory is also readily applicable to health care. Children often will cooperate with procedures (blood draws, X rays) if they see other children or adults they emulate cooperating for the same procedure.

A new mother asks whether she should feed her newborn colostrum, because it is not "real milk." The nurse's most appropriate answer is: a. Colostrum is high in antibodies, protein, vitamins, and minerals. b. Colostrum is lower in calories than milk and should be supplemented by formula. c. Giving colostrum is important in helping the mother learn how to breastfeed before she goes home. d. Colostrum is unnecessary for newborns.

a. Colostrum is high in antibodies, protein, vitamins, and minerals. Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. Supplementation is not necessary; it will decrease stimulation to the breast and decrease the production of milk. It is important for the mother to feel comfortable in this role before discharge; however, the importance of the colostrum to the infant is the top priority. Colostrum provides immunities and enzymes necessary to cleanse the gastrointestinal system, among other things.

According to Freudian psychodynamic theory, the attachment of a girl to her father produces anxiety, which must be resolved and controlled. Which name is used for this attachment? a. Electra c. Oedipus b. Cleopatra d. Olympia

a. Electra According to Freudian psychodynamic theory, the attachment of a girl to her father produces anxiety, which must be resolved and controlled. He named it the Electra complex.

A parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." The nurse's best action is: a. Encourage parent to verbalize feelings. b. Encourage parent not to worry so much. c. Assess parent for other signs of inadequate parenting. d. Reassure parent that colic rarely lasts past age 9 months.

a. Encourage parent to verbalize feelings. Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxieties. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

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

a. Erikson. 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. Jean Piaget's cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

Which is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine and follow it consistently. b. Maintain a nondistracting environment by not speaking to the infant during feeding. c. Place the infant in an infant seat during feedings to prevent overstimulation. d. Limit sensory stimulation and play activities to alleviate fatigue.

a. Establish a structured routine and follow it consistently. The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The nurse should talk to the infant by giving directions about eating. This will help the infant maintain focus. Young children should be held while being fed, and older children can sit at a feeding table. The infant should be fed in the same manner at each meal. The infant can engage in sensory and play activities at times other than mealtime.

An infant with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which highly technical method of treatment may be necessary for an infant who does not respond to conventional treatment? a. Extracorporeal membrane oxygenation b. Respiratory support with a ventilator c. Insertion of a laryngoscope and suctioning of the trachea d. Insertion of an endotracheal tube

a. Extracorporeal membrane oxygenation Extracorporeal membrane oxygenation is a highly technical method that oxygenates the blood while bypassing the lungs, thus allowing the infant's lungs to rest and recover. The infant is likely to have been first connected to a ventilator. Laryngoscope insertion and tracheal suctioning are performed after birth before the infant takes the first breath.

The nurse is using the Ballard scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks? a. Flexed posture b. Abundant lanugo c. Smooth, pink skin with visible veins d. Faint red marks on the soles of the feet

a. Flexed posture Term infants typically have a flexed posture. Abundant lanugo usually is seen on preterm infants. Smooth, pink skin with visible veins is seen on preterm infants. Faint red marks usually are seen on preterm infants.

A nurse is preparing to assess a 3-year-old child. What communication technique should the nurse use for this child? a. Focus communication on child. b. Explain experiences of others to child. c. Use easy analogies when possible. d. Assure child that communication is private.

a. Focus communication on child. Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, experiences of others, analogies, and assurances that the communication is private will not be effective because the child is not capable of understanding.

Nurses providing nutritional instruction should be cognizant of the uniqueness of human milk. Which statement is correct? a. Frequent feedings during predictable growth spurts stimulate increased milk production. b. The milk of preterm mothers is the same as the milk of mothers who gave birth at term. c. The milk at the beginning of the feeding is the same as the milk at the end of the feeding. d. Colostrum is an early, less concentrated, less rich version of mature milk.

a. Frequent feedings during predictable growth spurts stimulate increased milk production. These growth spurts (10 days, 3 weeks, 6 weeks, 3 months) usually last 24 to 48 hours, after which infants resume normal feeding. The milk of mothers of preterm infants is different from that of mothers of full-term infants to meet the needs of these newborns. Milk changes composition during feeding. The fat content of the milk increases as the infant feeds. Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).

Which information could be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large push-pull toys for kinesthetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.

a. Give large push-pull toys for kinesthetic stimulation. The 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for a child of this age include large push-pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.

The most important nursing action in preventing neonatal infection is: a. Good handwashing. c. Separate gown technique. b. Isolation of infected infants. d. Standard Precautions.

a. Good handwashing. Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of nosocomial infection in nursery units. Measures to be taken include Standard Precautions, careful and thorough cleaning, frequent replacement of used equipment, and disposal of excrement and linens in an appropriate manner. Overcrowding must be avoided in nurseries. However, the most important nursing action for preventing neonatal infection is effective handwashing.

In the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. The nurse should suspect: a. Hypovolemia and/or shock. c. Central nervous system injury. b. A nonneutral thermal environment. d. Pending renal failure.

a. Hypovolemia and/or shock. The nurse should suspect hypovolemia and/or shock. Other symptoms could include hypotension, prolonged capillary refill, and tachycardia followed by bradycardia. Intervention is necessary.

Nursing follow-up care often includes home visits for the new mother and her infant. Which information related to home visits is correct? a. Ideally, the visit is scheduled within 72 hours after discharge. b. Home visits are available in all areas. c. Visits are completed within a 30-minute time frame. d. Blood draws are not a part of the home visit.

a. Ideally, the visit is scheduled within 72 hours after discharge. The home visit is ideally scheduled within 72 hours after discharge. This timing allows early assessment and intervention for problems with feedings, jaundice, newborn adaptation, and maternal-infant interaction. Because home visits are expensive, they are not available in all geographic areas. Visits are usually 60 to 90 minutes in length to allow enough time for assessment and teaching. When jaundice is found, the nurse can discuss the implications and check the transcutaneous bilirubin level or draw blood for testing.

With regard to injuries to the infant's plexus during labor and birth, nurses should be aware that: a. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months. b. Erb palsy is damage to the lower plexus. c. Parents of children with brachial palsy are taught to pick up the child from under the axillae. d. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.

a. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months. However, if the ganglia are disconnected completely from the spinal cord, the damage is permanent. Erb palsy is damage to the upper plexus and is less serious than brachial palsy. Parents of children with brachial palsy are taught to avoid picking up the child under the axillae or by pulling on the arms. Breastfeeding is not contraindicated, but both the mother and infant will need help from the nurse at the start.

A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. Which statement is most accurate? Bottle-feeding using commercially prepared infant formulas: a. Increases the risk that the infant will develop allergies. b. Helps the infant sleep through the night. c. Ensures that the infant is getting iron in a form that is easily absorbed. d. Requires that multivitamin supplements be given to the infant.

a. Increases the risk that the infant will develop allergies. Exposure to cow's milk poses a risk of developing allergies, eczema, and asthma. "Bottle-feeding using commercially prepared infant formulas helps the infant sleep through the night" is a false statement. Iron is better absorbed from breast milk than from formula. Commercial formulas are designed to meet the nutritional needs of the infant and resemble breast milk.

Which infant would be more likely to have Rh incompatibility? a. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor b. Infant who is Rh negative and whose mother is Rh negative c. Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor d. Infant who is Rh positive and whose mother is Rh positive

a. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor, all the children will be Rh positive. Only Rh-positive children of an Rh-negative mother are at risk for Rh incompatibility. If the mother is Rh negative and the father is Rh positive and heterozygous for the factor, there is a 50% chance that each infant born of the union will be Rh positive and a 50% chance that each will be born Rh negative.

According to the recommendations of the American Academy of Pediatrics on infant nutrition: a. Infants should be given only human milk for the first 6 months of life. b. Infants fed on formula should be started on solid food sooner than breastfed infants. c. If infants are weaned from breast milk before 12 months, they should receive cow's milk, not formula. d. After 6 months mothers should shift from breast milk to cow's milk.

a. Infants should be given only human milk for the first 6 months of life. Breastfeeding/human milk should also be the sole source of milk for the second 6 months. Infants start on solids when they are ready, usually at 6 months, whether they start on formula or breast milk. If infants are weaned from breast milk before 12 months, they should receive iron-fortified formula, not cow's milk.

Sara, age 4 months, was born at 35 weeks' gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that: a. Infants' temperaments are part of their unique characteristics. b. Infants become less difficult if they are not kept on scheduled feedings and structured routines. c. Sara's behavior is suggestive of failure to bond completely with her parents. d. Sara's difficult temperament is the result of painful experiences in the neonatal period.

a. Infants' temperaments are part of their unique characteristics. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.

The nurse must assess 10-month-old infant. The infant is sitting on the father's lap and appears to be afraid of the nurse and of what may happen next. Which initial action by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask the father to place the infant on the examination table. c. Undress the infant while he is still sitting on his father's lap. d. Talk softly to the infant while taking him from his father.

a. Initiate a game of peek-a-boo. Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done while the child is on the father's lap. The nurse should have the father undress the child as needed for the examination.

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce himself or herself. c. Explain the purpose of the interview. b. Make the family comfortable. d. Give an assurance of privacy.

a. Introduce himself or herself. The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next, the purpose of the interview and the nurse's role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce self. b. Make family comfortable. c. Explain purpose of interview. d. Give assurance of privacy.

a. Introduce self. The first thing that nurses should do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. Clarification of the purpose of the interview and the nurse's role is the next thing that should be done. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.

The nurse is interviewing the father of 10-month-old Megan. She is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says "No" firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that Megan: a. Is old enough to understand the word "No." b. Is too young to understand the word "No." c. Should already know that electrical outlets are dangerous. d. Will learn safety issues better if she is spanked.

a. Is old enough to understand the word "No." By age 10 months, children are able to associate meaning with words. The child should be old enough to understand the word "No." The 10-month-old is too young to understand the purpose of an electrical outlet. The father is using both verbal and physical cues to teach safety measures and alert the child to dangerous situations. Physical discipline should be avoided.

From a worldwide perspective, infant mortality in the United States: a. Is the highest of the other developed nations. b. Lags behind five other developed nations. c. Is the lowest infant death rate of developed nations. d. Lags behind most other developed nations.

a. Is the highest of the other developed nations. Although the death rate has decreased, the United States still ranks last among nations with the lowest infant death rates. The United States has the highest infant death rate of developed nations.

The nurse has a 2-year-old boy sit in "tailor" position during palpation for the testes. The rationale for this position is that: a. It prevents cremasteric reflex. b. Undescended testes can be palpated. c. This tests the child for an inguinal hernia. d. The child does not yet have a need for privacy.

a. It prevents cremasteric reflex. The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. Privacy should always be provided for children.

An infant at 26 weeks of gestation arrives intubated from the delivery room. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. The nurse's most appropriate action would be to: a. Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician. b. Continue to observe and make no changes until the saturations are 75%. c. Continue with the admission process to ensure that a thorough assessment is completed. d. Notify the parents that their infant is not doing well.

a. Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician. Listening to breath sounds and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician are appropriate nursing interventions to assist in optimal oxygen saturation of the infant. Oxygenation of the infant is crucial. O2 saturation should be maintained above 92%. Oxygenation status of the infant is crucial. The nurse should delay other tasks to stabilize the infant. Notifying the parents that the infant is not doing well is not an appropriate action. Further assessment and intervention are warranted before determination of fetal status.

Caregivers share with the nurse a concern that their 34-month-old child may be masturbating. The nurse would do some teaching with the caregivers to help them understand which of the following ideas? a. Manipulation of the genitalia and masturbation are a natural, private behavior of toddlerhood. b. Masturbation needs to be stopped before the child enters public or private school. c. Their child may be overly interested in sex, and this may be a sign of sexual abuse. d. Other caregivers will not let their children play with a child who masturbates.

a. Manipulation of the genitalia and masturbation are a natural, private behavior of toddlerhood. Caregivers share with the nurse a concern that their 34-month-old child may be masturbating. The nurse would do some teaching with the caregivers to help them understand that manipulation of the genitalia and masturbation are a natural, private behavior of toddlerhood.

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. To reassure the new parents whose infant develops such a soft bulge, it is important that the nurse be aware that this condition: a. May occur with spontaneous vaginal birth. b. Happens only as the result of a forceps or vacuum delivery. c. Is present immediately after birth. d. Will gradually absorb over the first few months of life.

a. May occur with spontaneous vaginal birth Bleeding may occur during a spontaneous vaginal delivery as a result of the pressure against the maternal bony pelvis. The soft, irreducible fullness does not pulsate or bulge when the infant cries. Low forceps and other difficult extractions may result in bleeding. However, cephalhematomas can also occur spontaneously. The swelling may appear unilaterally or bilaterally and is usually minimal or absent at birth. It increases over the first 2 to 3 days of life. Cephalhematomas disappear gradually over 2 to 3 weeks. A less common condition results in calcification of

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick, meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate: a. Meconium aspiration, hypoglycemia, and dry, cracked skin. b. Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome. c. Golden yellow- to green stained-skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat. d. Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance.

a. Meconium aspiration, hypoglycemia, and dry, cracked skin. Meconium aspiration, hypoglycemia, and dry, cracked skin are consistent with a postmature infant. Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome would be consistent with a very premature infant. The skin may be meconium stained, but the infant would most likely have longer hair and decreased amounts of subcutaneous fat. Postmaturity with a nonreactive NST would indicate hypoxia. Signs and symptoms associated with fetal hypoxia are hypoglycemia, temperature instability, and lethargy.

Which of the following is descriptive of deaths caused by unintentional injuries? a. More deaths occur in males. b. More deaths occur in females. c. The pattern of deaths varies widely in Western societies. d. The pattern of deaths does not vary according to age and sex.

a. More deaths occur in males. Most deaths from unintentional injuries occur in males. The pattern of death caused by unintentional injuries is consistent in Western societies. Causes of unintentional deaths vary with age and gender.

A careful review of the literature on the various recreational and illicit drugs reveals that: a. More longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs. b. Heroin and methadone cross the placenta; marijuana, cocaine, and phencyclidine (PCP) do not. c. Mothers should discontinue heroin use (detox) any time they can during pregnancy. d. Methadone withdrawal for infants is less severe and shorter than heroin withdrawal.

a. More longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs. Studies on the effects of marijuana and cocaine use by mothers are somewhat contradictory. More long-range studies are needed. Just about all these drugs cross the placenta, including marijuana, cocaine, and PCP. Drug withdrawal is accompanied by fetal withdrawal, which can lead to fetal death. Therefore, detoxification from heroin is not recommended, particularly later in pregnancy. Methadone withdrawal is more severe and more prolonged than heroin withdrawal.

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. The nurse should recommend: a. Never heating a bottle in a microwave oven. b. Heating only 10 ounces or more. c. Always leaving the bottle top uncovered to allow heat to escape. d. Shaking the bottle vigorously for at least 30 seconds after heating.

a. Never heating a bottle in a microwave oven. Neither infant formula nor breast milk should be warmed in a microwave oven as this may cause oral burns as a result of uneven heating in the container. The bottle may remain cool while hot spots develop in the milk. Warming expressed milk in a microwave decreases the availability of antiinfective properties and causes separation of the fat content. Milk should be warmed in a lukewarm water bath.

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands; however, she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.

a. Normal development. This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of developmental lag, delayed development, or neurologic dysfunction is present.

What is probably the single most important influence on growth at all stages of development? a. Nutrition c. Culture b. Heredity d. Environment

a. Nutrition Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment all contribute to the child's growth and development; however, good nutrition is essential throughout the life span for optimal health.

When preparing to administer a hepatitis B vaccine to a newborn, the nurse should: a. Obtain a syringe with a 25-gauge, 5/8-inch needle. b. Confirm that the newborn's mother has been infected with the hepatitis B virus. c. Assess the dorsogluteal muscle as the preferred site for injection. d. Confirm that the newborn is at least 24 hours old.

a. Obtain a syringe with a 25-gauge, 5/8-inch needle. The hepatitis B vaccine should be administered with a 25-gauge, 5/8-inch needle. Hepatitis B vaccination is recommended for all infants. If the infant is born to an infected mother who is a chronic carrier, hepatitis vaccine and hepatitis B immune globulin should be administered within 12 hours of birth. Hepatitis B vaccine should be given in the vastus lateralis muscle. Hepatitis B vaccine can be given at birth.

A child with a diagnosis of cerebral palsy is admitted to the hospital pediatric ward. The night nurse notices that this child is grinding his teeth. This nurse is aware that this behavior is most often due to which of the following causes in a child with cerebral palsy? a. jaw muscle spasticity c. lack of sufficient oxygen b. normal preschooler tension d. low hemoglobin

a. jaw muscle spasticity Children with cerebral palsy grind their teeth due to jaw muscle spasticity.

With the goal of preventing plagiocephaly, the nurse should teach new parents to: a. Place the infant prone for 30 to 60 minutes per day. b. Buy a soft mattress. c. Allow the infant to nap in the car safety seat. d. Have the infant sleep with the parents.

a. Place the infant prone for 30 to 60 minutes per day Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or "tummy time" for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.

An appropriate play activity for a 7-month-old infant to encourage visual stimulation is: a. Playing peek-a-boo. c. Imitating animal sounds. b. Playing pat-a-cake. d. Showing how to clap hands.

a. Playing peek-a-boo. Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands will help with kinesthetic stimulation. Imitating animal sounds will help with auditory stimulation.

When teaching the caregivers about transporting children safely in the car, the nurse will stress that the adults must abide by the same rules they expect the children to abide by, and this includes putting on the seat belt before the car moves, because of which of the following reasons? a. Preschoolers like to imitate whatever adults do. b. The caregiver could die or be comatose and be of no help at all in an accident. c. It is not fair for an adult to expect a child to do something the adult will not do. d. Adults are more likely to be hurt in an accident.

a. Preschoolers like to imitate whatever adults do. When teaching the caregivers about transporting children safely in the car, the nurse will stress that the adults must abide by the same rules they expect the children to abide by because preschoolers like to imitate whatever adults do.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. c. Sit erect without support. b. Roll from back to abdomen. d. Move from prone to sitting position.

a. Roll from abdomen to back. Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

Which term refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period c. Terminal points b. Sequential period d. Differentiation points

a. Sensitive period Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.

The nurse is observing parents playing with their 10-month-old daughter. What should the nurse recognize as evidence that the child is developing object permanence? a. She looks for the toy the parents hide under the blanket. b. She returns the blocks to the same spot on the table. c. She recognizes that a ball of clay is the same when flattened out. d. She bangs two cubes held in her hands.

a. She looks for the toy the parents hide under the blanket. Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning blocks to the same spot on a table is not an example of object permanence. Recognizing a ball of clay is the same when flat is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.

The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that: a. Soft and flexible shoes are generally better. b. High-top shoes are necessary for support. c. Inflexible shoes are necessary to prevent in-toeing and out-toeing. d. This type of shoe will encourage the infant to walk sooner.

a. Soft and flexible shoes are generally better. The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may be helpful keeping the child's foot in the shoe. Inflexible shoes can delay walking, aggravate in-toeing and out-toeing, and impede development of the supportive foot muscles.

Which characteristic is representative of the newborn's gastrointestinal tract? a. Stomach capacity is approximately 90 ml. b. Peristaltic waves are relatively slow. c. Overproduction of pancreatic amylase occurs. d. Intestines are shorter in relation to body size.

a. Stomach capacity is approximately 90 ml. Newborns require frequent small feedings because their stomach capacity is approximately 90 ml. Peristaltic waves are rapid. A deficiency of pancreatic lipase limits the absorption of fats. Newborn's intestines are longer in relation to body size than those of an adult.

When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should be based on which principle? a. The child may think the equipment is alive. b. The child is too young to understand what the equipment does. c. Explaining the equipment will only increase the child's fear. d. One brief explanation is enough to reduce the child's fear.

a. The child may think the equipment is alive. Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the child's fear. The preschooler will need repeated explanations as reassurance.

A mother asks the nurse to tell her what creeping is. She is expecting her baby to crawl any day and another mother says that her baby creeps. The nurse explains that creeping is when the baby: a. moves on hands and knees with the abdomen off the floor b. crawls using the elbows to scoot across the floor c. draws the legs up, stretches out, and repeats the process d. stands and walks on the toes with heels off the ground

a. moves on hands and knees with the abdomen off the floor Creeping is best described as when the baby moves on hands and knees with the abdomen off the floor.

The nurse's approach when introducing hospital equipment to a preschooler should be based on which principle? a. The child may think the equipment is alive. b. The child is too young to understand what the equipment does. c. Explaining the equipment will only increase the child's fear. d. One brief explanation will be enough to reduce the child's fear.

a. The child may think the equipment is alive. Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations will help alleviate the child's fear. The preschooler will need repeated explanations as reassurance.

With regard to the respiratory development of the newborn, nurses should be aware that: a. The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth. b. Newborns must expel the fluid from the respiratory system within a few minutes of birth. c. Newborns are instinctive mouth breathers. d. Seesaw respirations are no cause for concern in the first hour after birth.

a. The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth. The first breath produces a cry. Newborns continue to expel fluid for the first hour of life. Newborns are natural nose breathers; they may not have the mouth-breathing response to nasal blockage for 3 weeks. Seesaw respirations instead of normal abdominal respirations are not normal and should be reported.

The best reason for recommending formula over breastfeeding is that: a. The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. b. The mother lacks confidence in her ability to breastfeed. c. Other family members or care providers also need to feed the baby. d. The mother sees bottle-feeding as more convenient.

a. The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. Breastfeeding is contraindicated when mothers have certain viruses, are undergoing chemotherapy, or are using/abusing illicit drugs. A lack of confidence, the need for others to feed the baby, and the convenience of bottle-feeding are all honest reasons for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability (expressing milk into bottles) could change some minds. In any case the nurse must provide information in a nonjudgmental manner and respect the mother's decision. Nonetheless, breastfeeding is definitely contraindicated when the mother has medical or drug issues of her own.

As related to the normal functioning of the renal system in newborns, nurses should be aware that: a. The pediatrician should be notified if the newborn has not voided in 24 hours. b. Breastfed infants likely will void more often during the first days after birth. c. "Brick dust" or blood on a diaper is always cause to notify the physician. d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

a. The pediatrician should be notified if the newborn has not voided in 24 hours. A newborn who has not voided in 24 hours may have any of a number of problems, some of which deserve the attention of the pediatrician. Formula-fed infants tend to void more frequently in the first 3 days; breastfed infants void less during this time because the mother's breast milk has not come in yet. Brick dust may be uric acid crystals; blood spotting could be caused by withdrawal of maternal hormones (pseudomenstruation) or a circumcision. The physician must be notified only if there is no apparent cause of bleeding. Weight loss from fluid loss may take 14 days to regain.

Nurses can assist parents who are trying to decide whether their son should be circumcised by explaining: a. The pros and cons of the procedure during the prenatal period. b. That the American Academy of Pediatrics (AAP) recommends that all newborn boys be routinely circumcised. c. That circumcision is rarely painful and any discomfort can be managed without medication. d. That the infant will likely be alert and hungry shortly after the procedure.

a. The pros and cons of the procedure during the prenatal period. Many parents find themselves making the decision during the pressure of labor. The AAP and other professional organizations note the benefits but stop short of recommendation for routine circumcision. Circumcision is painful and must be managed with environmental, nonpharmacologic, and pharmacologic measures. After the procedure the infant may be fussy for several hours, or he may be sleepy and difficult to awaken for feeding.

With regard to umbilical cord care, nurses should be aware that: a. The stump can easily become infected. b. A nurse noting bleeding from the vessels of the cord should immediately call for assistance. c. The cord clamp is removed at cord separation. d. The average cord separation time is 5 to 7 days.

a. The stump can easily become infected. The cord stump is an excellent medium for bacterial growth. The nurse should first check the clamp (or tie) and apply a second one. If the bleeding does not stop, the nurse calls for assistance. The cord clamp is removed after 24 hours when it is dry. The average cord separation time is 10 to 14 days.

During the school-age years, a malocclusion can occur. Which of the following statements best describes a malocclusion? a. The upper and lower teeth come together in a way that the permanent upper and lower teeth do not approximate. b. A permanent tooth cannot come through the gum due to a baby tooth still being in place. c. The teeth and jaws are aligned in such a manner as to prevent the lips from coming together. d. The tag of skin under the tongue is so tight that until it is cut the tongue cannot work properly in concert with the teeth.

a. The upper and lower teeth come together in a way that the permanent upper and lower teeth do not approximate. A malocclusion is an abnormality of the coming together of the teeth and occurs when the permanent upper and lower teeth do not approximate, leaving them crowded or uneven.

At what age do children tend to imitate the religious gestures and behaviors of others without understanding their significance? a. Toddlerhood c. Older school-age period b. Young school-age period d. Adolescence

a. Toddlerhood Toddlerhood is a time of imitative behavior. Children will copy the behavior of others without comprehending any significance or meaning to the activities. During the school-age period most children develop a strong interest in religion. The existence of a deity is accepted, and petitions to an omnipotent being are important. Although adolescents become more skeptical and uncertain about religious beliefs, they do understand the significance of religious rituals.

What type of breath sound is normally heard over the entire surface of the lungs, except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular c. Adventitious b. Bronchial d. Bronchovesicular

a. Vesicular Vesicular breath sounds are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions where trachea and bronchi bifurcate.

Which of the following best describes habituation? a. ability to decrease responses to disturbing stimuli b. staying still for longer periods of time c. breathing more slowly than usual d. adjusting to temperature increases and decreases

a. ability to decrease responses to disturbing stimuli The ability to decrease responses to disturbing stimuli best describes the term, habituation.

Which of the following statements best describes the term crowd then used to describe peer relationships? a. an association of two to four cliques with relations less intimate than in the cliques b. a large number of peers who gather periodically to socialize c. the number of people that then exceeded makes socialization uncomfortable d. five or more people who are engaged in observational and encouraging behaviors

a. an association of two to four cliques with relations less intimate than in the cliques The term crowd is defined as an association of two to four cliques with relations less intimate than in the cliques.

Which of the following behaviors best describes an example of classical conditioning? a. an infant getting excited when seeing the spoon used for feeding b. a child crying when frightened by a dog c. children singing when directed by the choir director d. the dog barking when seeing the master come down the stairs

a. an infant getting excited when seeing the spoon used for feeding An infant getting excited when seeing the spoon used for feeding does best describe an example of classical conditioning.

The nurse is teaching the caregivers about the immediate care of the newborn circumcised without a plastibell. The nurse would teach the caregivers to: a. apply a thin layer of petroleum jelly to the circumcision b. remove any yellow exudate that accumulates on the penis about the second day after circumcision c. apply powder to the area of the circumcision d. use hydrogen peroxide to wash the circumcision area after each voiding

a. apply a thin layer of petroleum jelly to the circumcision If the plastibell is not used, there will be an open cut that will adhere to diapers. A thin layer of petroleum jelly applied to the circumcision will keep the diapers from sticking.

The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother either staying in the room or leaving. This action should be considered: a. appropriate because of child's age. b. appropriate because mother would be uncomfortable making decisions for child. c. inappropriate because of child's age. d. inappropriate because child is same sex as mother.

a. appropriate because of child's age. The older school-age child should be given the option of having the parent present or not. During the examination, the nurse should respect the child's need for privacy. Although the question was appropriate for the child's age, the mother is responsible for making decisions for the child. It is appropriate because of the child's age. During the examination, the nurse must respect the child's privacy. The child should help determine who is present during the examination.

When comparing the development of a number of children, you would expect which aspect of developmental change to be the same in all the children? a. basic sequence of changes c. length of each change b. onset of each change d. response

a. basic sequence of changes When comparing the development of a number of children, you would expect the basic sequence of developmental change to be the same in all the children.

A mother asks the nurse for advice on what kind of books would best keep the attention of her preschooler. Which of the following descriptions by the nurse would be the best advice? a. books with a predictable storyline and repeated phrases that help keep a child's attention b. adventure books with unusual and unpredictable surprise happenings throughout the book c. various types of poetry d. nursery rhymes

a. books with a predictable storyline and repeated phrases that help keep a child's attention If the mother asks the nurse for advice on what kind of books would best hold the attention of her preschooler, the nurse will advise books with a predictable storyline and repeated phrases that help keep a child's attentionq

The caregivers are tired of their child's temper tantrums and share this information with the nurse. The nurse tells the caregivers that these temper tantrums will disappear: a. by the age of 4 b. when the caregivers discipline the child properly c. when the child is able to reason d. after the child is toilet trained

a. by the age of 4 The nurse tells the caregivers that these temper tantrums will disappear by the age of 4.

The nurse is assessing a 6-year-old child's thought processes. The nurse will find which of the following types of thinking? a. concrete and in present-time frame c. abstract and in future-time frame b. concrete and focused in the past d. abstract and focused in the past

a. concrete and in present-time frame A 6-year-old child is limited to thinking concretely and in the present time frame.

The type of heat exchange that occurs between the newborn and water during a bath or when exposed to drafts is called: a. convection c. conduction b. evaporation d. radiation

a. convection The type of heat exchange that occurs between the newborn and water during a bath or when exposed to drafts is called convection.

Growth rate slows for toddlers due to which of the following causes? a. decline in appetite and erratic eating habits b. hormonal changes, especially a decline in growth hormone c. increased activity levels burning more calories d. sleep problems resulting in less sleep per night

a. decline in appetite and erratic eating habits Growth rate slows for toddlers due to decline in appetite and erratic eating habits.

During Sullivan's early childhood stage, excessive parental disapproval may cause children to see themselves and the world as: a. negative or hostile c. undeserving b. inadequate and wanting d. sick

a. negative or hostile During Sullivan's early childhood stage, excessive parental disapproval may cause children to see themselves and the world as negative or hostile.

The nurse is assessing a toddler's psychosocial developmental level using Erikson's eight stages. Which of the following behaviors would the nurse most likely find if the child were demonstrating being in shame and doubt instead of having mastered autonomy? a. dependency and constantly looking to others for approval b. sleep disturbance, crying, and vomiting c. always imitating others rather than using imagination d. frequent crying, emotional outbursts, and whining

a. dependency and constantly looking to others for approval Erikson's theory of psychosocial development posits the toddler years are engaged in establishing autonomy versus shame and doubt. Children demonstrating dependency and constantly needing approval for their actions are experiencing doubt.

In males, which of the following secretions is responsible for sperm production and maturation of the seminiferous tubules? a. follicle-stimulating hormone (FSH) c. testosterone b. luteinizing hormone (LH) d. cortisone

a. follicle-stimulating hormone (FSH) In males, follicle-stimulating hormone (FSH) is responsible for sperm production and maturation of the seminiferous tubules.

When the fetus makes the transition to becoming a newborn and extrauterine life begins, there occurs a series of changes, including decreased pulmonary vascular resistance, increased pulmonary blood flow, increased pressure of the left atrium, decreased pressure of the right atrium, and closure of which of the following structures? a. foramen ovale c. inferior vena cava b. ductus venosus d. superior vena cava

a. foramen ovale The transition to extrauterine life requires the lungs to initiate respirations and the PaO2 levels increase. The opening between the left and right atria, the foramen ovale, closes shortly after birth.

.Which of the following tasks is one of the three major psychosocial tasks of toddlerhood? a. gaining self-control c. sharing with others b. learning to play well with others d. finding an identity

a. gaining self-control Gaining self-control is one of the three major psychosocial tasks of toddlerhood. The other two tasks are developing autonomy and increasing independence.

In the nature versus nurture controversy about human development, the nature view sees development as mainly influenced by which of the following factors? a. genetic c. culture b. environmental d. chance

a. genetic In the nature versus nurture controversy about human development, the nature view sees development as mainly influenced by genetics.

The nurse is teaching the caregivers about the immediate care of the newborn circumcised utilizing the plastibell. The nurse would instruct the caregivers to: a. gently lift the ring and squeeze warm water from a cotton ball onto the tip of the penis when changing the diaper b. take the bell off when the baby is awake, active, and likely to pull on the bell and dislodge it c. pull the ring off in 5 to 7 days when the circumcision is near or completely healed d. wash the bell and the penis with alcohol several times a day

a. gently lift the ring and squeeze warm water from a cotton ball onto the tip of the penis when changing the diaper The nurse is teaching the caregivers about the immediate care of the newborn circumcised utilizing the plastibell. The nurse would instruct the caregivers to gently lift the ring and squeeze warm water from a cotton ball onto the tip of the penis when changing the diaper.

The transitional stool of the newborn usually occurs by the 3rd day and is: a. green brown-yellow brown c. grayish b. clay color d. light yellow-light green

a. green brown-yellow brown The transitional stool of the newborn usually occurs by the 3rd day and is green brown-yellow brown.

Until myelination of the spinal cord is completed, the child will: a. have some difficulty in walking b. have difficulty kicking a ball forward without losing balance c. experience transitory paresthesia of the legs d. have diminished feeling from the waist down

a. have some difficulty in walking The child is not able to walk well until myelinization of the spinal cord is completed.

The school nurse is forking with a 17-year-old student who has experienced a crisis period and has achieved a sense of commitment to resulting decisions. This teen is well adjusted, stable, and mature. The nurse, using Marcia's theory that adolescents occupy one of four identity statuses, will find this student occupying which of the following identity statuses? a. identity achievement c. identity diffusion b. foreclosed d. moratorium

a. identity achievement Using Marcia's expansion of Erikson, the 17-year-old having experienced a period of crisis resulting in commitments exhibiting stability, maturity and is well adjusted, has arrived at identity achievement.

Who is usually the first to notice that something is wrong with vision or hearing in an infant? a. infant's caregivers c. nurse b. pediatrician d. relatives

a. infant's caregivers The infant's caregivers are usually the first to notice that something is wrong with vision or hearing in an infant.

The nurse assessing a 12-1/2-year-old child asks the child about siblings. This preteen tells the nurse that there has been recent conflict and less support from a sibling close in age. The nurse realizes that at this age this perceived decrease in support and increased conflict: a. is reaching a peak and is not unusual b. is possibly due to watching too much violence on television c. has to do with caregivers treating the children differently d. is a sign of impending lifelong relationship problems

a. is reaching a peak and is not unusual Progression through adolescence is associated with a reduction in perceived sibling support and a corresponding increase in perceived sibling conflict.

The pediatrician suggests that the caregivers begin to introduce iron-fortified rice cereal as the first solid food to their baby. The mother later asks the nurse why the health care practitioner wants her to give the baby iron-fortified rice cereal instead of some other food. The nurse's best response to this question is that this particular cereal: a. is the easiest to digest and least likely to cause allergies b. does not have many calories and won't decrease the baby's milk intake c. is an important bulk to help the baby have semisolid bowel movements d. is inexpensive and high in vitamins and minerals

a. is the easiest to digest and least likely to cause allergies If the mother is asking why the nurse recommends iron-fortified rice cereal, the nurse's best response to this question: it is the easiest to digest and least likely to cause allergies.

The nurse teaching the new mother about breast care will advise the mother to wash the breasts: a. with plain water c. with alcohol and cotton swabs b. with soap and water d. with a peroxide-and-water solution

a. with plain water The nurse teaching the new mother about breast care will advise the mother to wash the breasts with plain water.

The nurse can help caregivers understand the uniqueness of a child's personality and provide a guide for child-rearing techniques by assessing and explaining the: a. nine attributes of temperament and the characteristics of the personality type b. caregiver's personalities and identifying any underlying pathology c. ten personality traits associated with the introvert-extrovert scale d. wake-sleep pattern and percentage of time a child spends without crying

a. nine attributes of temperament and the characteristics of the personality type The nurse can help caregivers understand the uniqueness of a child's personality and provide a guide for child-rearing techniques by assessing and explaining the nine attributes of temperament and the characteristics of the personality type.

According to La Leche League International, what can happen if a pacifier is introduced before the nursing relationship has been established? a. nipple confusion or refusal to breastfeed b. pacifier may choke the infant c. continued use of the pacifier into grade school d. reliance on the pacifier for soothing instead of the breast

a. nipple confusion or refusal to breastfeed According to La Leche League International, nipple confusion or refusal to breastfeed can happen if a pacifier is introduced before the nursing relationship has been established

An adolescent boy is concerned that his pajamas are wet in the morning and worries that he is losing control over his bladder or beginning to wet the bed. His father explains that this dampness is most likely due to: a. nocturnal emissions, a normal occurrence in adolescents b. changes in the prostate gland during adolescence c. temporary bladder changes that occur as the male matures d. excessive masturbation, and he needs to decrease the amount

a. nocturnal emissions, a normal occurrence in adolescents Explaining the wet pajamas in the morning, the father tells the son that he is experiencing nocturnal emissions, a normal occurrence for boys after age 14.

When a mother plays peek-a-boo with a baby, the mother is helping teach the baby which of the following? a. object permanence c. visual skill b. coordination d. vocal rhythm

a. object permanence When a mother plays peek-a-boo with a baby, the mother is helping teach the baby object permanence.

To avoid overlooking food allergies in the toddler, the nurse would advise the caregivers to add new foods: a. one at a time c. on the weekends b. no more than once a week d. during the evening meal only

a. one at a time To avoid overlooking food allergies in the toddler, the nurse would advise the caregivers to add new foods one at a time.

From birth to 1 year of age, the infant is in which of the following stages, according to Freudian theory? a. oral c. phallic b. anal d. genital

a. oral From birth to 1 year of age, the infant is in the oral stage, according to Freudian theory.

The biggest predictor of a child's risk of developing obesity in adulthood is which of the following factors? a. parental obesity c. amount of time spent sleeping b. living in the country d. two-caregiver household

a. parental obesity The biggest predictor of a child's risk of developing obesity in adulthood is parental obesity.

Which of the following best describes the term physiologic anorexia? a. period of decreased appetite as a result of decreased caloric need b. refusing to eat in order to get secondary gains from behavior c. not eating, which brings a variety of changes in body function d. changes in appetite due to fluctuating eating habits

a. period of decreased appetite as a result of decreased caloric need A period of decreased appetite as a result of decreased caloric need best describe the term physiologic anorexia.

The school nurse is working with a child who has a crisis-oriented family, which is in crisis mode at the present time. Which of the following methods would be most productive for the nurse to use in helping this child release tension? a. play c. singing b. talk d. back rub

a. play Play is the most productive method for tension reducing and the release of frustrations in this child.

According to Kohlberg, the first level of moral development is called: a. preconventional c. conventional b. instrumental realistic orientation d. postconventional

a. preconventional The first level of moral development is called the preconventional level (birth to 7 years of age) and is characterized by an egocentric focus.

When children use language and have a growing understanding of the past, present, and future, they are in which of the following stages or phases of a stage, according to Piaget? a. preoperational stage c. mental combinations phase b. preconceptual phase d. tertiary circular reactions phase

a. preoperational stage During the preoperational stage (2-7 years) use language and have a growing understanding of the past, present, and future.

The nurse is working with the caregivers to prepare the preschooler for the first day of school. Which of the following activities by the caregivers would most likely help? a. put the child on a school schedule a few weeks before school starts b. have an older child tell the preschooler about the school schedule c. talk about the expectations and rules of the school d. give the child a book with lots of pictures and big print

a. put the child on a school schedule a few weeks before school starts By placing the child on a school schedule in advance, the child will become increasingly familiar with the routine, which will likely make the adjustment easier.

Which of the following statements best describes the purpose of phototherapy? a. reducing serum bilirubin level and preventing brain damage b. raising the body temperature of a neonate with a subnormal temperature c. producing X-rays of the internal organs of the body d. reducing pain in the muscles and joints of the body

a. reducing serum bilirubin level and preventing brain damage Phototherapy is the use of special high-intensity fluorescent lights as a method of reducing serum bilirubin level and preventing brain damage.

Routine physical examinations on children include height, weight, vital signs, physical examination, vision and hearing screening, diet assessment, screening for alcohol and other drug use, and screening for which of the following? a. scoliosis c. myasthenia gravis b. sickle-cell anemia d. parasites

a. scoliosis Routine physical examinations on children include all of the above including screening for scoliosis.

The Tanner stages are a rating for which of the following in females? a. sequence of secondary sexual characteristics with stages describing breast and pubic hair growth b. ability to be independent of caregivers and care for oneself while living alone c. readiness for marriage or mating and readiness for childbearing activities, with a scoring of 1 to 100 d. sequence of emotional and psychological changes occurring in adolescence and ending in maturity

a. sequence of secondary sexual characteristics with stages describing breast and pubic hair growth The Tanner stages are a rating for the sequence of secondary sexual characteristics with stages describing breast and pubic hair growth in females.

Piaget theorized that development moves from: a. simple to complex-begins with the concrete and proceeds to abstraction b. head to toe-begins with the face and proceeds to the hands and feet c. easy to difficult-begins with smiling and proceeds to complex thinking d. physical to neuronal-begins with small movements and proceeds to communication

a. simple to complex-begins with the concrete and proceeds to abstraction According to Piaget, cognitive development occurs gradually, sequentially, and without regression. He postulated that development moves from simple to complex, begins with concrete situations and objects, and proceeds to abstraction.

In Freudian theory the component of the personality that emerges when the child internalizes values, roles, and morals is called the: a. superego c. id b. ego d. anti-Narcissus

a. superego The superego, or conscience, emerges when the child internalizes caregiver or societal values, roles and morals.

A situation is considered stressful for a child when: a. the child perceives that he or she is unable to meet the demands placed on him or her b. a child's behavior changes from the usual behavior to new and different behaviors c. the child exhibits any of the symptoms normally associated with stress d. it would normally be considered stressful for a child

a. the child perceives that he or she is unable to meet the demands placed on him or her A situation is considered stressful for a child when there is a discrepancy between demands placed on her or him and the individual's perceived ability to meet these demands.

Which of the following statements best describes the term caregiver responsiveness? a. the degree to which caregivers respond to their children's needs in an accepting, supportive manner b. the speed with which caregivers provide for a child's physiological and psychological needs c. the caregivers' interest in providing for a child's needs, as perceived by the child d. the effect demonstrated by a caregiver in response to a child's demands

a. the degree to which caregivers respond to their children's needs in an accepting, supportive manner Caregiver responsiveness is best described as the degree to which caregivers respond to their children's needs in an accepting, supportive manner.

If a toddler seizes or loses consciousness, the tongue may obstruct the airway. This obstruction by the tongue is even more likely at this age because: a. the tongue is large in proportion to the size of the mouth b. children do not have as great a muscle control as adults c. younger children gag more easily than older children and adults d. the airway is smaller in the toddler than in the adult

a. the tongue is large in proportion to the size of the mouth If a toddler seizes or loses consciousness, the tongue may obstruct the airway. This obstruction by the tongue is even more likely at this age because the tongue is large in proportion to the size of the mouth.

According to Sullivan's stages of interpersonal development, the primary task of the first stage is: a. to learn to rely on others, especially the primary caregiver, to gratify physiological needs and achieve satisfaction b. to satisfy egotistical and narcissistic needs c. to learn how to please the caregivers and others d. to become independent of caregivers and separate oneself from the environment and significant people

a. to learn to rely on others, especially the primary caregiver, to gratify physiological needs and achieve satisfaction According to Sullivan's stages of interpersonal development, the primary task of the first stage is to learn to rely on others, especially the primary caregiver, to gratify physiological needs and achieve satisfaction.

The nurse uses what equipment to check for fluid between the parietal and visceral layers of the tunica vaginalis, the outermost covering of the testes? a. transilluminator c. manometer b. 30 cc syringe d. fluid meter

a. transilluminator The use of the transilluminator may reveal a hydrocele or a collection of fluid between the parietal and visceral layers of the tunica vaginalis, the outermost covering of the testes.

According to Erikson, the psychosocial development of an infant is centered around the concept of: a. trust versus mistrust c. growth versus failure to grow b. pleasure versus pain d. love versus hate

a. trust versus mistrust Erikson's psychosocial development of an infant is centered around the concept of trust versus mistrust.

The nurse is forking with a prepubescent adolescent. The family asks the nurse to explain then the adolescent will go through puberty. The nurse's response will be based on the idea that the age then puberty begins: a. varies individually b. is about the same for all females c. is slightly different for males and females d. depends on the person's culture

a. varies individually The age then puberty begins and how long adolescence lasts varies individually and cross-culturally.

A mother is concerned about her preschool child running into the street without looking. The nurse would advise this mother that for preschoolers: a. verbal reminders of established limits and looking before crossing are effective b. fear of punishment is the only thing that works to prevent this behavior c. an adult must be with the preschool child at all times d. children this age seldom run into the street without looking unless chasing a ball

a. verbal reminders of established limits and looking before crossing are effective For the mother concerned about her preschooler running into the street without looking, the nurse would advise that for preschoolers verbal reminders of established limits and looking before crossing are effective.

While assessing an infant, the nurse notices that the child does not watch objects when they are dropped. The nurse will most suspect which of the following problems that will be further assessed? a. visual problems c. decreased energy b. absent or diminished hearing d. infant depression

a. visual problems When the nurse notices that the child does not watch objects when they are dropped, you will suspect visual problems.

The mother of a 6-month-old infant is distressed because the infant can say "dada" but not "mama" and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond? a. "At this age, your baby does not understand the meaning of sounds." b. "Babies at this age cannot make the 'ma' sound." c. "Most sounds made by babies at this age are accidental." d. "This may mean that your baby doesn't hear well."

a. "At this age, your baby does not understand the meaning of sounds." At 6 months, infants delight in vocalizing sounds that they learn by imitation but do not ascribe meaning to the sounds they make. Infants can say "mama" but without meaning. Babies make sounds on purpose by imitating what they hear. A preference for one sound early in speech does not indicate a hearing deficit.

The nurse has discussed with a mother the process of introducing solid foods to her 6-month-old infant. What statement by the mother leads the nurse to determine that learning has taken place? a. "I will give my infant rice cereal first." b. "I will give my infant yellow vegetables first." c. "I will give my infant egg yolks first." d. "I will give my infant fruits first."

a. "I will give my infant rice cereal first." Solid foods are usually introduced at about 6 months of age, starting with rice cereal, which is the least allergenic.

The mother of a 2-week-old infant tells the nurse that she thinks he is sleeping too much. What is the most appropriate nursing response to this mother? a. "Tell me how many hours per day your baby sleeps." b. "It is normal for newborns to sleep most of the day." c. "Newborns generally sleep 12 to 15 hours per day." d. "You will find as the baby gets older, he sleeps less."

a. "Tell me how many hours per day your baby sleeps." Although it is true that newborns sleep a great deal of any 24-hour period, the nurse must find out what the mother means by "too much" before giving any information.

The mother of a postterm infant asks the nurse why the infant is being watched so closely. What is the nurse's most appropriate response? a. "The placenta does not function adequately as it ages." b. "Infants born postmaturely are generally large." c. "Delivery of the postterm infant is more difficult." d. "There is less amniotic fluid."

a. "The placenta does not function adequately as it ages." Fetal distress may occur in the postterm infant because placental functioning becomes inadequate with maturity.

The nurse caring for a preterm infant will record the intake and output. The nurse is aware that what is the optimum output for this infant? a. 1 to 3 mL/kg/hr b. 4 to 6 mL/kg/hr c. 7 to 9 mL/kg/hr d. 10 to 14 mL/kg/hr

a. 1 to 3 mL/kg/hr The optimum output for a preterm infant is 1 to 3 mL/kg/hr.

A mother asks the nurse how much food should be offered to her 2-year-old. What is a good rule of thumb for serving size (in tablespoons) per year of age? a. 2 b. 3 c. 4 d. 5

a. 2 The rule of thumb for serving sizes is to offer 1 tablespoon of each food group per year of age.

When does the posterior fontanelle close? a. 2 to 3 months b. 3 to 6 months c. 6 to 9 months d. 9 to 12 months

a. 2 to 3 months The posterior fontanelle closes between 2 and 3 months of age.

The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" What is the nurse's most accurate response? a. 5 months b. 9 months c. 1 year d. 2 years

a. 5 months The infant can usually drink from a cup when it is offered at about 5 months.

The primary care pediatric nurse practitioner is examining a school-age child who complains of frequent stomach pain and headaches. The parent reports that the child misses several days of school each month. The child has a normal exam. Before proceeding with further diagnostic tests, what will the nurse practitioner initially ask the parent? a. About the timing of the symptoms each day and during the week b. How well the child performs in school and in extracurricular activities c. If the parent feels a strong need to protect the child from problems d. Whether there are any unusual stressors or circumstances at home

a. About the timing of the symptoms each day and during the week Children with school refusal or school phobia often have symptoms that gradually improve as the day progresses and often disappear on weekends. The PNP should ask about the frequency and duration of the symptoms to evaluate this pattern. The other options are important questions when management of school phobia has begun as a way of understanding underlying causes for the reluctance to go to school.

The primary care pediatric nurse practitioner is counseling the parents of a toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the pediatric nurse practitioner recommend? a. a. Allow the child to explore and experiment while providing appropriate limits. b. b. Be present while the child plays to continually teach the child what is appropriate. c. c. Let the child experiment at will and to make mistakes in order to learn. d. d. Say "no" whenever the child does something that is not acceptable.

a. Allow the child to explore and experiment while providing appropriate limits. The child who is securely attached uses the parents as a base from which to safely explore the world. Toddlers learn by doing and need to experiment to gain mastery over the environment. It is important that parents are present for safety, but parents should not be ever-present and controlling. Parents should be close by and should intervene if the child is at risk for injury. Continual criticism and the use of the word "no" can make the toddler feel powerless.

The primary care pediatric nurse practitioner cares for children from a Native American family and learns that they used many herbs to treat and prevent illness. Which approach will the pediatric nurse practitioner use to promote optimum health in the children? a. Ask about the types of practices used and when they are applied. b. Provide a list of harmful herbs and ask the family to avoid those. c. Suggest that the family avoid using these remedies in their children. d. Tell the parents to use the herbs in conjunction with modern medications.

a. Ask about the types of practices used and when they are applied. The challenge, when working with families from different cultural backgrounds, who use alternative or complementary medicines, is to find ways to achieve a mutual understanding of the differences and to negotiate an acceptable plan of care. The first step is to begin a discussion about these practices. Providing a list of harmful herbs, suggesting that the family avoid certain herbs, and suggesting that the herbs are only an adjunct to "modern medicine" will sound disparaging and will convey a sense of mistrust.

During a well child exam of a school-age child, the primary care pediatric nurse practitioner learns that the child has been having angry episodes at school. The nurse practitioner observes the child to appear withdrawn and sad. Which action is appropriate? a. Ask the child and the parent about stressors at home b. Make a referral to a child behavioral specialist c. Provide information about anger management d. Suggest consideration of a different classroom

a. Ask the child and the parent about stressors at home School-age children are learning to manage emotions and need help to manage their feelings in acceptable ways. A variety of stressors, including parental divorce, substance abuse, bullying in school, and early responsibilities, can cause anxiety in the child, who may not manage these feelings well. Until the underlying cause is better understood, management options cannot be determined, so referrals to specialists, information about anger management, or moving to a different classroom may not be indicated.

The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschool-age child. How will the nurse practitioner assess this? a. Ask the child how many books he has at home. b. Ask the mother about her highest grade in school. c. Ask the mother to determine the correct dose of a drug from a label. d. Ask the mother to read a health information handout aloud.

a. Ask the child how many books he has at home. The "newest vital sign," or health literacy, can be determined quickly by asking the parent how many children's books are in the home. Greater than 10 books in the home is an independent positive predictor of adequate parent health literacy. The other questions may determine a specific level of literacy in general but are not as efficient.

The primary care pediatric nurse practitioner is evaluating a 2-year-old with a documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next? a. a. Ask the child's parents whether they read to the child. b. b. Give parents educational materials to encourage speech. c. c. Refer the child to an early intervention program. d. d. Suggest that they purchase age-appropriate music videos.

a. Ask the child's parents whether they read to the child. Language development requires oral-motor ability, auditory perception, and cognitive ability, which this child has been shown to have, as well as the psychosocial-cultural environment to motivate the child to engage in language use. The PCPNP's initial step should be to determine whether the parents provide such an environment. Educational materials may be used after it is determined that these are useful. Early intervention may be used if the speech delay persists. Music videos do not necessarily engage the child in expression of speech.

The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially? a. Ask the parents if they have an individualized family service plan (IFSP). b. Consult with a physician to ensure the child gets appropriate care. c. Inform the family that services are provided when the child begins school. d. Refer the family to a social worker for assistance with referrals and services.

a. Ask the parents if they have an individualized family service plan (IFSP). Families with children who have developmental delays are eligible for early intervention services and should have IFSPs in place. This family may have one from their previous community, and it can be used as a starting point to determine needs. It is not necessary to consult with a physician to coordinate community resources. Early intervention is provided from birth, according to federal law. Until the specific referrals are known, the social worker is not consulted.

The primary care pediatric nurse practitioner is examining a child whose parents recently emigrated from a war-torn country in the Middle East. Which is a priority assessment when performing the patient history? a. Asking about physical, psychological, and emotional trauma b. Determining the parents' English language competency and literacy level c. Learning about cultural preferences and complementary medicine practices d. Reviewing the child's previous health and illness records

a. Asking about physical, psychological, and emotional trauma Recent history that includes trauma, loss, and refugee camp experience may exacerbate difficulties adjusting to life in the U.S. and can lead to acute and chronic physical and mental health concerns. All of the other parts of the history will be necessary, but this should be a priority, since the family has escaped a war-torn country.

A primary care pediatric nurse practitioner working in a community health center wishes to develop a program to assist impoverished children and families to have access to healthy foods. Which strategy will the pediatric nurse practitioner employ to ensure the success of such a program? a. Asking community members to assist in researching and implementing a program b. Designing a community garden approach that involves children and their parents c. Gaining support from the corporate community to provide needed resources d. Providing evidence-based information about the importance of a healthy diet

a. Asking community members to assist in researching and implementing a program Community collaboration can be fostered through community-based participatory research (CBPR), which is transformative research that bridges the gap between science and practice by actively engaging communities with formally trained researchers. In this type of research, community members formally participate in all aspects of the process, making the findings more relevant to the community it affects the most. Designing a community garden approach without first knowing whether the community needs or wants it does not ensure success. Gaining support from the corporate community without input from the affected community does not guarantee success. Giving evidence-based information does not involve the community members in research and does not increase success.

The primary care pediatric nurse practitioner prescribes a twice daily inhaled corticosteroid for a 12- year-old child. At a well child visit, the child reports not using the medication on a regular basis. Which response by the pediatric nurse practitioner demonstrates an understanding of client-centered care? a. Asking the child to describe usual daily routines and schedules b. Referring the family to a social worker to help with medication compliance c. Reviewing the asthma action plan with the parent and the child d. Teaching the child how the medication will help to control asthma symptoms

a. Asking the child to describe usual daily routines and schedules In a client-centered relationship, there is reciprocal communication and understanding. The PNP should be able to understand the client's perspective and unique situation. The first step is to evaluate possible reasons for nonadherence and not to make referrals or re-educate until potential barriers have been identified and negotiation with the client has occurred.

The primary care pediatric nurse practitioner is performing a well child assessment on an adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner use? a. CRAFFT b. HEEADSSS c. PHQ-2 d. RAAPS

a. CRAFFT The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse. The HEEADSSS is used as a psychosocial screening tool. The PHQ-2 is a rapid screen for depression. The RAAPS is used to assess risk behaviors that contribute to most morbidity, mortality, and social problems in teens.

The primary care pediatric nurse practitioner has a cohort of patients who have special health care needs. Which is an important role of the nurse practitioner when caring for these children? a. Care coordination and collaboration b. Developing protocols for parents to follow c. Monitoring individual education plans (IEPs) d. Providing lists of resources for families

a. Care coordination and collaboration Care coordination is one of the key elements for children with special health care needs. PNPs are especially suited for this role and have the unique skills to function as care coordinators. Care for these children should involve shared decision making and individualized care and not "cookbook" approaches. The PNP may advocate for children's health care needs for the IEP but does not monitor these. The PNP should not just give parents lists of phone numbers but should assist them to make appointments.

What activity would the nurse choose to meet Erikson's developmental task of industry when caring for a 7-year-old? a. Completing a 50-piece jigsaw puzzle b. Looking at a comic book c. Playing a game of "I Spy" with the nurse d. Coloring a picture in a coloring book

a. Completing a 50-piece jigsaw puzzle In the developmental period of late childhood, children are striving to develop a sense of industry. The completion of a jigsaw puzzle is industrious play.

During an assessment of a 4-week-old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4-hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend? a. Continuing to nurse the infant using the current pattern b. Nursing the infant for longer periods every 4 hours c. Supplementing with formula at the last nighttime feeding d. Waking the infant every 2 hours to nurse during the night

a. Continuing to nurse the infant using the current pattern Infants who are encouraged to breastfeed every 2 to 3 hours may have one longer stretch of 4 hours at night. This infant is gaining between 0.5 and 1 gram per day, which is appropriate. It is not necessary to alter the pattern of nursing or to supplement with formula.

When assessing a preterm infant, the nurse observes nasal flaring, sternal retractions, and expiratory grunting. What do these findings indicate? a. Respiratory distress syndrome b. Postmaturity syndrome c. Apneic episode d. Cold stress

a. Respiratory distress syndrome Insufficient amounts of surfactant predispose the preterm infant to respiratory distress. The signs manifested by the infant are indicative of respiratory distress.

When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource? a. DC: 0-3R b. ICD-10-CM c. ICSD-3 d. NANDA International

a. DC: 0-3R The DC: 0-3R refers to the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood and is useful for developmental problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3 is the International Classification of Sleep Disorders - 3rd edition. NANDA International is used to label problems in the functional health domain.

The primary care pediatric nurse practitioner performs a physical examination on a 12-year-old child and notes poor hygiene and inappropriate clothes for the weather. The child's mother appears clean and well dressed. The child reports getting 6 to 7 hours of sleep each night because of texting with friends late each evening. What action by the nurse practitioner will help promote healthy practices? a. Discuss setting clear expectations about self-care with the mother b. Give the child information about sleep and self-care c. Reassure the mother that this "non-compliance" is temporary d. Tell the mother that experimenting with self-care behaviors is normal

a. Discuss setting clear expectations about self-care with the mother Parents of school-age children should be advised to set clear limits for their children for cleanliness, healthy exercise, hours of sleep, and other health promotion behaviors to encourage the development of responsibility for these things. Giving the child information can be done along with setting expectations, but, at this age, the parent should still be supervising. While "non-compliance" is a part of this process, and is a means of asserting independence, parents need to discuss this with children to resolve the issue.

The nurse compared the birth weight of a 3-day-old with her current weight and determined the infant had lost weight. What is the most appropriate intervention by the nurse? a. Do nothing because this is a normal occurrence. b. Report the discrepancy to the pediatrician immediately. c. Decrease the interval between the infant's feedings. d. Try feeding the infant a different type of formula.

a. Do nothing because this is a normal occurrence. It is typical for the newborn to lose 5% to 10% of his or her birth weight in the first 3 to 4 days of life. No change in the plan of care is needed.

The nurse encourages a Puerto Rican family to bring food to a child because he is not eating the food served on his hospital tray. What can the nurse expect the child to eat? a. Dried beans mixed with rice b. Crisp vegetables c. Spaghetti and meatballs d. Wild berries, roots, and seeds

a. Dried beans mixed with rice A common food choice of Americans of Puerto Rican descent is dried beans mixed with rice.

The nurse is caring for an infant born at 43 weeks. What would the physical assessment reveal? a. Dry, peeling skin b. Minimal hair on the head c. Short, rough nails d. Abundant lanugo on the body

a. Dry, peeling skin Loss of vernix caseosa leaves the skin dry, causing peeling.

The primary care pediatric nurse practitioner is evaluating recurrent stomach pain in a school-age child. The child's exam is normal. The nurse practitioner learns that the child reports pain most evenings after school and refuses to participate in sports but does not have nausea or vomiting. The child's grandmother recently had gallbladder surgery. Which action is correct? a. Encourage the child to keep a log of pain, stool patterns, and dietary intake b. Order radiologic studies and laboratory tests to rule out systemic causes c. Reassure the child and encourage resuming sports when symptoms subside d. Refer the child to a counselor to discuss anxiety about health problems

a. Encourage the child to keep a log of pain, stool patterns, and dietary intake The PNP suspects a somatic disorder after a normal exam and should encourage the child to keep a food or pain diary to help manage symptoms. The PNP should not "medicalize" the problem with tests. The child should be encouraged to resume sports and participate in normal activities. If the symptoms persist, referral for counseling is warranted.

A new mother is voicing concern she is breastfeeding her newborn too frequently. How often does the nurse instruct this mother she should expect her newborn to feed? a. Every 2 to 3 hours b. Every 4 to 6 hours c. Every 6 to 8 hours d. Every 8 to 10 hours

a. Every 2 to 3 hours Breastfed infants may require feedings at 2- to 3-hour intervals because breast milk is more easily digested. A flexible but regular schedule that provides a rest period between feedings is best for the parent and infant.

Which assessment of the newborn should be reported? a. Head circumference is 5 cm greater than the chest circumference b. Hands and feet are warm with a blue color c. Temperature is 36.6° C (97.8° F) d. Head has a longer than normal shape to it

a. Head circumference is 5 cm greater than the chest circumference The circumference of the head should be less than 2 cm greater than that of the chest. All other listed assessments are within the norm.

What nursing action is appropriate to prevent possible retinopathy in a preterm infant requiring oxygen therapy? a. Monitor arterial oxygen levels with a pulse oximeter. b. Position the head slightly lower than the body. c. Administer low concentrations of oxygen. d. Keep the infant's eyes covered at all times.

a. Monitor arterial oxygen levels with a pulse oximeter. Use of a pulse oximeter to carefully monitor arterial blood gases in high-risk infants continues to be a priority in the neonatal intensive care unit (NICU).

The primary care pediatric nurse practitioner is performing a well child check-up on a 20-month-old child. The child was 4 weeks premature and, according to a parent-completed developmental questionnaire, has achieved milestones for a 15-month-old infant. Which action is correct? a. Perform an in-depth developmental assessment screen at this visit to evaluate this child. b. Reassure the parent that the child will catch up to normal development by age 2 years. c. Re-evaluate this child's development and milestone achievements at the 2-year visit. d. Refer the child to a specialty clinic for evaluation and treatment of developmental delay.

a. Perform an in-depth developmental assessment screen at this visit to evaluate this child. This child should be at a 19-month adjusted age for prematurity so, according to the parent screen, is 4 months behind. The PNP should perform a more in-depth screen to evaluate this delay. Waiting to see if the child will "catch up" or assuring the parent that this will happen will cause the delays to become more severe. A referral to a specialty clinic should not be made solely on the basis of the parent-completed questionnaire but only after further evaluation of possible delays.

The primary care pediatric nurse practitioner is examining a 12-month-old infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first? a. Perform an in-depth developmental assessment. b. Reassure the parent that this is normal for a premature infant. c. Refer the infant to a developmental specialist. d. Suggest activities to improve fine motor skills.

a. Perform an in-depth developmental assessment. When developmental screening indicates an infant is not progressing at the expected rate, additional testing to determine the degree of delay is necessary. A referral may be needed if a delay is determined. This is not normal for this degree of prematurity; infants should develop a pincer grasp by 9 to 10 months of age.

What would the nurse further investigate when assessing patterns of growth in a child? a. Previous weight was in the 75th percentile, and present weight is in the 25th percentile. b. Height is in the 90th percentile, and weight is in the 75th percentile. c. Last weight was in the 5th percentile, and present weight is in the 10th percentile. d. Weight is in the 50th percentile, and sibling's weight at the same age was in the 75th percentile.

a. Previous weight was in the 75th percentile, and present weight is in the 25th percentile. The child showing a difference of two or more percentile levels from an established growth pattern should undergo further evaluation.

The nurse is assessing a 1-year-old infant in the pediatric office. What finding should the nurse report to the physician immediately? a. Respiratory rate of 60 breaths per minute b. Pulse rate of 100 beats per minute c. Minimal verbalization d. Fussy behavior

a. Respiratory rate of 60 breaths per minute Respirations of a 1-year-old should be 20 to 40 breaths per minute. Increased respiratory rate can lead to distress and should be reported immediately. Pulse rate of 100 to 140 beats/minute is normal. Minimal verbalization and fussy behavior are not emergency situations or abnormal for this age.

When the newborn's crib was moved suddenly, the nurse noticed that his legs flexed and arms fanned out, and then both came back toward the midline. How would the nurse interpret this behavior? a. The Moro reflex b. The grasp reflex c. An abnormality of the musculoskeletal system d. A neurological abnormality

a. The Moro reflex The Moro reflex is a normal neonatal reflex. It is elicited when the infant's crib is jarred. The infant responds by drawing the legs up, fanning the arms, and then bringing the arms to the midline in an embrace position.

A mother tells her 4-year-old child that balls should be played with outside and not inside the house. Why is the child likely to obey the rule? a. The child does not want to be punished. b. The child wants to please her mother. c. The child respects authority figures. d. The child believes that following the rules is right.

a. The child does not want to be punished. According to Kohlberg, children in the preconventional stage (4 to 7 years) are obedient to their parents for fear of punishment.

The parent of a 5-month-old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent? a. The infant may be expressing a desire to play or to rest. b. The parent should give ibuprofen for teething pain before nursing. c. This is an indication that the infant is ready for solid foods. d. This may indicate gastrointestinal discomfort such as constipation.

a. The infant may be expressing a desire to play or to rest At this age, infants may cry when they are tired or need social interaction and not just when they are hungry. The PNP should teach parents about this change in social development so they can be responsive to their infant's needs. Solid foods are not added until age 6 months. Teething usually does not begin until at least 6 months. GI discomfort usually occurs after eating.

The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. What does this behavior indicate the infant has developed? a. The pincer grasp b. A grasp reflex c. Prehension ability d. The parachute reflex

a. The pincer grasp By 1 year, the pincer-grasp coordination of index finger and thumb is well established.

Why does a 4-day-old infant born at 33 weeks of gestation possibly need to be fed by gavage during the first few days of life? a. Weak or absent sucking or swallowing reflex b. Inability to digest food properly c. Refusal to take formula by mouth d. Need for a larger quantity of formula at each feeding

a. Weak or absent sucking or swallowing reflex When the preterm infant's sucking and swallowing reflexes are immature, gavage feedings can be used to promote nutrition.

The nurse is caring for a newborn who is being breastfed. What will the nurse expect the stool color to be 2 days after birth? a. Yellow b. Brown c. Greenish brown d. Black and tarry

a. Yellow The stool of a breastfed infant is bright yellow, soft, and pasty.

A single mother of an infant worries that living in a household with only one parent will cause her child to be maladjusted. To help address the mother's concerns, the primary care pediatric nurse practitioner will suggest : a. developing consistent daily routines for the child. b. exposing her child to extended family members when possible. c. not working outside the home during the first few years. d. taking her child to regular play date activities with other children.

a. developing consistent daily routines for the child. Providers can teach parents that providing predictable, consistent, and loving care helps an infant to learn trust and help influence positive brain development. Involving extended family members and going to play dates are good ways to socialize children but are not essential to learning trust. It may not be possible for her to be a stay-at-home mother.

The parents of a special needs child tell the primary care pediatric nurse practitioner that they are planning a 3-month visit to their home country in Africa. The pediatric nurse practitioner assists the family to obtain a sufficient supply of medications and formula and to make sure that the child's equipment can be transported and used during the trip and at the destination. This is an example of a. global application. b. global awareness. c. system application. d. system awareness.

a. global application Global application involves having a willingness and ability to adjust to the needs of clients, families, and communities both nationally and globally. Global awareness involves knowledge of diseases, political, and economic factors worldwide that affect health. System application involves assisting clients to overcome institutional barriers to effective interventions. System awareness is knowledge of these barriers.

A father asks the nurse to explain what people mean when they use the term latency, because someone recently referred to his 7-year-old child as being in "latency." Which of the following is the most accurate response the nurse could give? a. "When children are gaining weight or height slower than the average child, this is referred to as latency growth." b. "Beginning at age 6 and lasting throughout the school-aged years, the child has a calm period in sexual development that is called latency." c. "When children are experiencing physical and emotional changes preparing them for puberty, this is latency." d. "This is a developmental period between the preschool period and the prepubescent period."

b. "Beginning at age 6 and lasting throughout the school-aged years, the child has a calm period in sexual development that is called latency." According to Freud's psychosexual theory, starting at age 6 years and throughout school-age, the child enters a calm period in the development of sexuality called latency.

The nurse is teaching the caregivers how to handle a 2-year-old's negativism. Which of the following communications to the child by the caregivers would indicate they had understood the nurse's teaching? a. "Do you want lunch now?" b. "Do you want peanut butter or bologna for lunch?" c. "If you don't stop for lunch now, you will have to go in time-out." d. "If you don't hurry up and eat, we won't have time to go to the store."

b. "Do you want peanut butter or bologna for lunch?" Communications to the child by the caregivers that would indicate they had understood the nurse's teaching about how to handle a 2-year-old's negativism would be "Do you want peanut butter or bologna for lunch?"

The mother asks the nurse if she can stop giving the baby iron-fortified rice cereal at age 13 months, as the baby prefers other foods. The best response by the nurse would be which of the following? a. "Yes, that is not a problem, as your baby is now producing enough iron." b. "Due to the baby's need for iron, you need to continue this cereal until the baby is 18 months old." c. "You could substitute potatoes for the iron-fortified rice cereal." d. "Give the baby whatever the baby prefers, as calories are more important than content at this age."

b. "Due to the baby's need for iron, you need to continue this cereal until the baby is 18 months old." If the mother asks the nurse if she can stop giving the baby iron-fortified rice cereal at 13 month, the best response by the nurse would be: "Due to the baby's need for iron, you need to continue this cereal until the baby is 18 months old."

A father asks the nurse why his toddler engages in fantasy and make-believe in play. The best answer by the nurse is: a. "Some children use fantasy to escape their stressful world, so the more stressful their life is, the more they fantasize." b. "Fantasy helps the toddler cope with caregiver expectations and helps the child conceptualize how he or she wishes the world to be." c. "Your child probably does not have enough playmates to keep busy in reality-based play." d. "Some children are just more imaginative and creative than others, and these children engage in fantasy play."

b. "Fantasy helps the toddler cope with caregiver expectations and helps the child conceptualize how he or she wishes the world to be." The best answer by the nurse is "Fantasy helps the toddler cope with caregiver expectations and helps the child conceptualize how he or she wishes the world to be."

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them: a. "Infants can see very little until about 3 months of age." b. "Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns." c. "The infant's eyes must be protected. Infants enjoy looking at brightly colored stripes." d. "It's important to shield the newborn's eyes. Overhead lights help them see better."

b. "Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns." "Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns" is an accurate statement. Development of the visual system continues for the first 6 months of life. Visual acuity is difficult to determine, but the clearest visual distance for the newborn appears to be 19 cm. Infants prefer to look at complex patterns, regardless of the color. Infants prefer low illumination and withdraw from bright light.

During a routine physical examination, the health care practitioner mentions that an adolescent girl has asymmetrical breasts. The girl is too embarrassed to ask the doctor about this, but she also notices one breast seems bigger than the other. She asks the school nurse: "Why is one of my breasts bigger than the other? What is wrong?" The best response by the nurse is which of the following? a. "You have not achieved full growth. The smaller breast will eventually grow and they will be the same size." b. "Many women have asymmetrical breasts. It is not unusual for one breast to be slightly larger." c. "Don't worry too much about this, as the health care practitioner will surely order a mammogram." d. "This condition will correct itself after you have experienced menarche."

b. "Many women have asymmetrical breasts. It is not unusual for one breast to be slightly larger." Asymmetry of the breasts is considered a normal finding in females.

A father asks the nurse how many hours of sleep a 2-year-old requires each day. The best response by the nurse would be: a. "Eight to ten hours and a nap is usually adequate by the time a child is 2." b. "Most 2-year-olds need 12 to 14 hours of sleep every day, with a nap as well." c. "A 2-year-old needs at least 15 hours and two naps per day." d. "It depends on the child, with some only needing 4 to 6 hours and others needing 9 to 10."

b. "Most 2-year-olds need 12 to 14 hours of sleep every day, with a nap as well." The best response by the nurse would be "Most 2-year-olds need 12 to 14 hours of sleep every day, with a nap as well."

Parents ask the nurse if their child will always have this innocent heart murmur. Which of the following is the best answer? a. "Yes, this murmur will not disappear and your child will have it throughout life." b. "No, this murmur will no longer be heard when your child becomes an adolescent." c. "Most children are lucky and the murmur goes away after a year or two." d. "This murmur will usually be cured with a period of rest, diet, and medication."

b. "No, this murmur will no longer be heard when your child becomes an adolescent." As many as 50% of all school-aged children have an innocent heart murmur between the ages of 6 and 10 years of age. Such murmurs are not associated with heart disease and will not be heard when the child reaches adolescence.

A child talks to the school nurse about the fact she is sleep talking at night. The child wants to know if there is something seriously wrong with her and if she needs to go to a physician. Which of the following is the nurse's best response? a. "Sleep talking can be a sign of intestinal parasites, so your parents do need to take you to the doctor." b. "Sleep talking does not indicate a health problem, and it does not require that anything be done." c. "I will call your parents and have them come in so we can all talk about this problem together." d. "This problem can be caused by any number of things including stress, and I wonder if you are under any stress."

b. "Sleep talking does not indicate a health problem, and it does not require that anything be done." Sleep talking or somniloquy can occur at any age across the life span and does not indicate a health concern or need for intervention.

A mother tells the nurse that she is frustrated by her toddler saying "no" to everything she says. Which of the following statements by the nurse would be true and most helpful to the mother? a. "Reform every question so the child will have to say 'yes' to get what she wants." b. "This is an expression of your child's search for autonomy, and it will usually stop by about 30 months of age." c. "Walk away from your child when she tells you 'no,' and pay attention when she says 'yes,' so you can modify this behavior." d. "Start telling the child 'no' whenever she asks you for something so she will get the idea that negativity is not rewarding."

b. "This is an expression of your child's search for autonomy, and it will usually stop by about 30 months of age." The statement by the nurse responding to a mother who verbalizes she is frustrated by her toddler saying "no" to everything she says that would be true and most helpful is "This is an expression of your child's search for autonomy, and it will usually stop by about 30 months of age."

The mother observes traces of blood on the diaper of her newborn daughter and calls this to the attention of the nurse. The nurse's best reply would be which of the following? a. "I suspect this is from a urinary tract infection, a condition common in newborns when the bladder is not completely developed." b. "This is probably caused by the baby not getting maternal hormones from the placenta. It will probably go away soon." c. "This is probably from the trauma of the birth and will disappear in time." d. "This is some placental blood we missed when bathing the baby at birth."

b. "This is probably caused by the baby not getting maternal hormones from the placenta. It will probably go away soon." The usual cause of small traces of blood on the female newborn's diaper is from the withdrawal of maternal hormones, called pseudomenstruation, and caregivers may need reassurance that this is normal and will soon disappear.

The nurse is preparing to give a 34-month-old toddler who has a persistent cough some cough syrup. Which of the following statements by the nurse would best help the toddler understand why he or she is being given this medicine? a. "This will help you not to cough your head off." b. "This medicine will help you feel better and will help your cough go away." c. "If you take this, you won't have to have a stick in the arm." d. "The doctor wants you to take this medicine whenever you have a bad cough."

b. "This medicine will help you feel better and will help your cough go away." The statement by the nurse "this medicine will help you feel better and will help your cough go away" would best help the toddler understand why he or she is being given this medicine.

Which of the following statements by the caregiver of a preschooler would indicate that the caregiver had paid attention to the nurse's instructions on dental hygiene practices? a. "Our child brushes his teeth all by himself without any help from us." b. "We give our child a pea-sized amount of fluoride toothpaste." c. "When our child is 6 years old, we will make an appointment to see the dentist." d. "When our child does a good job brushing, we let her have a lollypop."

b. "We give our child a pea-sized amount of fluoride toothpaste." "We give our child a pea-sized amount of fluoride toothpaste" is the statement made by the caregiver that would indicate that the caregiver had paid attention to the nurse's instructions on dental hygiene practices.

The school nurse is talking with a group of parents about the growth and development of their school-aged children. A parent asks the nurse, "Just what are growing pains?" Which of the following is the best response? a. "The bones hurt when calcium builds up and the bones are stretching out in length." b. "When the long bones are growing faster than the attached muscle, pain can occur." c. "The nerves are chemically irritated when the bones are elongating in growth." d. "As the bones get longer, the skin has to grow and stretch and this hurts."

b. "When the long bones are growing faster than the attached muscle, pain can occur." Growing pains are the result of the long bones growing faster than the attached muscles.

The nurse is doing some teaching with a toddler, explaining that the child is to take medicine to help him get well and that it is taken once a day until the total amount prescribed is finished (7 days). The mother and the nurse agree that this medicine will be given in the early morning each day. Which of the following statements by the nurse will the toddler understand best? a. "Your mommy will give you the medicine between 8:00 and 9:00 AM each morning until it is gone." b. "You will be taking your medicine every morning after breakfast until it is gone." c. "For a week you will be taking your medicine in the early morning." d. "Your mommy will give you your medicine every day by 9:00 AM until it is gone."

b. "You will be taking your medicine every morning after breakfast until it is gone. The nurse is explaining to a toddler that he is to take medicine to help him get well and that it is taken once a day until the total amount prescribed is finished (7 days). The toddler will understand best the statement

The pediatric nurse is assigned to care for a 7-year-old child in the hospital. The child is going to have surgery in the morning. The child asks the nurse if this surgery will hurt. Which of the following is the nurse's best response? a. "An anesthetist will put you to sleep so you won't feel anything." b. "You will sleep through the surgery so it won't hurt. When you wake up, we will give you medicine to make any hurting better." c. "The doctor who specializes in sleep is going to knock you out real good, so don't worry about feeling any pain." d. "A stick in the arm to give you medicine to sleep is all you will feel."

b. "You will sleep through the surgery so it won't hurt. When you wake up, we will give you medicine to make any hurting better." When caring for school-age children, it is important to use correct terminology they will understand. Children of this age may interpret each word literally. It is best to explain the sequence of events the child will experience and exactly what will happen.

The nurse is forking with an adolescent client in the hospital. The adolescent requests the caregivers bring some books about puns to the hospital. He frequently uses puns in conversation and is highly critical about the hospital rules, the caregivers, and many aspects of the world. The caregivers ask the nurse why their adolescent is acting so differently in adolescence compared to then he was younger. The best answer by the nurse would include which of the following statements? a. "This is your child's way of dealing with the stress of hospitalization." b. "Your child has developed the ability to use abstract thinking." c. "Perhaps some psychological tests might help determine if this is normal." d. "Setting limits in regard to critical statements often helps stop this behavior."

b. "Your child has developed the ability to use abstract thinking." The best answer by the nurse concerning the adolescent who expresses criticism and likes to make puns, is: "Your child has developed the ability to use abstract thinking."

The normal value of the specific gravity of a newborn's urine is: a. 0.008-0.009 c. 1.1-1.7 b. 1.001-1.02 d. 1.8-1.9

b. 1.001-1.02 The normal value of the specific gravity of a newborn's urine is close to the specific gravity of water, as their kidneys are not able to concentrate urine immediately after birth.

The typical age that girls begin dating in the United States is which of the following? a. 10 to 11 c. 14 to 15 b. 12 to 13 d. 16 to 17

b. 12 to 13 Girls begin dating in the United States typically between the ages of 12 and 13.

It is appropriate for the nurse to recommend that an adolescent girl see a pediatrician if she has not yet begun breast development by what age? a. 11 years c. 15 years b. 13 years d. 17 years

b. 13 years It is appropriate for the nurse to recommend that an adolescent girl see a pediatrician if she has not yet begun breast development by age 13.

The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately: a. 10 pounds. c. 20 pounds. b. 15 pounds. d. 25 pounds.

b. 15 pounds. Birth weight doubles at about age 5 to 6 months. At 6 months, an infant who weighed 7 pounds at birth would weigh approximately 15 pounds. Ten pounds is too little; the infant would have gone from the 50th percentile at birth to below the 5th percentile. Twenty pounds or more is too much; the infant would have tripled the birth weight at 6 months.

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month c. 3 months b. 2 months d. 4 months

b. 2 months At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months, the infant can enjoy social interactions.

The earliest age at which a satisfactory radial pulse can be taken in children is: a. 1 year c. 3 years b. 2 years d. 6 years

b. 2 years Satisfactory radial pulses can be used in children older than 2 years. In infants and young children the apical pulse is more reliable. The radial pulse can be used for assessment at ages 3 and 6 years.

How many kilocalories per ounce do breast milk and most formulas provide? a. 10 c. 30 b. 20 d. 40

b. 20 Breast milk and most formulas provide 20 kilocalories per ounce.

Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? a. 1 month c. 6 to 8 months b. 3 to 4 months d. 12 months

b. 3 to 4 months Binocularity is usually achieved by ages 3 to 4 months. Age 1 month is too young for binocularity. If binocularity is not achieved by 6 months, the child must be observed for strabismus.

A caregiver asks the nurse when his baby can have semisolid foods like infant cereal and applesauce. The nurse replies that the introduction of semisolid foods usually occurs between: a. 1 and 2 months c. 7 and 9 months b. 4 and 6 months d. 10 and 11 months

b. 4 and 6 months The nurse will recommend the introduction of semisolid foods at 4 to 6 months of age.

The mother asks the nurse when her baby will be able to hold his head up. The best response by the nurse is that the baby will be able to hold his head up at: a. 3 months b. 4 months and also use the forearms for support c. 6 months, if the baby is not overfed and overweight d. 7 months

b. 4 months and also use the forearms for support The best response by the nurse is that the baby will be able to hold his head up at 4 months and also use the forearms for support.

When is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months c. When birth weight has tripled b. 4 to 6 months d. When tooth eruption has started

b. 4 to 6 months Physiologically and developmentally, the 4- to 6-month-old is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding. Two to 3 months is too young. The extrusion reflex is strong, and the infant will push food out with the tongue. No research base indicates that the addition of solid food to bottle-feeding has any benefit. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

A parent asks the pediatric nurse, "How tall is the average 6-year-old boy, and how much does the average 6-year-old boy weigh?" After advising the parent that each child is unique and growth is affected by many factors, the nurse would give the average height and weight for a 6-year-old boy as: a. 36 inches tall and 37 pounds c. 50 inches tall and 54 pounds b. 46 inches tall and 45 pounds d. 60 inches tall and 63 pounds

b. 46 inches tall and 45 pounds At 6 years, the average boy weighs 45 pounds and is 46 inches tall.

According to the American Academy of Pediatrics, the use of fluoride supplements to babies whose home drinking water does not contain at least 0.3 parts per million (ppm) concentration should begin at which of the following ages? a. 3 months c. 1 year b. 6 months d. 2 years

b. 6 months The American Academy of Pediatrics recommends the use of fluoride supplements beginning at 6 months, but only if the home drinking water does not contain at least 0.3 parts per million (ppm) concentration.

According to Piaget, the concrete operations stage occurs in which of the following age ranges? a. 3 to 6 years c. 12 to 15 years b. 7 to 11 years d. 16 to 18 years

b. 7 to 11 years The concrete operations stage occurs during the ages 7-11 years.

Unless there is some contraindication, the nurse knows to check with the caregivers to be certain that most fruits and vegetables have been added, as well as strained meats, by the time that the infant is how many months old? a. 5 to 7 c. 11 to 13 b. 8 to 10 d. 14 to 16

b. 8 to 10 The nurse knows to check with the caregivers to be certain that most fruits, vegetables and strained meats have been added to the infant's diet at about 8 to 10 months.

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. This should be interpreted as: a. Inappropriate, because of child's age. b. A way to establish rapport. c. Too distracting, when cooperation is important. d. Acceptable, if there is adequate time.

b. A way to establish rapport. A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic.

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include: a. Hypertonia, tachycardia, and metabolic alkalosis. b. Abdominal distention, temperature instability, and grossly bloody stools. c. Hypertension, absence of apnea, and ruddy skin color. d. Scaphoid abdomen, no residual with feedings, and increased urinary output.

b. Abdominal distention, temperature instability, and grossly bloody stools. Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis.

Which statement is true about toy safety? a. Adults should be the only ones who select toys. b. Adults should be alert to notices of recalls by manufacturers. c. Government agencies inspect all toys on the market. d. Evaluation of toy safety is a joint effort between children and adults.

b. Adults should be alert to notices of recalls by manufacturers. Adults should be involved in the selection of toys for children to ensure that they are safe and age appropriate. Once the child is using a toy, the adult should be alert to manufacturer recalls. The child and adult should be involved in the joint process of toy selection. Government agencies do not inspect all toys for sale. The U.S. Consumer Products Safety Commission does keep track of potentially dangerous and recalled toys. Children do not have the ability to determine the safety of a toy. It is the adult's responsibility.

An examiner who discovers unequal movement or uneven gluteal skin folds during the Ortolani maneuver would then: a. Tell the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. b. Alert the physician that the infant has a dislocated hip. c. Inform the parents and physician that molding has not taken place. d. Suggest that, if the condition does not change, surgery to correct vision problems may be needed.

b. Alert the physician that the infant has a dislocated hip. The Ortolani maneuver is a technique for checking hip integrity. Unequal movement suggests that the hip is dislocated. The physician should be notified.

When the nurse interviews an adolescent, it is especially important to: a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Emphasize that confidentiality will always be maintained. d. Use the same type of language as the adolescent.

b. Allow an opportunity to express feelings. Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

When the nurse interviews an adolescent, which is especially important? a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Emphasize that confidentiality will always be maintained. d. Use the same type of language as the adolescent.

b. Allow an opportunity to express feelings. Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

The activity view of a child's development would most believe which of the following statements? a. The personality and activity levels of children are for the most part shaped by association with family. b. An inquisitive, friendly, outgoing child may encourage the same behavior in indifferent and unfriendly people. c. Children who are fearful as toddlers will most likely retain some paranoia as adults and isolate themselves. d. Teachers and peers are the most important indicators of a child's motivation to seek meaningful experiences.

b. An inquisitive, friendly, outgoing child may encourage the same behavior in indifferent and unfriendly people. The activity view of a child's development would most believe an inquisitive, friendly, outgoing child may encourage the same behavior in indifferent and unfriendly people.

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap

b. Brian playing with his truck next to Kristina playing with her truck An example of parallel play is when both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play, such as Brian and Kristina playing with their own trucks side by side. Sharing clay is characteristic of associative play. A group of children playing a board game is characteristic of cooperative play. Playing alone on the mother's lap is an example of solitary play.

To prevent the abduction of newborns from the hospital, the nurse should: a. Instruct the mother not to give her infant to anyone except the one nurse assigned to her that day. b. Apply an electronic and identification bracelet to mother and infant. c. Carry the infant when transporting him or her in the halls. d. Restrict the amount of time infants are out of the nursery.

b. Apply an electronic and identification bracelet to mother and infant. A measure taken by many facilities is to band both the mother and the baby with matching identification bracelets and band the infant with an electronic device that will alarm if the infant is removed from the maternity unit. It is impossible for one nurse to be on call for one mother and baby for the entire shift, so parents need to be able to identify the nurses who are working on the unit. Infants should always be transported in their bassinette, for both safety and security reasons. All maternity unit nursing staff should have unique identification bracelets in comparison with the rest of the hospital. Infants should remain with their parents and spend as little time in the nursery as possible.

The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is sexually active is to: a. Ask her, "Are you sexually active?" b. Ask her, "Are you having sex with anyone?" c. Ask her, "Are you having sex with a boyfriend?" d. Ask both the girl and her parent if she is sexually active.

b. Ask her, "Are you having sex with anyone?" Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information to the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone.

The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined? a. Ask for a detailed listing of symptoms. b. Ask the adolescent, "Why did you come here today?" c. Use what the adolescent says to determine, in correct medical terminology, what the problem is. d. Interview the parent away from the adolescent to determine the chief complaint.

b. Ask the adolescent, "Why did you come here today?" The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him or her to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time.

The caregivers ask the nurse how to deal with questions of sexuality. Which of the following suggestions would the nurse most likely stress? a. Give as detailed an explanation as you can about the subject. b. Before explaining anything, find out what the child really wants to know. c. Tell the child before he or she finds out from the television or movies. d. Talk to your child with one of his or her friends present.

b. Before explaining anything, find out what the child really wants to know. The caregivers need to clarify what the child really wants to know before beginning detailed explanations.

The breastfeeding mother should be taught a safe method to remove the breast from the baby's mouth. Which suggestion by the nurse is most appropriate? a. Slowly remove the breast from the baby's mouth when the infant has fallen asleep and the jaws are relaxed. b. Break the suction by inserting your finger into the corner of the infant's mouth. c. A popping sound occurs when the breast is correctly removed from the infant's mouth. d. Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.

b. Break the suction by inserting your finger into the corner of the infant's mouth. Inserting a finger into the corner of the baby's mouth between the gums to break the suction avoids trauma to the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in "chewing" on the nipple that makes it sore. A popping sound indicates improper removal of the breast from the baby's mouth and may cause cracks or fissures in the breast. Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.

Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is supportive; however, known interventions may decrease the risk of NEC. To develop an optimal plan of care for this infant, the nurse must understand which intervention has the greatest effect on lowering the risk of NEC: a. Early enteral feedings c. Exchange transfusion b. Breastfeeding d. Prophylactic probiotics

b. Breastfeeding A decrease in the incidence of NEC is directly correlated with exclusive breastfeeding. Breast milk enhances maturation of the gastrointestinal tract and contains immune factors that contribute to a lower incidence or severity of NEC, Crohn's disease, and celiac illness. The neonatal intensive care unit nurse can be very supportive of the mother in terms of providing her with equipment to pump breast milk, ensuring privacy, and encouraging skin-to-skin contact with the infant. Early enteral feedings of formula or hyperosmolar feedings are a risk factor known to contribute to the development of NEC. The mother should be encouraged to pump or feed breast milk exclusively. Exchange transfusion may be necessary; however, it is a known risk factor for the development of NEC. Although still early, a study in 2005 found that the introduction of prophylactic probiotics appeared to enhance the normal flora of the bowel and therefore decrease the severity of NEC when it did occur. This treatment modality is not as widespread as encouraging breastfeeding; however, it is another strategy that the care providers of these extremely fragile infants may have at their disposal.

The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would be inaccurate and provide conflicting information to the patient? a. Women who breastfeed have a decreased risk of breast cancer. b. Breastfeeding is an effective method of birth control. c. Breastfeeding increases bone density. d. Breastfeeding may enhance postpartum weight loss.

b. Breastfeeding is an effective method of birth control. Women who breastfeed have a decreased risk of breast cancer, an increase in bone density, and a possibility of quicker postpartum weight loss. Breastfeeding delays the return of fertility; however, it is not an effective birth control method.

Which tool measures body fat most accurately? a. Stadiometer c. Cloth tape measure b. Calipers d. Paper or metal tape measure

b. Calipers Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. The nurse is testing for: a. Deep tendon reflexes. c. Sensory discrimination. b. Cerebellar function. d. Ability to follow directions.

b. Cerebellar function. The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although this test enables the nurse to evaluate the child's ability to follow directions, it is used primarily for cerebellar function.

A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant's body temperature every hour. Maintaining the newborn's body temperature is important for preventing: a. Respiratory depression. c. Tachycardia. b. Cold stress. d. Vasoconstriction.

b. Cold stress. Loss of heat must be controlled to protect the infant from the metabolic and physiologic effects of cold stress, and that is the primary reason for placing a newborn under a radiant heat warmer. Cold stress results in an increased respiratory rate and vasoconstriction.

The type of injury a child is especially susceptible to at a specific age is most closely related to: a. Physical health of the child. b. Developmental level of the child. c. Educational level of the child. d. Number of responsible adults in the home.

b. Developmental level of the child. The child's developmental stage determines the type of injury that is likely to occur. The child's physical health may facilitate his or her recovery from an injury. Educational level is related to developmental level, but it is not as important as the child's developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child's developmental stage.

A mother reports that her 6-year-old child is highly active and irritable and that she has irregular habits and adapts slowly to new routines, people, or situations. According to Chess and Thomas, which category of temperament best describes this child? a. Easy child c. Slow-to-warm-up child b. Difficult child d. Fast-to-warm-up child

b. Difficult child This is a description of difficult children, who compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. Fast-to-warm-up children is not one of the categories identified by Chess and Thomas.

A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan? a. Avoid use of pacifiers. b. Eliminate all secondhand smoke contact. c. Lay infant flat after feeding. d. Avoid swaddling the infant.

b. Eliminate all secondhand smoke contact. To prevent and treat colic, teach parents that if household members smoke, they should avoid smoking near the infant; smoking activity should preferably be confined to outside of the home. A pacifier can be introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy blanket and placed in an upright seat after feedings.

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the: a. Transition period. c. Organizational stage. b. First period of reactivity. d. Second period of reactivity.

b. First period of reactivity. The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The infant is highly alert during this phase. The transition period is the phase between intrauterine and extrauterine existence. There is no such phase as the organizational stage. The second period of reactivity occurs roughly between 4 and 8 hours after birth, after a period of prolonged sleep.

A newborn was admitted to the neonatal intensive care unit after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until premature rupture of membranes and preterm birth. The newborn's parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. The nurse's most appropriate action would be to: a. Wait quietly at the newborn's bedside until the parents come closer. b. Go to the parents, introduce himself or herself, and gently encourage the parents to come meet their infant; explain the equipment first, and then focus on the newborn. c. Leave the parents at the bedside while they are visiting so they can have some privacy. d. Tell the parents only about the newborn's physical condition, and caution them to avoid touching their baby.

b. Go to the parents, introduce himself or herself, and gently encourage the parents to come meet their infant; explain the equipment first, and then focus on the newborn. The nurse is instrumental in the initial interactions with the infant. The nurse can help the parents "see" the infant, rather than focus on the equipment. The importance and purpose of the apparatus that surrounds their infant also should be explained to them. Parents often need encouragement and recognition from the nurse to acknowledge the reality of the infant's condition. Parents need to see and touch their infant as soon as possible to acknowledge the reality of the birth and the infant's appearance and condition. Encouragement from the nurse is instrumental in this process. Telling the parents only about the newborn's physical condition and cautioning them to avoid touching their baby is an inappropriate action.

How does the onset of the pubertal growth spurt compare in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls it depends on their growth in infancy.

b. It occurs earlier in girls. Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.

The nurse is forking with adolescents to get them to improve their diet. Which approach would be most helpful in achieving this goal? a. Send dietary information to the caregivers of the adolescents. b. Have the adolescents get involved in meal planning after receiving information on dietary needs. c. Show a film on dietary needs and what happens to the body if those needs are not met. d. Have a series of lectures by a variety of health specialists on dietary needs of the adolescent.

b. Have the adolescents get involved in meal planning after receiving information on dietary needs. Nurses can help caregivers and adolescents improve their nutrition by explaining the importance of a good diet and encouraging adolescents to be involved in meal planning.q

Based on a recommendation from the American Academy of Pediatrics, the nurse will advise the caregivers to do which of the following to help prevent sudden infant death syndrome? a. Have the baby sleep in a prone position. b. Have the baby sleep in a supine or side-lying position. c. Provide hourly checks while the baby is sleeping. d. Avoid the use of a pacifier at night.

b. Have the baby sleep in a supine or side-lying position. To help prevent sudden infant death syndrome, The American Academy of Pediatrics would recommend that the nurse will advise the caregivers to have the baby sleep in a supine or side-lying position.

The most common cause of pathologic hyperbilirubinemia is: a. Hepatic disease. c. Postmaturity. b. Hemolytic disorders in the newborn. d. Congenital heart defect.

b. Hemolytic disorders in the newborn. Hemolytic disorders in the newborn are the most common cause of pathologic jaundice. Hepatic damage may be a cause of pathologic hyperbilirubinemia, but it is not the most common cause. Prematurity would be a potential cause of pathologic hyperbilirubinemia in neonates, but it is not the most common cause. Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.

An adolescent boy in the 7th grade is having difficulty in algebra. Using Vygotsky's concept of the zone of proximal development, the educational team (including the nurse) would most likely suggest which of the following courses of action to the student and his caregivers? a. Stop all television and free-time activities until the grades improve. b. Hire an adult tutor or a peer who understands algebra and the upper limit of the student's understanding of algebra and can push the adolescent to think at the higher level. c. Provide sufficient rewards for doing the fork so the student has enough incentive to push himself to learn the material. d. Ground the adolescent from association with peers, and surround him with adults who have math skills.

b. Hire an adult tutor or a peer who understands algebra and the upper limit of the student's understanding of algebra and can push the adolescent to think at the higher level. Using Vygotsky's concept of the zone of proximal development concerning an adolescent boy in the 7th grade having difficulty in algebra, the educational team (including the nurse) would most likely suggest: hire an adult tutor or a peer who understands algebra and the upper limit of the student's understanding of algebra and can push the adolescent to think at the higher level.

In addition to injuries, the leading causes of death in adolescents ages 15 to 19 years are: a. Suicide, cancer. c. Homicide, heart disease. b. Homicide, suicide d. Drowning, cancer.

b. Homicide, suicide In this age group the leading cause of death is accidents, followed by homicide and suicide. Other causes of death include cancer and heart disease.

Which of the following is the best initial approach when a child has shown signs of regression? a. Have the child sit in time-out and think about what he or she is doing and about his or her feelings. b. Ignore the regression, and compliment the child on positive attributes and behaviors. c. Ask the child why he or she is behaving like a little baby. d. Distract the child with new foods and new activities.

b. Ignore the regression, and compliment the child on positive attributes and behaviors. The best initial approach when a child has shown signs of regression is to ignore the regression, and compliment the child on positive attributes and behaviors.

By the time children reach their twelfth birthday, they should have learned to trust others and should have developed a sense of: a. Identity. c. Integrity. b. Industry. d. Intimacy.

b. Industry. Industry is the developmental task of school-age children. By age 12 years, children engage in tasks that they can carry through to completion. They learn to compete and cooperate with others, and they learn rules. Identity versus role confusion is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.

With regard to small for gestational age (SGA) infants and intrauterine growth restrictions (IUGR), nurses should be aware that: a. In the first trimester diseases or abnormalities result in asymmetric IUGR. b. Infants with asymmetric IUGR have the potential for normal growth and development. c. In asymmetric IUGR weight is slightly more than SGA, whereas length and head circumference are somewhat less than SGA. d. Symmetric IUGR occurs in the later stages of pregnancy.

b. Infants with asymmetric IUGR have the potential for normal growth and development. IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.

Which statement best describes the process of critical thinking? a. It is a simple developmental process. b. It is purposeful and goal directed. c. It is based on deliberate and irrational thought. d. It assists individuals in guessing what is most appropriate.

b. It is purposeful and goal directed. Critical thinking is a complex, developmental process based on rational and deliberate thought. When thinking is clear, precise, accurate, relevant, consistent, and fair, a logical connection develops between the elements of thought and the problem at hand.

Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with the age of child. d. It decreases as proportion of surface area to body mass increases.

b. It is slightly higher in boys than in girls at all ages. The BMR is the rate of metabolism when the body is at rest. At all ages the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.

The transition period between intrauterine and extrauterine existence for the newborn: a. Consists of four phases, two reactive and two of decreased responses. b. Lasts from birth to day 28 of life. c. Applies to full-term births only. d. Varies by socioeconomic status and the mother's age.

b. Lasts from birth to day 28 of life. Changes begin right after birth; the cutoff time when the transition is considered over (although the baby keeps changing) is 28 days. The transition period has three phases: first reactivity, decreased response, and second reactivity. All newborns experience this transition regardless of age or type of birth. Although stress can cause variation in the phases, the mother's age and wealth do not disturb the pattern.

A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. The nurse can explain to him that beginning solid foods before 4 to 6 months may: a. Decrease the infant's intake of sufficient calories. b. Lead to early cessation of breastfeeding. c. Help the infant sleep through the night. d. Limit the infant's growth.

b. Lead to early cessation of breastfeeding. Introduction of solid foods before the infant is 4 to 6 months of age may result in overfeeding and decreased intake of breast milk. It is not true that feeding of solids helps infants sleep through the night. The proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast milk or formula.

Grandparents who are expecting a toddler to visit most need to do which of the following things in preparation for the visit? a. Buy whole milk and soft foods. b. Lock up all medications and toxic substances. c. Check out reading material for toddlers from the library. d. Rest up for the visit.

b. Lock up all medications and toxic substances. Grandparents who are expecting a toddler to visit most need to lock up all medications and toxic substances in preparation for the visit.

A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2.5 to 3 hours when she: a. Waves her arms in the air. c. Has hiccups. b. Makes sucking motions. d. Stretches her legs out straight.

b. Makes sucking motions. Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding-readiness cues. Waving the arms in the air, hiccupping, and stretching the legs out straight are not typical feeding-readiness cues.

The karyotype of a person is 47, XY, +21. This person is a: a. Normal male. c. Normal female. b. Male with Down syndrome. d. Female with Turner syndrome.

b. Male with Down syndrome. This person is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47 instead of 46), resulting in Down syndrome. A normal male would have 46 chromosomes. A normal female would have 46 chromosomes and XX for the sex chromosomes. A female with Turner syndrome would have 45 chromosomes; the sex chromosomes would have just one X.

Which statement regarding childhood morbidity is the most accurate? a. Morbidity does not vary with age. b. Morbidity is not distributed randomly. c. Little can be done to improve morbidity. d. Unintentional injuries do not have an effect on morbidity.

b. Morbidity is not distributed randomly. Morbidity is not distributed randomly in children. Increased morbidity is associated with certain groups of children, including children living in poverty and those who were low birth weight. Morbidity does vary with age. The types of illnesses in children are different for each age group. Morbidity can be decreased with interventions focused on groups with high morbidity and on decreasing unintentional injuries, which also affect morbidity.

To provide optimal care of infants born to mothers who are substance abusers, nurses should be aware that: a. Infants born to addicted mothers are also addicted. b. Mothers who abuse one substance likely will use or abuse another, thus compounding the infant's difficulties. c. The NICU Network Neurobehavioral Scale (NNNS) is designed to assess the damage the mother has done to herself. d. No laboratory procedures are available that can identify the intrauterine drug exposure of the infant.

b. Mothers who abuse one substance likely will use or abuse another, thus compounding the infant's difficulties. Multiple substance use (even just alcohol and tobacco) makes it difficult to assess the problems of the exposed infant, particularly with regard to withdrawal manifestations. Infants of substance-abusing mothers may have some of the physiologic signs but are not addicted in the behavioral sense. "Drug-exposed newborn" is a more accurate description than "addict." The NNNS is designed to assess the neurologic, behavioral, and stress/abstinence function of the neonate. Newborn urine, hair, or meconium sampling may be used to identify an infant's intrauterine drug exposure.

Birth weights differ with ethnic backgrounds. Which of the following babies are typically the largest at birth, compared to the others? a. European American c. Chinese b. Native American d. Japanese

b. Native American Native American infants are often heavier at birth than European American infants.

The process whereby parents awaken the infant to feed every 3 hours during the day and at least every 4 hours at night is: a. Known as demand feeding. b. Necessary during the first 24 to 48 hours after birth. c. Used to set up the supply-meets-demand system. d. A way to control cluster feeding.

b. Necessary during the first 24 to 48 hours after birth. The parents do this to make sure that the infant has at least eight feedings in 24 hours. Demand feeding is when the infant determines the frequency of feedings; this is appropriate once the infant is feeding well and gaining weight. The supply-meets-demand system is a milk production system that occurs naturally. Cluster feeding is not a problem if the baby has eight feedings in 24 hours.

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? a. Necrotizing enterocolitis (NEC) c. Bronchopulmonary dysplasia (BPD) b. Retinopathy of prematurity (ROP) d. Intraventricular hemorrhage (IVH)

b. Retinopathy of prematurity (ROP) ROP is thought to occur as a result of high levels of oxygen in the blood. NEC is caused by the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site. BPD is caused by the use of positive pressure ventilation against the immature lung tissue. IVH results from rupture of the fragile blood vessels in the ventricles of the brain. It is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow.

To care adequately for infants at risk for neonatal bacterial infection, nurses should be aware that: a. Congenital infection progresses more slowly than does nosocomial infection. b. Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot. c. Infections occur with about the same frequency in boy and girl infants, although female mortality is higher. d. The clinical sign of a rapid, high fever makes infection easier to diagnose.

b. Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot. Handwashing is an effective preventive measure for late-onset (nosocomial) infections because these infections come from the environment around the infant. Early-onset, or congenital, infections are caused by the normal flora at the maternal vaginal tract and progress more rapidly than do nosocomial (late-onset) infections. Infection occurs about twice as often in boys and results in higher mortality. Clinical signs of neonatal infection are nonspecific and are similar to those of noninfectious problems, thus making diagnosis difficult.

The nurse's initial action when caring for an infant with a slightly decreased temperature is to: a. Notify the physician immediately. b. Place a cap on the infant's head and have the mother perform kangaroo care. c. Tell the mother that the infant must be kept in the nursery and observed for the next 4 hours. d. Change the formula because this is a sign of formula intolerance.

b. Place a cap on the infant's head and have the mother perform kangaroo care. Keeping the head well covered with a cap will prevent further heat loss from the head, and having the mother place the infant skin to skin should increase the infant's temperature. Nursing actions are needed first to correct the problem. If the problem persists after interventions, notification may then be necessary. A slightly decreased temperature can be treated in the mother's room. This would be an excellent time for parent teaching on prevention of cold stress. Mild temperature instability is an expected deviation from normal during the first days as the infant adapts to external life.

To prevent nipple trauma, the nurse should instruct the new mother to: a. Limit the feeding time to less than 5 minutes. b. Position the infant so the nipple is far back in the mouth. c. Assess the nipples before each feeding. d. Wash the nipples daily with mild soap and water.

b. Position the infant so the nipple is far back in the mouth. If the infant's mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, thus causing trauma to the area. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. This will also limit access to the higher-fat "hindmilk." Assessing the nipples for trauma is important; however, this action alone will not prevent sore nipples. Soap can be drying to the nipples and should be avoided during breastfeeding.

The nurse is preparing staff in-service education about atraumatic care for pediatric patients. Which intervention should the nurse include? a. Prepare the child for separation from parents during hospitalization by reviewing a video. b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control associated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure.

b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In providing atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care.

The goal of treatment of the infant with phenylketonuria (PKU) is to: a. Cure mental retardation. b. Prevent central nervous system (CNS) damage, which leads to mental retardation. c. Prevent gastrointestinal symptoms. d. Cure the urinary tract infection.

b. Prevent central nervous system (CNS) damage, which leads to mental retardation. CNS damage can occur as a result of toxic levels of phenylalanine. No known cure exists for mental retardation. Digestive problems are a clinical manifestation of PKU. PKU does not involve any urinary problems.

A new father wants to know what medication was put into his infant's eyes and why it is needed. The nurse explains to the father that the purpose of the Ilotycin ophthalmic ointment is to: a. Destroy an infectious exudate caused by Staphylococcus that could make the infant blind. b. Prevent gonorrheal and chlamydial infection of the infant's eyes potentially acquired from the birth canal. c. Prevent potentially harmful exudate from invading the tear ducts of the infant's eyes, leading to dry eyes. d. Prevent the infant's eyelids from sticking together and help the infant see.

b. Prevent gonorrheal and chlamydial infection of the infant's eyes potentially acquired from the birth canal. The purpose of the Ilotycin ophthalmic ointment is to prevent gonorrheal and chlamydial infection of the infant's eyes potentially acquired from the birth canal. Prophylactic ophthalmic ointment is instilled in the eyes of all neonates to prevent gonorrheal or chlamydial infection. Prophylactic ophthalmic ointment is not instilled to prevent dry eyes. Prophylactic ophthalmic ointment has no bearing on vision other than to protect against infection that may lead to vision problems.

The hormone necessary for milk production is: a. Estrogen. c. Progesterone. b. Prolactin. d. Lactogen.

b. Prolactin. Prolactin, secreted by the anterior pituitary, is a hormone that causes the breasts to produce milk. Estrogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Progesterone decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Human placental lactogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced.

The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: a. Front facing in back seat. b. Rear facing in back seat. c. Front facing in front seat if an air bag is on the passenger side. d. Rear facing in front seat if an air bag is on the passenger side.

b. Rear facing in back seat. The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. Infants should face the rear from birth to 20 pounds and as close to 1 year of age as possible. The middle of the back seat provides the safest position. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

The breath sounds of a toddler are especially easily heard through the stethoscope. Which of the following reasons explains this? a. The heart makes less competitive noise as it beats. b. The body is lengthening and adipose tissues are decreasing. c. The alveoli are more elastic in young children. d. Children are easily frightened and they breathe more heavily. Children are easily frightened and they breathe more heavily.

b. The body is lengthening and adipose tissues are decreasing. The reason the breath sounds of a toddler are especially easily heard through the stethoscope is because the body is lengthening and adipose tissues are decreasing.

Which of the following activities are most closely identified with the latency stage suggested by Freud? a. The id is out of control, and the child struggles with antisocial thoughts and deeds. b. The child increasingly identifies with the same-sex parent and has intense involvement with same-sex peers. c. Energies are directed toward sexual thoughts and curiosity about opposite-sex parent and peers. d. The superego has not yet developed, and the child has little focus on society and useful skills.

b. The child increasingly identifies with the same-sex parent and has intense involvement with same-sex peers. During the latency stage, sexual drives are submerged, appropriate gender roles are adopted, and the Oedipal or Electra conflicts are resolved. The child increasingly identifies with the same-sex parent and has intense involvement with same-sex peers.

Which "expected outcome" would be developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times.

b. The child will independently ask for play materials or other personal needs. Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate 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 an inappropriate 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.

By knowing about variations in infants' blood count, nurses can explain to their clients that: a. A somewhat lower than expected red blood cell count could be the result of delay in clamping the umbilical cord. b. The early high white blood cell (WBC) count is normal at birth and should decrease rapidly. c. Platelet counts are higher than in adults for a few months. d. Even a modest vitamin K deficiency means a problem with the ability of the blood to clot properly.

b. The early high white blood cell (WBC) count is normal at birth and should decrease rapidly. The WBC count is high the first day of birth and then declines rapidly. Delayed clamping of the cord results in an increase in hemoglobin and the red blood cell count. The platelet count essentially is the same for newborns and adults. Clotting is sufficient to prevent hemorrhage unless the vitamin K deficiency is significant.

During the complete physical examination 24 hours after birth: a. The parents are excused to reduce their normal anxiety. b. The nurse can gauge the neonate's maturity level by assessing the infant's general appearance. c. Once often neglected, blood pressure is now routinely checked. d. When the nurse listens to the heart, the S1 and S2 sounds can be heard; the first sound is somewhat higher in pitch and sharper than the second.

b. The nurse can gauge the neonate's maturity level by assessing the infant's general appearance. The nurse will be looking at skin color, alertness, cry, head size, and other features. The parents' presence actively involves them in child care and gives the nurse a chance to observe interactions. Blood pressure is not usually taken unless cardiac problems are suspected. The second sound is higher and sharper than the first.

The appropriate placement of a tongue blade for assessment of the mouth and throat is the: a. The center back area of the tongue. c. Against the soft palate. b. The side of the tongue. d. On the lower jaw.

b. The side of the tongue. The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. Placement on the center back area of the tongue elicits the gag reflex. Against the soft palate and on the lower jaw are not appropriate places for the tongue blade.

What is characteristic of the preoperational stage of cognitive development? a. Thinking is logical. c. Reasoning is inductive. b. Thinking is concrete. d. Generalizations can be made.

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

The nurse teaches the caregivers of a colicky baby some comfort measures. Which of the following measures would the nurse most likely teach them to use? a. Place a garlic-and-oil potion around the infant's neck, to be worn 24 hours a day. b. Use a front carrier and white noise and swaddle the baby, or take the baby for a car ride. c. Place the infant on the stomach (prone) to sleep as long as it has the symptoms of colic. d. Keep the infant's stomach full at all times so there is no room for any gas to form.

b. Use a front carrier and white noise and swaddle the baby, or take the baby for a car ride. Comfort measures for a colicky baby include the use of a front carrier and white noise and swaddle the baby, or take the baby for a car ride.

How can the nurse best assess the infant's language development and detect any potential problems? a. Teach caregivers to do the word count test. b. Use the Denver II Screening Test. c. Have simple observational periods. d. Use the Minnesota Multiphasic Test.

b. Use the Denver II Screening Test. The best assessment of the infant's language development to detect any potential problems is to use the Denver II Screening Test.

A type of dental caries that is seen in infants who drink a bottle of formula or juice at nap time or bedtime, or in infants who breastfeed for prolonged times, is called: a. rapid deciduous tooth decay c. sleep-time dental caries b. nursing or bottle-mouth caries d. sugar-source mouth caries

b. nursing or bottle-mouth caries The type of dental caries seen in infants who drink a bottle of formula or juice at nap time or bed time is called nursing or bottle-mouth caries.

What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with the child when the parent is not present.

b. Use transition objects such as a doll. Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child. Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.

What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects, such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with child when parent is not present.

b. Use transition objects, such as a doll. Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child this age. Speaking in this manner will tend to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception will lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.

Which communication technique should the nurse avoid when interviewing children and their families? a. Using silence b. Using clichés c. Directing the focus d. Defining the problem

b. Using clichés Using stereotyped comments or clichés can block effective communication, and this technique should be avoided. After use of such trite phrases, parents will often not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximal freedom of expression. By using open-ended questions, along with guiding questions, the nurse can obtain the necessary information and maintain the relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention.

When parents select or approve physical activities for their children, they most need to select activities according to the: a. interests of the child b. abilities of the child c. child's potential for improvement d. child's potential for building lifelong skills

b. abilities of the child Due to the potential for muscles to be easily injured in the school-aged child, it is necessary to select physical activities that match the abilities of the child.

The nurse is assessing a small infant and notices that when the child's head is moved to the right or left, the eyes follow and do not lag behind as they normally do in a small infant. The nurse would document this finding as: a. bilateral lag syndrome c. absence of horizontal vibratory motion b. absence of doll's eye reflex d. follow-through visual abnormality

b. absence of doll's eye reflex When the eyes of an infant tracks with the movement of the head, it is best described as absence of doll's eye reflex.

Elkind identified two types of social thinking especially evident during adolescence, one of which is imaginary audience. Which of the following statements best describes what Elkind meant by imaginary audience? a. a fantasy of having powerful imaginary friends who will rescue the adolescent then others are difficult or unkind b. adolescents' feelings of always being on stage and that others are just as concerned about their appearance as they are c. a temporary paranoid state in which the adolescent feels watched by others at all times then awake d. a feeling that they are living in an audience watching their own life, as if it were on stage or in public

b. adolescents' feelings of always being on stage and that others are just as concerned about their appearance as they are Elkind described imaginary audiencce as the adolescents' feelings of always being on stage and that others are just as concerned about their appearance as they are

The very first sucking by an infant occurs because of: a. the mother stroking the cheeks c. a purposeful seeking of pleasure b. an accidental reflex of rooting d. hunger and a message to the brain

b. an accidental reflex of rooting The very first sucking by an infant occurs because of an accidental reflex of rooting.

he current practice of feeding newborns is: a. to place them on a frequent feeding schedule b. an on-demand feed c. to offer five feedings a day d. to set up a specific schedule

b. an on-demand feed The current practice of feeding newborns is best described as an on-demand feed.

The nurse instructing the mother on how to care for the umbilical cord of the newborn would direct the mother to: a. wash the cord only with warm water and gently dry it b. apply 70% isopropyl alcohol or hydrogen peroxide to the base next to the skin and to the cord with each diaper change c. use a solution of baby shampoo and water on the cord, rinse, and dry carefully d. wash the cord with a solution of Ivory soap and water, dry, air for 30 minutes, and apply triple antibiotic ointment after baths and diaper changes

b. apply 70% isopropyl alcohol or hydrogen peroxide to the base next to the skin and to the cord with each diaper change The nurse instructing the mother on how to care for the umbilical cord of the newborn would direct the mother to apply 70% isopropyl alcohol or hydrogen peroxide to the base next to the skin and to the cord with each diaper change.

A parent asks the nurse in the pediatric clinic how often school-aged children need to have a routine medical exam. The nurse, following the American Academy of Pediatrics recommendation for routine medical exams, will give which of the following responses? a. every year at approximately the same time of year b. at least every 2 years preferably at ages 5, 6, 8, 10, 11, and 12 c. every 3 years preferably at ages 5, 8, and 11 d. before entering kindergarten, 5th grade, and 7th grade

b. at least every 2 years preferably at ages 5, 6, 8, 10, 11, and 12 The American Academy of Pediatrics (AAP) recommends routine medical exams for the school-age child at least every 2 years and suggests they occur at ages 5, 6, 8, 10, 11, and 12.

The 20% of adolescents in the United States who are "only" children have been found by research to experience which of the following because of being only children? a. loneliness and a tendency to isolate themselves b. fairly high self-esteem and achievement motivation c. serious jealousy of children from large families d. high-risk behaviors in at least three areas of their lives

b. fairly high self-esteem and achievement motivation he 20% of adolescents in the United States who are "only" children have been found by research to experience fairly high self-esteem and achievement motivation.

The preschooler can best learn to cope with frustration and dissatisfaction through which of the following activities? a. interacting with caregivers in regard to rules and expectations b. attending some type of early childhood program such as day care or preschool c. observing the interactions of groups of people on the television d. going out to eat or to social events with the caregivers and other adults

b. attending some type of early childhood program such as day care or preschool Attending some type of early childhood program such as day care or preschool is the best activity that teaches the preschooler to cope with frustration and dissatisfaction.

According to Kohlberg's theory of moral development, school-aged children are at Stage 3 of the conventional level of moral development. Which of the following statements best describes what these children's morality is based on? a. imitating what they see their role models display in terms of behavior b. avoiding the disapproval of others and maintaining positive relationships c. following the lead of older siblings and peers in deciding what is right and wrong d. doing the right thing and showing respect for authority figures

b. avoiding the disapproval of others and maintaining positive relationships At this level of Kohlberg's theory of moral development, the school-age child's morality is based on avoiding the disapproval of others and maintaining positive relationships with friends, family, and teachers.

The school nurse is forking with a group of adolescent boys who are on a sports team in the school. A few of the boys have experienced early maturation (appearance of secondary sexual characteristics). The nurse reads some studies about early maturation in adolescent boys and finds that most studies reveal that: a. adolescent boys usually have the same experience as adolescent girls with early maturation b. boys with early maturation often have a positive self-image, high status, and prestige in the peer group c. these adolescent boys have much more difficulty adjusting to their early maturation than adolescent females d. early maturing males are more likely to commit suicide than males who mature normally or late

b. boys with early maturation often have a positive self-image, high status, and prestige in the peer group The nurse reads some studies about early maturation in adolescent boys and finds that most studies reveal that boys with early maturation often have a positive self-image, high status, and prestige in the peer group.

After a long labor, the mother is concerned about the swelling of her baby's scalp. The newborn is 24 hours old. The nurse palpates the scalp and finds swelling that extends across the suture lines. In addition to explaining the probable cause of the swelling and the time of resolution, the nurse explains that the term for this condition is: a. cephalhematoma c. molding b. caput succedaneum d. crepitation

b. caput succedaneum Caput succedaneum is often evident after long labor, is swelling of the soft tissues of the scalp. The edema extends across the suture lines, and presents within the first 24 hours following birth.

If you view a child's development from a passivity theory rather than an activity theory, you would most probably believe that: a. creative teachers have little to do with a child's interest in a particular subject b. children become delinquent because of association with an antisocial peer group c. child-rearing practices have little to do with whether a child is passive or assertive d. children seek their own experiences to shape their development

b. children become delinquent because of association with an antisocial peer group If you view a child's development from a passivity theory rather than an activity theory, you would most probably believe that children become delinquent because of association with an antisocial peer group.

Which of the following factors has been found to most influence whether school has a positive effect on an adolescent? a. both caregivers forking outside the home and earning a good wage b. close friends before, during, and after the transition to high school c. living in the same house for the last 5 years d. a good school principal

b. close friends before, during, and after the transition to high school Having close friends before, during, and after the transition to high school has the most influence whether school has a positive effect on an adolescent.

During early adolescence, the adolescent's interactions with the opposite sex are usually: a. carried out cautiously in one-on-one interactions b. considered dangerous and approached in the security of one's clique c. conducted mainly in the company of another couple or several couples d. limited to interactions forced on the adolescent by caregivers or other adults

b. considered dangerous and approached in the security of one's clique During early adolescence, the adolescent's interactions with the opposite sex are usually considered dangerous and approached in the security of one's clique.

A mother asks the nurse to explain what fine motor skills are. She has heard that it has something to do with the ability to draw and color within the lines in school-aged children, and she is curious to know what this means in an infant. The nurse would explain that fine motor development is the ability to: a. write and draw and that infants do not have any fine motor skills b. coordinate hand-to-eye movement in an orderly and progressive manner c. pick up items and move them from place to place in a voluntary fashion d. use all of the fingers equally well and both hands in a coordinated method

b. coordinate hand-to-eye movement in an orderly and progressive manner Fine motor development is the ability to coordinate hand-eye movement in an orderly and progressive manner.

What ideal or model do adolescents compare themselves to then developing a sense of body image? a. family c. friends b. culture d. religion

b. culture Adolescents compare themselves to the ideal or model body image of their culture.

Psychosocial effects of obesity in adolescents include: a. sense of humor or jolliness b. discrimination by others and feelings of rejection c. high self-esteem d. a positive body image and security about self

b. discrimination by others and feelings of rejection Psychosocial effects of obesity in adolescents include discrimination by others and feelings of rejection.

During stage one of Kohlberg's stages of moral development, the child conforms to rules: a. to please caregivers c. because children like rules b. due to fear of punishment d. to get rewards

b. due to fear of punishment During stage one (punishment and obedience orientation stage) of the first level of moral development (preconventional level), the child conforms to rules due to fear of punishment.

When working with adolescent girls, the school nurse is aware that in regard to body image: a. most girls are satisfied with their physical appearance b. few girls are satisfied with their physical appearance c. the majority of girls think they are too thin d. girls focus mainly on their abdomen and hips

b. few girls are satisfied with their physical appearance When working with adolescent girls, the school nurse is aware that in regard to body image, few girls are satisfied with their physical appearance.

After a talk by the nurse on the importance of zinc in the diet and a discussion of foods high in zinc, adolescents are to select a diet high in zinc. The nurse will evaluate how well adolescents understood the information then they select which of the following diets? a. lettuce salad, pasta with tomato sauce, iced tea, flavored gelatin b. fish, deviled egg, green beans, milk c. peanut butter and jelly sandwich, celery and carrot sticks, juice d. baked potato with butter, tomato soup, broccoli, hot tea

b. fish, deviled egg, green beans, milk After a discussion of the importance of zinc in the adolescent diet, they will choose fish, deviled egg, green beans, milk.

A school nurse is talking with an adolescent who shares about her ideology and career aspirations in terms of what her caregivers and other important adults in her life have to say. This adolescent cannot explain why she has these beliefs other than to quote authority figures. Using Marcia's theory of adolescents occupying one of four identity statuses, the nurse will find this student occupying which of the following identity statuses? a. identity achievement c. identity diffusion b. foreclosed d. moratorium

b. foreclosed The adolescent unable to explain why they are committed to certain beliefs indicates the foreclosed status.

The nurse is instructing the caregivers in changing the diaper of their newborn daughter. The nurse will instruct the caregivers to wipe the baby from: a. back to front using a wipe designed for a baby b. front to back using plain water and absorbent cotton or a fresh washcloth c. from the vagina forward and then from the vagina to the rectum d. from the vagina forward and then from the vagina to the rectum

b. front to back using plain water and absorbent cotton or a fresh washcloth When changing the diaper of a female, instruct caregivers to wipe from front to back. This will control feces contamination of the vaginal area. The AAP recommends using plain water and absorbent cotton or fresh washcloth.

The way adolescents think about themselves as either male or female, their biological makeup, personal experiences, and social expectations and recommendations about how males and females should think and behave is referred to most correctly by which of the following terms? a. masculinity versus femininity c. sexual identity b. gender identity d. personal makeup

b. gender identity Gender identity refers to the way we think about ourselves as either male or female, and is a culmination of biological makeup, personal and social expectations, and recommendations about how males and females should behave.

Maturation refers to changes that are due to: a. major life experiences c. illness b. genetic inheritance d. injury

b. genetic inheritance Maturation refers to changes that are due to genetic inheritance.

Freud theorized that during the phallic stage, a child's energy is focused on which of the following areas of the body? a. mouth c. anus b. genitals d. hands

b. genitals Freud theorized that during the phallic stage, a child's energy is focused on the genitals.

Which of the following adult behaviors would be most important for preschoolers to witness caregivers engaging in? a. modeling positive behavior b. giving or receiving rewards for positive behavior c. punishing others for poor behavior d. receiving punishment or feeling bad about their bad behavior

b. giving or receiving rewards for positive behavior An effective tool for teaching appropriate behavior, giving attention or rewards to positive behaviors communicates the desired actions to the preschooler. It is common for bad behaviors to be disciplined, while good behaviors are ignored.

Locomotion, or the ability to move from place to place without assistance, is dependent on: a. developed muscles in the upper arm b. head control and sitting without support c. leg muscle strength d. the ability to roll over

b. head control and sitting without support Locomotion, the ability to move from place to place without assistance, is dependent on head control and sitting without support.

The most popular theory of developmentalists today is that: a. nature provides the most important contribution to development b. how biological and environmental factors interact is more important than the predominance of one over the other c. development depends almost entirely on the experiences an individual has by age 5 d. genetics is most important, and we are about to engineer people to correct all defects

b. how biological and environmental factors interact is more important than the predominance of one over the other The most popular theory of developmentalists today is that how biological and environmental factors interact is more important than the predominance of one over the other.

A collection of fluid between the parietal and visceral layers of the tunica vaginalis is called: a. spermatocele c. glandulitis b. hydrocele d. epididymitis

b. hydrocele A collection of fluid between the parietal and visceral layers of the tunica vaginalis is called a hydrocele.

The nurse is forking with an adolescent who complains of being lonely and having a lack of fulfillment in her life. This adolescent shies away from intimate relationships at times, yet at other times she appears promiscuous. The nurse will likely work with this adolescent most in which of the following areas, as it is at the center of the other problems? a. loneliness c. isolation b. identity d. lack of fulfillment

b. identity According to Erikson, the youth not sure of his identity avoids interpersonal intimacy or throws himself into acts of intimacy which are promiscuous.

The first level of moral development according to Kohlberg is divided into three stages. Which of the following types of behavior characterizes stage zero? a. magical thinking c. sharing b. impulsiveness d. goodness

b. impulsiveness Stage zero is characterized by impulses that rule behavior. What is good is pleasant or exciting; what is bad is painful or fearful.

When a person is discussing the strong influences that child-rearing methods have on the development of the child, this person is most probably coming from which of the following viewpoints or theories? a. neoclassic c. nature b. nurture d. naturalistic

b. nurture When a person is discussing the strong influences that child-rearing methods have on the development of the child, this person is coming from a nurture viewpoint.

Fat found primarily in the subscapular, axillary, adrenal, and mediastinal regions of the newborn does which of the following things? a. protects the newborn from injury in case of falling or other trauma b. increases cellular metabolic rates and oxygen consumption c. provides a store of usable energy in case the baby does not nurse well d. is used in the production of hormones, especially testosterone

b. increases cellular metabolic rates and oxygen consumption Brown fat found primarily in the subscapular, axillary, adrenal, and mediastinal regions of the newborn does increases cellular metabolic rates and oxygen consumption to produce additional heat.

According to Erikson's psychosocial theory of development, a child between ages 6 and 11 is going through which of the following stages? a. initiative versus guilt c. identity versus role confusion b. industry versus inferiority d. autonomy versus shame and doubt

b. industry versus inferiority According to Erikson's psychosocial theory of development, a child between ages 6 and 11 is going through the stage called industry versus inferiority.

When comparing the way infants react to pain with the way older children respond to pain, you will find that: a. there is little difference between the way infants and children respond to pain b. infants respond with their whole body while children can localize the pain c. children will cry more and infants will withdraw more d. infants will refuse to nurse during pain while children will continue to eat

b. infants respond with their whole body while children can localize the pain Development becomes increasingly differentiated. For example, infants will react with their entire body to pain by crying and withdrawing, whereas an older child is able to localize the pain, can often identify its source, and may only withdraw the extremity experiencing the pain.

A nurse is assessing the play of a 4-year-old. Which of the following best describes what the nurse would observe in the play of this age preschooler? a. playing alongside but not with playmates, taking toys away from others, using a pounding bench, and playing with a musical toy b. interactive play, obeying limits, creating an imaginary friend, and engaging in fantasy play c. engaging in group sports or games and playing with puppets d. playing by him- or herself in the corner, engaged in putting a puzzle together

b. interactive play, obeying limits, creating an imaginary friend, and engaging in fantasy play Correct. A 4-year-old's play is interactive; the child cooperates with another child, obeying limits, creating an imaginary friend, and engaging in fantasy play.

What effect can obesity in adolescence have on the developmental tasks of separation and individuation? a. no effect c. speeds them up a little b. interference and delay d. speeds them up significantly

b. interference and delay Interference and delay to the developmental tasks of separation and individuation is one effect of obesity in adolescence.

Sullivan believed that a person's self-image emerged according to how the infant: a. was treated by the extended family b. interpreted the primary caregiver relationship c. was or was not the center of attention of the family d. was treated in relation to other people or siblings by the primary caregivers

b. interpreted the primary caregiver relationship Sullivan felt one's self-image emerged according to how the infant interpreted the mother-infant relationship (primary caregiver) when basic physiological needs were met.

If a baby is weaned too soon, which of the following problems is most likely to develop? a. weight loss c. vitamin D deficiency b. iron-deficiency anemia d. delayed mobility

b. iron-deficiency anemia If a baby is weaned too soon, iron-deficiency anemia is the most likely problem to develop.

A parent asks the school nurse to explain there children usually feel growing pains. The nurse explains that the discomfort is usually in the: a. toes, feet, and ankles c. hip and pelvis b. knees, calves, and thigh d. fingers, wrists, and elbows

b. knees, calves, and thigh The discomfort of growing pains is typically located in the knees, calves, and thighs.

Gross motor development is best exemplified by the ability to: a. use the muscles of the hands to grasp toys b. maintain balance, postural control, and locomotion c. use the facial muscles to smile, cry, and frown d. open the hand, look at the fingers, and place them in the mouth

b. maintain balance, postural control, and locomotion Gross motor development is best exemplified by the ability to maintain balance, postural control, and locomotion.

The nurse is working with caregivers who are very concerned that their new infant will grow up with a healthy sense of trust. What areas of assessment and teaching would the nurse most focus on in working with these caregivers? a. knowledge of the physical development of children in the first 3 years b. meeting the infant's basic needs and demonstrating caring behaviors c. extended family, friends, and other sources of family support d. child-rearing philosophies and the educational levels of the caregivers

b. meeting the infant's basic needs and demonstrating caring behaviors Correct. An area of assessment and teaching about developing a healthy sense of trust will focus upon meeting the infant's basic needs and demonstrating caring behaviors.

Freud theorized that methods used to toilet-train children might have a lasting effect on their personality. Children who had rigid, severe toilet training would most likely show which of the following behaviors later in life? a. narcissistic c. self-mutilating b. meticulous and hypercritical d. bullying to others and aggressive

b. meticulous and hypercritical Freud suggested methods caregivers use to toilet train children during this period may have long-lasting effects on personality. For example, children who were products of rigid, severe toilet training could become obsessive about routines and their schedules, or very meticulous and hypercritical.

Which of the following behaviors by an infant best exemplifies the beginning of reasoning? a. crying for food or attention b. moving any obstacles to find a hidden object c. saying bye-bye in response to others saying bye-bye d. blowing kisses or clapping the hands

b. moving any obstacles to find a hidden object Object permanence is apparent and demonstrated when the infant actively seeks a hidden object. The beginning of reason is evident when the infant moves any obstacle to uncover a hidden object. Occurs in Piaget's fourth substage of the sensorimotor stage.

The nurse will advise caregivers not to allow their child to watch programs with violence or programs there people make poor choices and behave badly because: a. these shows are too long considering the amount of time children are allowed to watch television b. preschoolers cannot differentiate between reality and fantasy and may use the behaviors of actors on television to deal with their own problems c. young children keep these pictures in their minds all their lives and affect them when they are older d. preschoolers begin to confuse the actors with their caregivers and accuse their caregivers of doing what the actors did

b. preschoolers cannot differentiate between reality and fantasy and may use the behaviors of actors on television to deal with their own problems The reason the nurse advises caregivers not to allow their children to watch programs with violence or there people make poor choices and behave badly is because preschoolers cannot differentiate between reality and fantasy and may use the behaviors of actors on television to deal with their own problems.

The caregivers can best minimize separation issues associated with school by: a. letting the child know that this experience will not be fun all the time b. presenting the experience as a fun and exciting adventure c. telling the child ahead of time about all the things he or she will not like, to prepare the child d. staying away from the school and letting the child know he or she is big now and can solve his or own problems

b. presenting the experience as a fun and exciting adventure By suggesting that school is an adventure and that learning can be fun, the transition to school can be enhanced.

B. F. Skinner discovered that behavioral change becomes more lasting when consequences are: a. less than the rewards c. continuous b. provided intermittently d. not part of the plan of change

b. provided intermittently Skinner discovered behavioral change became more permanent when consequences are provided intermittently than continuously, and believed the essence of development involved constantly acquiring new behaviors or habits due to reinforcing or punishing stimuli.

Infants start grasping with the whole hand, and as they develop they begin to use just the fingers. This development is an example of which of the following types of development? a. cephalocaudal c. anterior-posterior b. proximodistal d. internal-external

b. proximodistal Proximodistal development involves controlled movements closest to the body's center first, followed by controlled movements distant to the body, such as the fingers. Grasping changes from using the entire hand to just the fingers as infants develop.

In assessing the amount of head lag in an infant, the nurse will: a. see how long the infant can hold his or her own head up, measuring the time in seconds b. pull the infant up by the arms from a supine to a sitting position c. measure the distance from the baby's fingertips to the ear d. hold the baby upright in the nurse's lap and let the head fall back against the nurse's chest

b. pull the infant up by the arms from a supine to a sitting position In assessing the amount of head lag in an infant, the nurse will pull the infant up by the arms from a supine to a sitting position.

An adolescent girl who has experienced menarche asks the nurse how much she will grow before she reaches her full height. The nurse's best response is to explain that once menarche has occurred, maximum growth will: a. have already been achieved c. occur within 2 years b. rarely be more than 2 more inches d. often take a spurt of 4 or 5 inches

b. rarely be more than 2 more inches For the female adolescent who has reached menarche, it is rare for height to increase by more than 2 inches.

Piaget believed that interactions with the environment caused people to organize patterns of thought called: a. synapses c. strings b. schema d. social maps

b. schema To Piaget, interactions with the environment caused people to organize patterns of thought (schema), which they used to interpret or make sense of their experiences.

Which of the following foods would be best for the toddler? a. bacon, fried egg, toast and butter, and whole milk b. sliced white turkey breast, green beans, and skim milk c. fried chicken leg, potatoes and gravy, and ice cream d. hot dog, French fries, and pudding

b. sliced white turkey breast, green beans, and skim milk Sliced white turkey breast, green beans, and skim milk would be the best foods for the toddler because all these items are low in fat.

Puberty is best defined as the: a. beginning of adolescence b. state of development then reproduction first is possible and the adolescent growth spurt starts c. period between childhood and adulthood in which a person matures and readies for adult life d. time then thinking changes to include abstraction and the consideration of others' viewpoints

b. state of development then reproduction first is possible and the adolescent growth spurt starts Puberty is defined as the state of physical development then secondary sex characteristics begin to appear, sex organs mature, reproduction becomes possible, and the adolescent growth spurt starts.

The way a child behaviorally interacts with the surrounding environment is called by which of the following terms? a. introvert or extrovert c. risk seeking b. temperament d. environmental interest

b. temperament Temperament is the way a child interacts with the surrounding environment.

A mother is comparing her child with the neighbor's child who is the same age. The mother is concerned that her child does not have as advanced language skills as the neighbor child. The nurse assesses the child and determines the language skills are within the range of normal. This nurse would advise the mother that: a. speech develops more rapidly in children with siblings b. the development of language skills varies greatly in children c. some children's talents lie in areas other than language skills d. the child needs to have a battery of psychological tests

b. the development of language skills varies greatly in children This nurse would best advise the mother that the development of language skills varies greatly in children. Every child has a unique timetable for development.

Toilet-training success depends on which of the following factors? a. rewards that the caregivers come up with for compliance b. the readiness of both the child and the caregiver c. how stubborn the child is compared to the caregiver d. what playmates are doing in terms of toileting

b. the readiness of both the child and the caregiver Toilet-training success does depend on the readiness of both the child and the caregiver.

Adolescence is broken down into how many distinct periods? a. two c. four b. three d. five

b. three Adolescence consists of early, middle, and late periods. These periods of development are further described as prepubertal, pubertal, and postpubertal. Therefore, there are three distinct periods.

When an infant is hospitalized, the nurse recognizes the importance of this infant mastering the first of Erikson's eight life stages. He or she would most help the infant by instructing the caregivers: a. not to visit as it could upset the infant when the caregivers leave b. to spend as much time with the infant as possible c. to schedule visits around nursing care d. to limit visits to official visiting hours

b. to spend as much time with the infant as possible When an infant is hospitalized, the nurse recognizes the importance of this infant mastering the first of Erikson's eight life stages. He or she would most help the infant by instructing the caregivers to spend as much time with the infant as possible.

According to Piaget, the coordination of the secondary schemes phase of development (8 to 12 months) occurs when the infant: a. is interested in novelty and repetition as seen in activities such as continual hitting with a hammer b. understands concepts of space and object permanence and anticipates actions of others c. is able to think before acting and use memory for simple trial-and-error problem solving d. can name and locate familiar objects and demonstrate symbolic and ritualistic play

b. understands concepts of space and object permanence and anticipates actions of others According to Piaget, the coordination of the secondary schemes phase of development (8 to 12 months) occurs when the infant understands concepts of space and object permanence and anticipates actions of others.

The usual eating patterns of toddlers are to: a. eat a lot in the morning and taper off by night b. vary widely in amount eaten and in foods liked and disliked from day to day c. eat consistently the same amount and type of food day by day d. eat only one preferred food at every meal day after day

b. vary widely in amount eaten and in foods liked and disliked from day to day The usual eating patterns of toddlers are to vary widely in amount eaten and in foods liked and disliked from day to day.

The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. Which statement made by the mother would indicate an unsafe behavior? a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs."

b. "In the car, she rides in a front-facing car seat." A rear-facing infant car seat should be used for infants younger than 1 year of age.

At what age does an infant's birth weight triple? a. 9 months b. 1 year c. 18 months d. 2 years

b. 1 year The infant usually triples his or her birth weight by about 12 months of age.

What is the earliest age at which the infant should be able to walk independently? a. 8 to 10 months b. 12 to 15 months c. 15 to 18 months d. 18 to 21 months

b. 12 to 15 months For the majority of children, the milestone of walking alone is achieved between 12 and 15 months.

An infant's birth weight is 7 pounds, 8 ounces. What can the nurse project the weight to be at 6 months? a. 12 pounds b. 15 pounds c. 18 pounds d. 22 pounds

b. 15 pounds An infant usually doubles his or her birth weight by 5 to 6 months.

The nurse in a pediatrician's office is preparing to do a developmental assessment on a 3-month-old infant who was born at 36 weeks. The nurse knows that the infant should be evaluated in what month of achievement to adjust for the preterm birth? a. 1 b. 2 c. 3 d. 4,

b. 2 The growth and development of a preterm infant are based on the current age minus the number of weeks before term that the infant was born.

What does the nurse calculate the basal metabolic index (BMI) of an 8-year-old child who is 48 inches tall (1.2 meters) and weighs 100 pounds (45.4 kg) to be? a. 28.9 b. 32.4 c. 34.8 d. 37.6

b. 32.4 The formula for BMI calculation is weight in kg divided by height in meters (squared): 45.4 (weight in kg) divided by 1.4 (1.2 squared) = 32.4. A BMI of over 30 is classified as obese.

The nurse is planning anticipatory guidance for a caregiver of a preschool-age child. The nurse will explain that permanent teeth begin erupting at what age? a. 4 years old b. 6 years old c. 8 years old d. 10 years old

b. 6 years old Permanent teeth do not erupt through the gums until the sixth year.

The nurse observes that a 2-year-old is able to use a spoon steadily at mealtime. What does self-feeding help to develop in the toddler? a. Good nutrition b. A sense of independence c. Adequate height and weight d. Healthy teeth

b. A sense of independence By the end of the second year, toddlers can feed themselves. This helps them to develop a sense of independence.

The nurse is measuring the vital signs of a full-term newborn. Which finding is abnormal? a. An axillary temperature of 36.6° C (98° F) b. An apical pulse rate of 178 beats/min c. Respirations of 35 breaths/min d. Blood pressure of 80/50 mm Hg

b. An apical pulse rate of 178 beats/min The normal range for a newborn's pulse rate is 110 to 160 beats/min. A pulse rate outside of this range should be reported.

A parent is concerned because her infant has a diaper rash. What is the best action the nurse would advise the parent to implement? a. Use commercial diaper wipes to clean the area. b. Apply a protective ointment on the area. c. Change the infant's diaper less frequently. d. Keep the diaper area covered all of the time.

b. Apply a protective ointment on the area. A protective ointment can be applied when the skin in the diaper area appears pink and irritated.

A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. What will the nurse weighing the infant today would expect her weight to be? a. At least 12 pounds b. At least 16 pounds c. At least 20 pounds d. At least 24 pounds

b. At least 16 pounds Birth weight is usually doubled by 6 months of age.

A mother reports that she and her husband have had one child together, but both have children from previous marriages living in their home. The nurse will base the care planning on what type of family? a. Nuclear b. Blended c. Alternate d. Extended

b. Blended A blended family involves the remarriage of persons with children.

What would the nurse assess for in a preterm infant receiving an intravenous infusion containing calcium gluconate? a. Seizures b. Bradycardia c. Dysrhythmias d. Tetany

b. Bradycardia The infant receiving intravenous calcium gluconate should be monitored for bradycardia.

The parents of a newborn girl express concern about the infant's vaginal discharge, which appears to be bloody mucus. What does the nurse explain as the cause? a. Premature stimulation of the ovarian hormones by the pituitary system b. Cessation of female sex hormones transferred in utero from mother to infant c. The increased amount of circulating blood from the mother throughout pregnancy d. Trauma to the genitalia during the birth process

b. Cessation of female sex hormones transferred in utero from mother to infant Blood-tinged mucus discharged from the vagina is caused by hormonal withdrawal from the mother at birth.

When the nurse asks a 10-year-old Native American if he is ready to go to therapy, he does not answer immediately. How does the nurse interpret this response? a. Indecision b. Considering the answer in silence c. Shyness with strangers d. Fear of medical personnel

b. Considering the answer in silence Native Americans value silence. They need to sit and consider matters before replying to questions.

When a small group of preschool-age children were playing house, each child was pretending to be a particular family member. What type of play does the nurse recognize these children are participating in? a. Parallel b. Cooperative c. Symbolic d. Fantasy

b. Cooperative In cooperative play, children play with each other, each taking a specific role.

The nurse caring for a 4-year-old postoperative patient instructs him to blow bubbles. What nursing intervention is the nurse most likely implementing by using this form of therapeutic play? a. Providing pain relief b. Encouraging deep breathing c. Decreasing risk of infection d. Maintaining body temperature

b. Encouraging deep breathing is Play can also be therapeutic and aid in the recovery process. An example of therapeutic play is the game of having the child blow bubbles to promote deep breathing.

A school-age child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent? a. Allow the child to make food choices since this is usually a phase b. Ensure that the child has three nutritious meals and two nutritious snacks each day c. Prepare vegetables separately for the child to encourage adequate intake d. Teach the child how important it is to eat healthy fruits and vegetables

b. Ensure that the child has three nutritious meals and two nutritious snacks each day Children have food jags that are generally self-limited. The parent's responsibility is to provide three nutritious meals and two nutritious snacks each day so that all available choices are acceptable. Allowing food choices may result in an overabundance of non-nutritious foods selected. It is not necessary to prepare separate dishes for a child who is going through a temporary phase. Teaching the child about nutrition is important but will not likely have much impact during this phase.

How often will the nurse caring for a preterm infant in an incubator record the temperature of the infant and the incubator? a. Every hour b. Every 2 hours c. Every 4 hours d. Every 8 hours

b. Every 2 hours

The apnea monitor indicates that a preterm infant is having an apneic episode. What is the most appropriate nursing action in this situation? a. Administer oxygen via a nasal cannula. b. Gently rub the infant's feet or back. c. Ventilate with an Ambu bag. d. Perform nasopharyngeal suctioning.

b. Gently rub the infant's feet or back. Gently rubbing the infant's back, ankles, or feet may stimulate the infant to breathe.

What term describes the age of a neonate that is based on the actual time in utero? a. Maturational age b. Gestational age c. Neurological age d. Chronological age

b. Gestational age The gestational age is the age based on the actual time in the uterus.

The mother of a 3-month-old child tells the primary care pediatric nurse practitioner that it is "so much fun" now that her infant coos and smiles and wants to play. What is important for the nurse practitioner to teach this mother? a. Appropriate ways to stimulate and entertain the infant b. How to read the infant's cues for overstimulation c. The importance of scheduling "play dates" with other infants d. To provide musical toys to engage the infant

b. How to read the infant's cues for overstimulation By 3 months, infants demonstrate a social smile and will become more active, alert, and responsive. Parents may mistakenly assume that the infant can handle more activity and stimulation when this occurs, and the PNP should teach caregivers how to recognize infant cues for the need to rest or to have decreased stimulation.

The nurse caring for an infant born at 36 weeks of gestation assesses tremors and a weak cry. The nurse is aware that these symptoms indicate what? a. Respiratory distress syndrome b. Hypoglycemia c. Necrotizing enterocolitis d. Renal failure

b. Hypoglycemia The preterm infant, before 38 weeks, should be assessed for hypoglycemia because the infant's glycogen stores are not adequate.

An infant receives surfactant via endotracheal (ET) tube at birth for symptoms of respiratory distress syndrome (RDS). When will the nurse anticipate seeing improvement of lung function? a. Immediately b. Within 3 days c. 1 to 2 weeks d. At least 1 month

b. Within 3 days In preterm newborns, surfactant can be administered via ET tube at birth or when symptoms of RDS occur, with improvement of lung function seen within 72 hours.

A Somalian immigrant mother is concerned that her 8-year-old child is underweight. The primary care pediatric nurse practitioner notes that the child's weight is at the 25th percentile. After realizing that the mother is comparing her child to a group of American-born children who are overweight, the pediatric nurse practitioner is able to convince the mother that this is a normal weight. Which domain of cultural competence does this represent? a. Global b. Interpersonal c. Intrapersonal d. Organizational

b. Interpersonal The interpersonal domain of cultural competence refers to how cultural competence is manifested between and among individuals and includes all relationships within the health care setting. The PNP becomes aware of cultural norms in body weight and uses this knowledge to discuss healthy weights with the parent. The global domain recognizes a movement toward integration and interconnection of the world population in economic, political, technological, and sociocultural terms. The intrapersonal domain refers to an understanding of the self to understand one's own cultural background. The organizational domain is knowledge of institutional culture and how it affects health care.

Which is true about the health status of children in the United States? a. Globalism has relatively little impact on child health measures in the U.S. b. Obesity rates among 2- to 5-year-olds have shown a recent significant decrease. c. The rate of household poverty is lower than in other economically developed nations. d. Young children who attend preschool or day care have higher food insecurity.

b. Obesity rates among 2- to 5-year-olds have shown a recent significant decrease. Obesity rates are a major concern for child health in the U.S. but recently have stabilized in the rate of increase and have declined among 2- to 5-year-olds between 2004 and 2013. Globalism has an increasing effect on child health in the U.S. The rate of household poverty in the U.S. is higher than in other economically developed nations. Young children who attend preschool or day care have lower food insecurity.

The parents of a 3-year-old child are concerned that the child has begun refusing usual foods and wants to eat mashed potatoes and chicken strips at every meal and snack. The child's rate of weight has slowed, but the child remains at the same percentile for weight on a growth chart. What will the primary care pediatric nurse practitioner tell the parents to do? a. a. Allow the child to choose foods for meals to improve caloric intake. b. b. Place a variety of nutritious foods on the child's plate at each meal. c. c. Prepare mashed potatoes and chicken strips for the child at mealtimes. d. d. Suggest cutting out snacks to improve the child's appetite at mealtimes.

b. Place a variety of nutritious foods on the child's plate at each meal. Young children should have three meals and two nutritious snacks each day. The parents' responsibility is to provide nutritious foods and allow children to choose how much they will eat. Children who are allowed to choose foods will likely make selections that are not healthy. Parents should be discouraged from preparing separate meals for their children. Snacks are necessary to maintain adequate intake and energy.

Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3-year-old child who draws on the walls with crayons? a. Give the child washable markers so the drawings can be removed easily. b. Provide a roll of paper for drawing and teach the child to use this. c. Put the child in "timeout" each time the child draws on the walls. d. Take the crayons away from the child to prevent the behavior.

b. Provide a roll of paper for drawing and teach the child to use this. Discipline involves training or education that molds appropriate behavior and is used to teach the child what is permitted and encouraged. Providing an appropriate outlet for drawing helps to teach the child where to use the crayons. Using washable markers allows the parents to clean the walls but does not teach the child appropriate behaviors. Timeout and taking away the crayons are forms of punishment, or a loss of privileges, that are administered as a form of retribution.

The primary care pediatric nurse practitioner is performing a well child examination on a 9-month-old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant? a. Provide educational videos that focus on language. b. Read simple board books to the infant at bedtime. c. Sing to the child and play lullabies in the baby's room. d. Turn the television to Sesame Street during the day.

b. Read simple board books to the infant at bedtime. The best way to improve language skills is to read to children. As long as the reading includes positive interactions with the baby and the reader, the baby is learning language. Educational videos, music, and television are all passive media and do not involve this interaction.

The nurse is caring for an infant with hydrocephalus. What nursing action is most important for this nurse to implement? a. Align the limbs. b. Support the head. c. Keep the head lower than the hip. d. Check intake and output.

b. Support the head. The child with hydrocephalus has a heavy head on a small body with poor muscle tone; the head must be supported when feeding and moving the child to prevent injury to the neck.

The primary care pediatric nurse practitioner performs a developmental assessment on a 3-year-old child and notes normal cognitive, fine-motor, and gross-motor abilities. The child responds appropriately to verbal commands during the assessment but refuses to speak when asked questions. The parent tells the nurse practitioner that the child talks at home and that most other adults can understand what the child says. The nurse practitioner will : a. ask the parent to consider a possible speech delay and report any concerns. b. continue to evaluate the child's speech at subsequent visits. c. refer the child for a speech and hearing evaluation. d. tell the parent to spend more time in interactive conversations with the child.

b. continue to evaluate the child's speech at subsequent visits. Development should be monitored over time and within the context of the child's overall well-being, rather than at an isolated testing session. The child has normal development in observed measures and appears to hear and understand well. By parental report, the child is able to speak. The PNP should continue to evaluate speech over time, since this refusal to speak may be associated with shyness or intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay. Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a home therapy.

A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks, "What is that medicine for?" The nurse responds: a. "It is an eye ointment to help your baby see you better." b. "It is to protect your baby from contracting herpes from your vaginal tract." c. "Erythromycin is given prophylactically to prevent a gonorrheal infection." d. "This medicine will protect your baby's eyes from drying out over the next few days."

c. "Erythromycin is given prophylactically to prevent a gonorrheal infection." With the prophylactic use of erythromycin, the incidence of gonococcal conjunctivitis has declined to less than 0.5%. Eye prophylaxis is administered at or shortly after birth to prevent ophthalmia neonatorum. Erythromycin has no bearing on enhancing vision, is used to prevent an infection caused by gonorrhea, not herpes, and is not used for eye lubrication.

A mother calls the pediatrician's office and asks the nurse if she should bring the baby for scheduled immunizations. The baby has a clear nasal discharge and a little cough, and the mother thinks perhaps the baby should not get immunizations if he has a cold. The nurse's best response is: a. "You are correct not to bring the baby to the office and expose other children." b. "Let's wait until the baby is free of these symptoms. There is no hurry for these immunizations." c. "Immunizations are not usually contraindicated with a mild illness such as a cold." d. "Take the baby's temperature. If it is not over 38.8 degrees C (101.8 degrees F), we will go ahead with the immunizations."

c. "Immunizations are not usually contraindicated with a mild illness such as a cold." "Immunizations are not usually contraindicated with a mild illness such as a cold" is the best response when advising a mother about keeping an appointment for scheduled immunizations.

A mother seems concerned as she asks why her infant is walking sideways while holding onto furniture. The best response by the nurse is: a. "You need to get a neurological consultation for your baby, to rule out some pathology." b. "If you hold the baby's hands while the baby walks, you can break the baby of this habit." c. "Infants start walking sideways while holding onto furniture before they walk or stand alone." d. "You need to make an appointment with your pediatrician and have this problem checked out."

c. "Infants start walking sideways while holding onto furniture before they walk or stand alone." Correct. Infants start walking sideways while holding onto furniture before they walk or stand alone.

Caregivers ask the nurse how they need to deal with their toddler who is a picky eater and eats very little at mealtime. In addition to telling the caregivers that this is not unusual behavior for a toddler, which of the following statements by the nurse would be most helpful? a. "Serve 1 tablespoon per year of age of each of the major food groups, and make the child sit at the table until this is consumed." b. "Serve more vegetable and fruit juice as well as protein shakes, allowing the child to drink when unwilling to eat." c. "Offer smaller amounts of food to encourage the toddler to ask for more, and serve frequent nutritious snacks throughout the day." d. "Serve new foods frequently, as children like variety and the child may be tired of the same old foods at every meal."

c. "Offer smaller amounts of food to encourage the toddler to ask for more, and serve frequent nutritious snacks throughout the day." In addition to telling the caregivers that this is not unusual behavior for a toddler, the statement by the nurse that would be most helpful is "Offer smaller amounts of food to encourage the toddler to ask for more, and serve frequent nutritious snacks throughout the day."

Caregivers complain to the nurse that their 2-year-old child insists on having his own way and is very stubborn about wanting things done at the same time in the same way every day. The best response by the nurse is which of the following responses? a. "Usually stubbornness can be corrected with behavior modification." b. "You will need to teach your child that the caregiver is the one in charge." c. "Routines provide a sense of security and control over the environment." d. "Coming up with a way to change this presents a challenge to caregivers."

c. "Routines provide a sense of security and control over the environment." Toddlers like habit and routine and are beginning to test the idea of independence.

The nurse would instruct the mother of a baby under 2 months to contact the health care provider if the baby's temperature is at which of the following readings or higher? a. 37.2 degrees C (99.0 degrees F) c. 37.9 degrees C (100.2 degrees F) b. 37.6 degrees C (99.6 degrees F) d. 38.9 degrees C (102 degrees F)

c. 37.9 degrees C (100.2 degrees F) The nurse would instruct the mother of a baby under 2 months to call the health care provider if the baby's temperature is 37.9 degrees C (100.2 degrees F) or higher.

At how many months of age does the infant have good head control and no head lag while sitting? a. 2 c. 4 b. 3 d. 6

c. 4 An infant does have good head control and no head lag at 4 months.

The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride supplements because she is exclusively breastfed. The nurse's best response is: a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 6 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

c. "She may need to begin taking them at age 6 months." Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. The recommendation is to begin supplementation at 6 months, not at 2 weeks. The amount of water that is ingested and the amount of fluoride in the water are evaluated when supplementation is being considered.

A couple is expecting their new baby any day, and they are concerned their 2-year-old will have problems accepting a new sister or brother. Which of the following statements by the caregivers would indicate they have acted on the teaching provided by the nurse about helping the toddler to deal with the birth of his sibling? a. "We started toilet training this week and hopefully will have our 2-year-old trained by the time the baby is born." b. "We told the 2-year-old that he will have not only a brother or sister but a new playmate soon." c. "The grandparents have been having our 2-year-old sleep over at least once a week for the past month." d. "The 2-year-old was moved out of the nursery this week. We wanted to wait longer but the baby is due any day."

c. "The grandparents have been having our 2-year-old sleep over at least once a week for the past month."

The nurse is helping an obese child learn about healthy food choices. The child shares with the nurse that he usually drinks a half a gallon of whole milk a day and often has a toasted cheese sandwich or macaroni and cheese for lunch and sometimes has a bowl of ice cream or yogurt for dessert. Based on knowledge of the nutritional needs of the school-aged child, the nurse's response to the amount of milk this child drinks each day would be which of the following? a. "You can drink all the milk and eat all the milk products you want, as they are very healthy." b. "You need to reduce your milk intake to a glass at each meal and at bedtime." c. "The recommended daily amount of milk and milk products such as cheese or ice cream is two to three servings a day." d. "If you drink a half a gallon of milk a day, you need to omit cheese and other milk products."

c. "The recommended daily amount of milk and milk products such as cheese or ice cream is two to three servings a day." The recommended daily amount of milk and milk products is two to three servings a day, so this is the best response. One serving is equal to one cup of milk or yogurt or 1 1/2 ounces of cheese.

Which of the following statements by caregivers of a preschooler would best indicate that the caregivers were paying attention to the teachings of the nurse on how to decrease the incidence of illnesses in their child? a. "We don't let our child play with other children unless the caregivers assure us they are not ill." b. "Our child's temperature is taken every morning and every night, and if it is elevated, we call the health care practitioner." c. "We make certain that our child washes her hands after using the bathroom and before eating." d. "Our child takes a vitamin pill every day, eats a balanced diet, and takes sufficient fluids."

c. "We make certain that our child washes her hands after using the bathroom and before eating." "We make certain that our child washes her hands after using the bathroom and before eating" is the statement by the caregivers of a preschooler that best indicates they comprehend how best to decrease the incidence of illnesses in their child.

An infant experienced an apparent life-threatening event and is being placed on home apnea monitoring. The parents have understood the instructions for use of a home apnea monitor when they state: a. "We can adjust the monitor to eliminate false alarms." b. "We should sleep in the same bed as our monitored infant." c. "We will check the monitor several times a day to be sure the alarm is working." d. "We will place the monitor in the crib with our infant."

c. "We will check the monitor several times a day to be sure the alarm is working." The parents should check the monitor several times a day to be sure the alarm is working and that it can be heard from room to room. The parents should not adjust the monitor to eliminate false alarms. Adjustments could compromise the monitor's effectiveness. The monitor should be placed on a firm surface away from the crib and drapes. The parents should not sleep in the same bed as the monitored infant.

An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents? a. "Did you hear the infant cry out?" b. "Why didn't you check on the infant earlier?" c. "What time did you find the infant?" d. "Was the head buried in a blanket?"

c. "What time did you find the infant?" During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as "Why didn't you go in earlier?" "Didn't you hear the infant cry out?" or "Was the head buried in a blanket?"

An adolescent girl asks the school health nurse about pregnancy. One of her questions is about irregular menses and whether or not she can get pregnant the first month after her first period. The nurse's best answer would be: a. "You cannot become pregnant until your menses are regular." b. "Pregnancy can occur only after the second period." c. "You can become pregnant after your first period." d. "Ovulation does not begin until about 6 months after menarche."

c. "You can become pregnant after your first period." Even though regular menstrual cycles typically begin 6-14 months after menarche, adolescent females can become pregnant after their first menstrual period.

The caregivers of a newborn baby mention to the nurse that they sleep on a water bed and are planning to have the baby sleep with them. The nurse would say which of the following things to the family in her teaching? a. "Many people believe that a family that sleeps together bonds well." b. "This will make it more convenient to feed the baby at night." c. "You need to sleep on a firm mattress with the baby or give the baby a crib with a firm mattress." d. "Some caregivers report not getting enough rest at night when they have the baby or other children sleep with them."

c. "You need to sleep on a firm mattress with the baby or give the baby a crib with a firm mattress." Correct. The nurse in her family teaching will discuss the types of bedding to avoid with the newborn: soft bedding, pillows, comforters, sheepskin and waterbeds.

An infant is being discharged from the neonatal intensive care unit after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including respiratory distress syndrome, mild bronchopulmonary dysplasia, and retinopathy of prematurity requiring surgical treatment. During discharge teaching the infant's mother asks the nurse whether her baby will meet developmental milestones on time, as did her son who was born at term. The nurse's most appropriate response is: a. "Your baby will develop exactly like your first child did." b. "Your baby does not appear to have any problems at the present time." c. "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing." d. "Your baby will need to be followed very closely."

c. "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing." The age of a preterm newborn is corrected by adding the gestational age and the postnatal age. The infant's responses are evaluated accordingly against the norm expected for the corrected age of the infant. Although it is impossible to predict with complete accuracy the growth and development potential of each preterm infant, certain measurable factors predict normal growth and development. The preterm infant experiences catch-up body growth during the first 2 to 3 years of life. The growth and developmental milestones are corrected for gestational age until the child is approximately 2.5 years old. Stating that the baby does not appear to have any problems at the present time is inaccurate. Development will need to be evaluated over time.

The approximate increase in height for babies is how many inches per month in the first 6 months of life? a. 1/4 c. 1 b. 1/2 d. 1-1/2

c. 1 Correct. The approximate increase in height during the first 6 months of life for babies is 1 inch per month.

The age range for an infant is defined as which of the following time spans? a. newborn to 3 months c. 1 month to 1 year b. newborn to 6 months d. 3 months to 15 months

c. 1 month to 1 year The age range for an infant is defined as 1 month to 1 year.

By what age do the head and chest circumferences generally become equal? a. 1 month c. 1 to 2 years b. 6 to 9 months d. 2.5 to 3 years

c. 1 to 2 years Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference at ages 1 month and 6 to 9 months. Chest circumference is larger than head circumference at age 2.5 to 3 years.

At about what age does the Babinski sign disappear? a. 4 months b. 6 months c. 1 year d. 2 years

c. 1 year The presence of the Babinski reflex after about age 1 year, when walking begins, is abnormal. Four to 6 months is too young for the disappearance of the Babinski reflex. Persistence of the Babinski reflex requires further evaluation.

The approximate weight gain for babies in the first 6 months of life is: a. 1/2 pound per month c. 1-1/2 pounds per month b. 1 pound per month d. 2 pounds per month

c. 1-1/2 pounds per month The approximate weight gain during the first 6 months of life is about 1 1/2 pounds per month.

The nurse notices a baby in the waiting room. The baby is sitting on the mother's lap and picking up small green peas out of a bowl with a true pincer grasp and eating them unassisted. The nurse knows that this baby is at least how many months old? a. 4 to 6 c. 10 to 12 b. 7 to 9 d. 13 to 15

c. 10 to 12 By 10 months of age, the infant's pincer grasp is more refined and reflected in the ability to grasp small finger foods such as green peas.

The nurse is working in an immunization clinic and is assessing the immunization records of the children presenting there to see what immunizations they need. When the nurse finds a child who has not received a measles-mumps-rubella (MMR) booster or a tetanus, diphtheria and pertussis (DTaP) booster between ages 4 and 6, the nurse will tell the parents to have this booster or boosters given to their child at what age? a. 8 c. 11 to 12 b. 8 to 10 d. 13

c. 11 to 12 When the nurse finds a child who has not received a measles-mumps-rubella (MMR) booster or a tetanus, diphtheria and pertussis (DTaP) booster between ages 4 and 6, the nurse will tell the parents to have this booster or boosters given to their child at ages 11-12 years.

The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? a. 6 months c. 12 months b. 9 months d. 18 months

c. 12 months The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is: a. 80 to 100 beats/min. c. 120 to 160 beats/min. b. 100 to 120 beats/min. d. 150 to 180 beats/min.

c. 120 to 160 beats/min. The average infant heart rate while awake is 120 to 160 beats/min. The newborn's heart rate may be about 85 to 100 beats/min while sleeping. The infant's heart rate typically is a bit higher when alert but quiet. A heart rate of 150 to 180 beats/min is typical when the infant cries.

Which of the following ages might be a more opportune time for the birth of an additional sibling, because at this age the child is less jealous of a younger sibling? a. 1 c. 3 b. 2 d. 4

c. 3 The 3-year old child likes to please caregivers and conform to their wishes. At this age, the child is less jealous of a younger sibling, so this may be an opportune time for the birth of a younger sibling.

At what age is the infant able to concentrate urine completely? a. birth c. 3 months b. 1 week d. 1 year

c. 3 months An infant is able to concentrate urine completely at 3 months.

The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? a. 1 month c. 3 to 4 months b. 1 to 2 months d. 6 months

c. 3 to 4 months Visual fixation and following a target should be present by ages 3 to 4 months. Ages 1 to 2 months are too young for this developmental milestone. If the infant is not able to fix and follow by 6 months of age, further ophthalmologic evaluation is needed.

The rooting reflex of an infant disappears at approximately how many months of age? a. 1 c. 4 b. 2 d. 6

c. 4 Correct. The rooting reflex of an infant does disappear at approximately 4 months of age.

The nurse on the pediatric unit is working with the recreational and developmental specialists to plan some activities for the children. One activity is a card game, in which the participant is required to sort into piles cards picturing like objects. The nurse realizes that children of which of the following age groups have just begun to have this capacity? a. 3 years c. 4 years b. 3-1/2 years d. 6 years

c. 4 years By age 4 years, the child can sort objects into like categories.

By what age does birth length usually double? a. 1 year c. 4 years b. 2 years d. 6 years

c. 4 years Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average most children have doubled their birth length at age 4 years. One year and 2 years are too young for doubling of length.

During the toddler stage, a child will gain approximately how many pounds per year? a. 1 c. 5 b. 3 d. 7

c. 5 During the toddler stage, a child will not gain approximately 5 pounds per year.

When working with school-aged children, the nurse should keep in mind that these children will increase their weight by how many pounds per year? a. 1-2 c. 5-6 b. 3-4 d. 7-8

c. 5-6 During the school-aged years, the child's weight increases by 5-6 pounds per year.

You are to determine how many kilocalories per day (kcal/day) an infant who weighs 4.5 kilograms needs. The number of kcal/day would be which of the following? a. 310 c. 540 b. 420 d. 660

c. 540 An infant requiring 540 kilocalories per day will weigh 4.5 kilograms (540/120=4.5)

A parent asks the nurse "At what age do most babies begin to fear strangers?" The nurse responds that most infants begin to fear strangers at age: a. 2 months. c. 6 months. b. 4 months. d. 12 months.

c. 6 months. Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months, the infant is just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the infant does not fear strangers at this age.

At which age can most infants sit steadily unsupported? a. 4 months c. 8 months b. 6 months d. 10 months

c. 8 months Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)-for-age percentile indicates a risk for being overweight? a. 10th percentile c. 85th percentile b. 9th percentile d. 95th percentile

c. 85th percentile Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight.

Male Jewish newborns are typically circumcised in a religious ceremony on what day of life? a. 3rd c. 8th b. 5th d. 12th

c. 8th Male Jewish newborns are typically circumcised in a religious ceremony on the 8th day of life.

By what age should the nurse expect that an infant will be able to pull to a standing position? a. 6 months c. 9 months b. 8 months d. 11 to 12 months

c. 9 months Most infants can pull themselves to a standing position at age 9 months. Any infant who cannot pull to a standing position by age 11 to 12 months should be referred for further evaluation for developmental dysplasia of the hip. At 6 months, the infant has just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs.

How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day? a. 50 to 65 c. 95 to 110 b. 75 to 90 d. 150 to 200

c. 95 to 110 For the first 3 months the infant needs 110 kcal/kg/day. At ages 3 to 6 months the requirement is 100 kcal/kg/day. This level decreases slightly to 95 kcal/kg/day from 6 to 9 months and increases again to 100 kcal/kg/day until the baby reaches 12 months.

High self-esteem can best be identified in which of the following instances? a. A child is respectful of the parents and other adult and authority figures. b. A child keeps quiet around others and displays good listening skills. c. A child perceives him- or herself to be close to how he or she would like to be. d. A child is asked if he or she has high self-esteem, and the child answers "yes."

c. A child perceives him- or herself to be close to how he or she would like to be. The closer the perceived self is to the ideal self (how the child would like to be) the higher the child's self-esteem.

According to demographic research, the woman least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding would be: a. A woman who is 30 to 35 years of age, Caucasian, and employed part time outside the home. b. A woman who is younger than 25 years of age, Hispanic, and unemployed. c. A woman who is younger than 25 years of age, African-American, and employed full time outside the home. d. A woman who is 35 years of age or older, Caucasian, and employed full time at home.

c. A woman who is younger than 25 years of age, African-American, and employed full time outside the home. Women least likely to breastfeed typically are younger than 25 years of age, have a lower income, are less educated, are employed full time outside the home, and are African-American.

A preschooler knows she should not ram her tricycle into the garage door at home, but she does this at a friend's house. What is the most logical reason for this difference in behavior at home and at the friend's house? a. The preschooler values her own house more than she values the house of a playmate. b. The child's mother is much stricter and supervises children much more closely than the playmate's mother. c. A young preschool child may have difficulty applying known rules to a different situation. d. There is a higher level of frustration when outside her own home and play territory.

c. A young preschool child may have difficulty applying known rules to a different situation. Young preschoolers may have difficulty applying known rules to different situations, hence knowing not to ram her tricycle into her home garage door is not the same as ramming her tricycle into her friend's garage door.

Which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face such as the mother b. Recognizes familiar object such as a bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

c. Actively searches for a hidden object During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows that an object exists even when it is not visible. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. They cry, smile, vocalize, and show distinct preference for their mothers. This preference is one of the stages that influence the attachment process, but it is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect, such as pulling on a string to secure an object, is part of secondary schema development.

At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse agree that, to gain weight faster, the infant needs to: a. Begin solid foods. b. Have a bottle of formula after every feeding. c. Add at least one extra breastfeeding session every 24 hours. d. Start iron supplements.

c. Add at least one extra breastfeeding session every 24 hours. Usually the solution to slow weight gain is to improve the feeding technique. Position and latch-on are evaluated, and adjustments are made. It may help to add a feeding or two in a 24-hour period. Solid foods should not be introduced to an infant for at least 4 to 6 months. Bottle-feeding may cause nipple confusion and limit the supply of milk. Iron supplements have no bearing on weight gain.

In caring for the mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that: a. The pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over. b. Two thirds of newborns with fetal alcohol syndrome (FAS) are boys. c. Alcohol-related neurodevelopmental disorders not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school. d. Both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time.

c. Alcohol-related neurodevelopmental disorders not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school. Some learning problems do not become evident until the child is at school. The pattern of growth restriction persists after birth. Two thirds of newborns with FAS are girls. Although the distinctive facial features of the FAS infant tend to become less evident, the mental capacities never become normal.

The intrauterine environment can have a profound and permanent effect on the developing fetus with or without chromosome or gene abnormalities. Most adverse intrauterine effects are the result of teratogens. The nurse is cognizant that this group of agents does not include: a. Accutane c. Amniotic bands b. Rubella d. Alcohol

c. Amniotic bands Amniotic bands are a congenital anomaly known as a "disruption" that occurs with the breakdown of previously normal tissue. Congenital amputations caused by amniotic bands are not the result of a teratogen. Other agents include Dilantin, warfarin, cytomegalovirus, radiation, and maternal PKU.

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered because these milestones are: a. Unnecessary information because the child is age 3 years. b. An important part of the family history. c. An important part of the child's past growth and development. d. An important part of the child's review of systems.

c. An important part of the child's past growth and development. Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. Developmental milestones provide important information about the child's physical, social, and neurologic health. The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones.

In what type of play are children engaged in similar or identical activity without organization, division of labor, or mutual goal? a. Solitary c. Associative b. Parallel d. Cooperative

c. Associative In associative play no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play activities for a common goal.

An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed: a. Only if the newborn is in obvious distress. b. Once by the obstetrician, just after the birth. c. At least twice, 1 minute and 5 minutes after birth. d. Every 15 minutes during the newborn's first hour after birth.

c. At least twice, 1 minute and 5 minutes after birth. Apgar scoring is performed at 1 minute and 5 minutes after birth. Scoring may continue at 5-minute intervals if the infant is in distress and requires resuscitation efforts.

The nurse administers vitamin K to the newborn for which reason? a. Most mothers have a diet deficient in vitamin K, which results in the infant's being deficient. b. Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection. c. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. d. The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.

c. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. Vitamin K is provided because the newborn does not have the intestinal flora to produce this vitamin for the first week. The maternal diet has no bearing on the amount of vitamin K found in the newborn. Vitamin K promotes the formation of clotting factors in the liver and is used for the prevention and treatment of hemorrhagic disease in the newborn. Vitamin K is not produced in the intestinal tract of the newborn until after microorganisms are introduced. By day 8, normal newborns are able to produce their own vitamin K.

Which statement best describes the infant's physical development? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

c. Birth weight doubles by age 5 months and triples by age 1 year. Growth is very rapid during the first year of life. The birth weight approximately doubles by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the patient accordingly. Which statement as part of this discussion would be incorrect? a. Breastfeeding requires fewer supplies and less cumbersome equipment. b. Breastfeeding saves families money. c. Breastfeeding costs employers in terms of time lost from work. d. Breastfeeding benefits the environment.

c. Breastfeeding costs employers in terms of time lost from work. Actually less time is lost to work by breastfeeding mothers, in part because infants are healthier. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. It saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.

With regard to the nutrient needs of breastfed and formula-fed infants, nurses should be understand that: a. Breastfed infants need extra water in hot climates. b. During the first 3 months breastfed infants consume more energy than do formula-fed infants. c. Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months. d. Vitamin K injections at birth are not needed for infants fed on specially enriched formula.

c. Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months. Human milk contains only small amounts of vitamin D. Neither breastfed nor formula-fed infants need to be given water, even in very hot climates. During the first 3 months formula-fed infants consume more energy than do breastfed infants and therefore tend to grow more rapidly. Vitamin K shots are required for all infants because the bacteria that produce it are absent from the baby's stomach at birth.

A breastfeeding woman develops engorged breasts at 3 days' postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman: a. Skips feedings to let her sore breasts rest. b. Avoids using a breast pump. c. Breastfeeds her infant every 2 hours. d. Reduces her fluid intake for 24 hours.

c. Breastfeeds her infant every 2 hours. The mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding. Skipping feedings may cause further swelling and discomfort. If the infant does not feed adequately and empty the breast, the mother may pump to extract the milk and relieve some of the discomfort. Dehydration further irritates swollen breast tissue.

A new mother wants to be sure that she is meeting her daughter's needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant care. The mother meets her child's needs when she: a. Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition. b. Warms the bottles using a microwave oven. c. Burps her infant during and after the feeding as needed. d. Refrigerates any leftover formula for the next feeding.

c. Burps her infant during and after the feeding as needed. Most infants swallow air when fed from a bottle and should be given a chance to burp several times during a feeding and after the feeding. Solid food should not be introduced to the infant for at least 4 to 6 months after birth. A microwave should never be used to warm any food to be given to an infant. The heat is not distributed evenly, and this may pose a risk of burning the infant. Any formula left in the bottle after the feeding should be discarded because the infant's saliva has mixed with it.

Parent guidelines for relieving colic in an infant include: a. Avoiding touching the abdomen. b. Avoiding using a pacifier. c. Changing the infant's position frequently. d. Placing the infant where the family cannot hear the crying.

c. Changing the infant's position frequently. Changing the infant's position frequently may be beneficial. The parent can walk holding the infant face down and with the infant's chest across the parent's arm. The parent's hand can support the infant's abdomen, applying gentle pressure. Gently massaging the abdomen is effective in some infants. Pacifiers can be used for meeting additional sucking needs. The infant should not be placed where monitoring cannot be done. The infant can be placed in the crib and allowed to cry. Periodically, the infant should be picked up and comforted.

While caring for a critically ill child, the nurse observes that respirations are gradually increasing in rate and depth, with periods of apnea. What pattern of respiration will the nurse document? a. Dyspnea b. Tachypnea c. Cheyne-Stokes respirations d. Seesaw (paradoxic) respirations

c. Cheyne-Stokes respirations Cheyne-Stokes respirations are a pattern of respirations that gradually increase in rate and depth, with periods of apnea. Dyspnea is defined as distress during breathing. Tachypnea is an increased respiratory rate. In seesaw respirations, the chest falls on inspiration and rises on expiration.

The nurse is working with the caregivers of a child who is 2-1/2 years old. The nurse advises the caregivers that it is important for the child to know what it feels like to have a wet diaper. This advice was given because of which rationale? a. The nurse is acting on an old wives' tale and has no rationale. b. Children need to know the connection between being wet and being changed by a caregiver. c. Children have to be able to tell a caregiver they are wet before they can be successfully toilet trained. d. This is an important sensory experience for maximum development of brain potential.

c. Children have to be able to tell a caregiver they are wet before they can be successfully toilet trained. The nurse advises the caregivers that it is important for the child to know what it feels like to have a wet diaper. Children have to be able to tell a caregiver they are wet before they can be successfully toilet trained.

Which is the most appropriate vision acuity test for a child who is in preschool? a. Cover test b. Ishihara test c. HOTV chart d. Snellen letter chart

c. HOTV chart The HOTV test consists of a wall chart of these letters. The child is asked to point to a corresponding card when the examiner selects one of the letters on the chart. The cover test determines ocular alignment. The Ishihara test is used for the detection of color blindness. The Snellen letter chart is usually used for older children.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home? a. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. b. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. c. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. d. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

c. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. Cleansing the penis gently with water and putting petroleum jelly around the glans after each diaper change are appropriate when caring for an infant who has had a circumcision. With each diaper change, the penis should be washed off with warm water to remove any urine or feces. If bleeding occurs, the nurse should apply gentle pressure to the site of the bleeding with a sterile gauze square. Yellow exudates cover the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudates should not be removed.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given: a. Skim milk. c. Commercial iron-fortified formula. b. Whole cow's milk. d. Commercial formula without iron.

c. Commercial iron-fortified formula. For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron deficiency anemia.

Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of: a. Gonorrhea. c. Congenital syphilis. b. Herpes simplex virus infection. d. Human immunodeficiency virus.

c. Congenital syphilis. The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.

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.

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

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. The nurse should: a. Notify the physician immediately. b. Move the newborn to an isolation nursery. c. Document the finding as erythema toxicum. d. Take the newborn's temperature and obtain a culture of one of the vesicles.

c. Document the finding as erythema toxicum. Erythema toxicum (or erythema neonatorum) is a newborn rash that resembles flea bites. This is a normal finding that does not require notification of the physician, isolation of the newborn, or any additional interventions.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

c. Explain in simple terms how it works. School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively to requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so the child can then observe during the procedure.

In the classification of newborns by gestational age and birth weight, the appropriate for gestational age (AGA) weight would: a. Fall between the 25th and 75th percentiles for the infant's age. b. Depend on the infant's length and the size of the head. c. Fall between the 10th and 90th percentiles for the infant's age. d. Be modified to consider intrauterine growth restriction (IUGR).

c. Fall between the 10th and 90th percentiles for the infant's age. The AGA range is large: between the 10th and the 90th percentiles for the infant's age. The infant's length and size of the head are measured, but they do not affect the normal weight designation. IUGR applies to the fetus, not the newborn's weight.

The school nurse is called to the playground to attend to a child who has had a tooth knocked out during a playground fight. Which of the following would be the best action for the nurse to take? a. Have the child gargle with hot salt water and put the tooth in an envelope so the child can put it under his or her pillow. b. Apply an ice pack to the side of the face there the tooth came out, and have the child rinse the mouth several times with ice-cold water. c. Gently rinse the tooth with water, put the tooth back into the socket, and call the caregivers to take the child to the dentist. d. Call the parents immediately so they can contact the dentist to find out what the dentist wants them to do.

c. Gently rinse the tooth with water, put the tooth back into the socket, and call the caregivers to take the child to the dentist. An evulsed tooth (tooth that is knocked out) should be picked up, rinsed gently under water, and placed back in the socket. The child should hold the tooth in place, and a dentist should be contacted immediately. If the tooth cannot be held in place, it should be put in cold milk or held in the mouth, under the child's or caregiver's tongue, until seen by a dentist.

Which strategy would be the least appropriate for a child to use to cope? a. Learning problem solving c. Having parents solve problems b. Listening to music d. Using relaxation techniques

c. Having parents solve problems Children respond to everyday stress by trying to change the circumstances or adjust to the circumstances the way they are. Strategies that provide relaxation and other stress-reduction techniques should be used. An inappropriate response would be for the parents to solve the problems. Some children develop socially unacceptable strategies such as lying, stealing, or cheating. Learning problem solving, listening to music, and using relaxation techniques are positive approaches for coping in children.

The nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age. This intervention: a. Is adopted from classical British nursing traditions. b. Helps infants with motor and central nervous system impairment. c. Helps infants to interact directly with their parents and enhances their temperature regulation. d. Gets infants ready for breastfeeding.

c. Helps infants to interact directly with their parents and enhances their temperature regulation. Kangaroo care is skin-to-skin holding in which the infant, dressed only in a diaper, is placed directly on the parent's bare chest and then covered. The procedure helps infants interact with their parents and regulates their temperature, among other developmental benefits.

While examining a newborn, the nurse notes uneven skin folds on the buttocks and a click when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has: a. Polydactyly. c. Hip dysplasia. b. Clubfoot. d. Webbing

c. Hip dysplasia. The Ortolani maneuver is used to detect the presence of hip dysplasia. Polydactyly is the presence of extra digits. Clubfoot (talipes equinovarus) is a deformity in which the foot turns inward and is fixed in a plantar-flexion position. Webbing, or syndactyly, is a fusing of the fingers or toes.

An infant was born 2 hours ago at 37 weeks of gestation and weighing 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of: a. Birth injury. c. Hypoglycemia. b. Hypocalcemia. d. Seizures.

c. Hypoglycemia. Hypoglycemia is common in the macrosomic infant. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis.

As related to laboratory tests and diagnostic tests in the hospital after birth, nurses should be aware that: a. All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases. b. Federal law prohibits newborn genetic testing without parental consent. c. If genetic screening is done before the infant is 24 hours old, it should be repeated at age 1 to 2 weeks. d. Hearing screening is now mandated by federal law.

c. If genetic screening is done before the infant is 24 hours old, it should be repeated at age 1 to 2 weeks. If done very early, genetic screening should be repeated. States all test for PKU and hypothyroidism, but other genetic defects are not universally covered. Federal law mandates newborn genetic screening, but not screening for hearing problems (although more than half the states do mandate hearing screening).

As the nurse assists a new mother with breastfeeding, the client asks, "If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better?" The nurse's best response is that it contains: a. More calories. c. Important immunoglobulins. b. Essential amino acids. d. More calcium.

c. Important immunoglobulins. Breast milk contains immunoglobulins that protect the newborn against infection. The calorie count of formula and breast milk is about the same. All the essential amino acids are in both formula and breast milk; however, the concentrations may differ. Calcium levels are higher in formula than in breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly.

As related to central nervous system injuries that could occur to the infant during labor and birth, nurses should be aware that: a. Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in the preterm, low-birth-weight infant. b. Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants as a result of hypoxia. c. In many infants signs of hemorrhage in a full-term infant are absent and are diagnosed only through laboratory tests. d. Spinal cord injuries almost always result from forceps-assisted deliveries.

c. In many infants signs of hemorrhage in a full-term infant are absent and are diagnosed only through laboratory tests. Abnormalities in lumbar punctures or red blood cell counts, for instance, or in visuals on computed tomography scan may reveal a hemorrhage. ICH as a result of birth trauma is more likely to occur in the full-term, large infant. Subarachnoid hemorrhage in term infants is a result of trauma; in preterm infants it is a result of hypoxia. Spinal cord injuries are almost always from breech births; they are rare today because cesarean birth often is used for breech presentation.

Which behavior is most characteristic of the concrete operations stage of cognitive development? a. Progression from reflex activity to imitative behavior b. Inability to put oneself in another's place c. Increasingly logical and coherent thought processes d. Ability to think in abstract terms and draw logical conclusions

c. Increasingly logical and coherent thought processes During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child's ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another's place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.

Which statement is most descriptive of pediatric family-centered care? a. It reduces the effect of cultural diversity on the family. b. It encourages family dependence on the health care system. c. It recognizes that the family is the constant in a child's life. d. It avoids expecting families to be part of the decision-making process.

c. It recognizes that the family is the constant in a child's life. The key components of family-centered care are for the nurse to support, respect, encourage, and embrace the family's strength by developing a partnership with the child's parents. Family-centered care recognizes the family as the constant in the child's life. The nurse should support the cultural diversity of the family, not reduce its effect. The family should be enabled and empowered to work with the health care system and to be part of the decision-making process.

The nurse is performing a gestational age and physical assessment on the newborn. The infant appears to have an excessive amount of saliva. The nurse recognizes that this finding: a. Is normal. b. Indicates that the infant is hungry. c. May indicate that the infant has a tracheoesophageal fistula or esophageal atresia. d. May indicate that the infant has a diaphragmatic hernia.

c. May indicate that the infant has a tracheoesophageal fistula or esophageal atresia. The presence of excessive saliva in a neonate should alert the nurse to the possibility of tracheoesophageal fistula or esophageal atresia.

When doing a nutritional assessment on an Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: a. Indicates that they live in poverty. b. Is lacking in protein. c. May provide sufficient amino acids. d. Should be enriched with meat and milk.

c. May provide sufficient amino acids. The diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that contain this combination of foods. It does not indicate poverty. Combinations of foods contain the essential amino acids necessary for growth. A dietary assessment should be done, but many vegetarian diets are sufficient for growth.

The leading cause of death from unintentional injuries in children is: a. Poisoning. c. Motor vehicle-related fatalities. b. Drowning. d. Fire- and burn-related fatalities.

c. Motor vehicle-related fatalities. Motor vehicle-related fatalities comprise the leading cause of death in children, as either passengers or pedestrians. Poisoning is the ninth leading cause of death.

As a result of large body surface in relation to weight, the preterm infant is at high risk for heat loss and cold stress. By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. While evaluating the plan that has been implemented, the nurse knows that the infant is experiencing cold stress when he or she exhibits: a. Decreased respiratory rate. b. Bradycardia followed by an increased heart rate. c. Mottled skin with acrocyanosis. d. Increased physical activity.

c. Mottled skin with acrocyanosis. The infant has minimal to no fat stores. During times of cold stress the skin will become mottled, and acrocyanosis will develop, progressing to cyanosis. Even if the infant is being cared for on a radiant warmer or in an isolette, the nurse's role is to observe the infant frequently to prevent heat loss and respond quickly if signs and symptoms occur. The respiratory rate increases followed by periods of apnea. The infant initially tries to conserve heat and burns more calories, after which the metabolic system goes into overdrive. In the preterm infant experiencing heat loss, the heart rate initially increases, followed by periods of bradycardia. In the term infant, the natural response to heat loss is increased physical activity. However, in a term infant experiencing respiratory distress or in a preterm infant, physical activity is decreased.

What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 c. Murmur b. S3, S4 d. Physiologic splitting

c. Murmur Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves, and both are considered normal heart sounds. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

A nurse is assessing a child with an unrepaired ventricular septal defect. Which heart sound does the nurse expect to assess? a. S3 b. S4 c. Murmur d. Physiologic splitting

c. Murmur Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. These are the sounds expected to be heard in a child with a ventricular septal defect because of the abnormal opening between the ventricles. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is: a. Pharmacologic treatment. b. Reduction of environmental stimuli. c. Neonatal abstinence syndrome scoring. d. Adequate nutrition and maintenance of fluid and electrolyte balance.

c. Neonatal abstinence syndrome scoring. Neonatal abstinence syndrome (NAS) is the term used to describe the cohort of symptoms associated with drug withdrawal in the neonate. The Neonatal Abstinence Scoring System evaluates central nervous system (CNS), metabolic, vasomotor, respiratory, and gastrointestinal disturbances. This evaluation tool enables the care team to develop an appropriate plan of care. The infant is scored throughout the length of stay, and the treatment plan is adjusted accordingly. Pharmacologic treatment is based on the severity of withdrawal symptoms. Symptoms are determined by using a standard assessment tool. Medications of choice are morphine, phenobarbital, diazepam, or diluted tincture of opium. Swaddling, holding, and reducing environmental stimuli are essential in providing care to the infant who is experiencing withdrawal. These nursing interventions are appropriate for the infant who displays CNS disturbances. Poor feeding is one of the gastrointestinal symptoms common to this client population. Fluid and electrolyte balance must be maintained and adequate nutrition provided. These infants often have a poor suck reflex and may need to be fed via gavage.

Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face c. Oral mucosa b. Buttocks d. Palms and soles

c. Oral mucosa Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark skin unless they are in the mouth or conjunctiva.

During a routine health assessment, the nurse notes that an 8-month-old infant has significant head lag. Which is the nurse's most appropriate action? a. Teach the parents appropriate exercises. b. Recheck head control at the next visit. c. Refer the child for further evaluation. d. Refer the child for further evaluation if the anterior fontanel is still open.

c. Refer the child for further evaluation. Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Reduction of head lag is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated.

As related to the eventual discharge of the high risk newborn or transfer to a different facility, nurses and families should be aware that: a. Infants will stay in the neonatal intensive care unit (NICU) until they are ready to go home. b. Once discharged to home, the high risk infant should be treated like any healthy term newborn. c. Parents of high risk infants need special support and detailed contact information. d. If a high risk infant and mother need transfer to a specialized regional center, it is better to wait until after birth and the infant is stabilized.

c. Parents of high risk infants need special support and detailed contact information. High risk infants can cause profound parental stress and emotional turmoil. Parents need support, special teaching, and quick access to various resources available to help them care for their baby. Parents and their high risk infant should spend a night or two in a predischarge room, where care for the infant is provided away from the NICU. Just because high risk infants are discharged does not mean that they are normal, healthy babies. Follow-up by specialized practitioners is essential. Ideally, the mother and baby are transported with the fetus in utero; this reduces neonatal morbidity and mortality.

What marks on a baby's skin may indicate an underlying problem that requires notification of a physician? a. Mongolian spots on the back b. Telangiectatic nevi on the nose or nape of the neck c. Petechiae scattered over the infant's body d. Erythema toxicum anywhere on the body

c. Petechiae scattered over the infant's body Petechiae (bruises) scattered over the infant's body should be reported to the pediatrician because they may indicate underlying problems. Mongolian spots are bluish-black spots that resemble bruises but fade gradually over months and have no clinical significance. Telangiectatic nevi (stork bites, angel kisses) fade by the second year and have no clinical significance. Erythema toxicum is an appalling-looking rash, but it has no clinical significance and requires no treatment.

A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method would be to: a. Apply an oil-based lotion to the newborn's skin to prevent dying and cracking. b. Limit the newborn's intake of milk to prevent nausea, vomiting, and diarrhea. c. Place eye shields over the newborn's closed eyes. d. Change the newborn's position every 4 hours.

c. Place eye shields over the newborn's closed eyes. The infant's eyes must be protected by an opaque mask to prevent overexposure to the light. Eye shields should cover the eyes completely but not occlude the nares. Lotions and ointments should not be applied to the infant because they absorb heat, and this can cause burns. The lights increase insensible water loss, placing the infant at risk for fluid loss and dehydration. Therefore, it is important that the infant be adequately hydrated. The infant should be turned every 2 hours to expose all body surfaces to the light.

In giving anticipatory guidance to caregivers about infant self-feeding, the nurse would suggest that the caregivers do which of the following things? a. Place the high chair in an area that is carpeted. b. Hold the baby on the lap during feedings. c. Place the high chair on a washable surface. d. Put off self-feeding as long as possible.

c. Place the high chair on a washable surface. In giving anticipatory guidance to caregivers about infant self-feeding, the nurse would suggest that the caregivers place the high chair on a washable surface.

For clinical purposes, preterm and post-term infants are defined as: a. Preterm before 34 weeks if appropriate for gestational age (AGA) and before 37 weeks if small for gestational age (SGA). b. Post-term after 40 weeks if large for gestational age (LGA) and beyond 42 weeks if AGA. c. Preterm before 37 weeks, and post-term beyond 42 weeks, no matter the size for gestational age at birth. d. Preterm, SGA before 38 to 40 weeks, and post-term, LGA beyond 40 to 42 weeks.

c. Preterm before 37 weeks, and post-term beyond 42 weeks, no matter the size for gestational age at birth. Preterm and post-term are strictly measures of time—before 37 weeks and beyond 42 weeks, respectively—regardless of size for gestational age.

Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patient's status c. Questioning the use of daily central line dressing changes d. Clarifying a physician's prescription for morphine

c. Questioning the use of daily central line dressing changes The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates evidence-based practice (EBP), which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patient's status are practices that follow established guidelines. Clarifying a physician's prescription for morphine constitutes safe nursing care.

Which type of formula is not diluted before being administered to an infant? a. Powdered c. Ready-to-use b. Concentrated d. Modified cow's milk

c. Ready-to-use Ready-to-use formula can be poured directly from the can into baby's bottle and is good (but expensive) when a proper water supply is not available. Formula should be well mixed to dissolve the powder and make it uniform in consistency. Improper dilution of concentrated formula may cause malnutrition or sodium imbalances. Cow's milk is more difficult for the infant to digest and is not recommended, even if it is diluted.

Latasha is a breastfed infant being seen in the clinic for her 6-month checkup. Her mother tells the nurse that Latasha recently began to suck her thumb. The best nursing intervention is to: a. Recommend that the mother substitute a pacifier for Latasha's thumb. b. Assess Latasha for other signs of sensory deprivation. c. Reassure the mother that this is very normal at this age. d. Suggest that the mother breastfeed Latasha more often to satisfy sucking needs.

c. Reassure the mother that this is very normal at this age. Sucking is an infant's chief pleasure, and she may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. Dental damage does not appear to occur unless the use of the pacifier or finger persists after age 4 to 6 years. The nurse should explore with the mother her feelings about pacifier vs. thumb. This is a normal behavior to meet nonnutritive sucking needs. No data support that Latasha has sensory deprivation.

To best assess the effectiveness of the phototherapy treatment, the nurse will monitor which of the following? a. skin color of the newborn c. serial serum bilirubin levels b. pulse oximetry d. activity level of the baby

c. serial serum bilirubin levels To best assess the effectiveness of the phototherapy treatment, the nurse will rely upon serial serum bilirubin levels.

With regard to the gastrointestinal (GI) system of the newborn, nurses should be aware that: a. The newborn's cheeks are full because of normal fluid retention. b. The nipple of the bottle or breast must be placed well inside the baby's mouth because teeth have been developing in utero, and one or more may even be through. c. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the baby's head. d. Bacteria are already present in the infant's GI tract at birth because they traveled through the placenta.

c. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the baby's head. Avoiding overfeeding can also reduce regurgitation. The newborn's cheeks are full because of well-developed sucking pads. Teeth do develop in utero, but the nipple is placed deep because the baby cannot move food from the lips to the pharynx. Bacteria are not present at birth, but they soon enter through various orifices.

Infants of mothers with diabetes (IDMs) are at higher risk for developing: a. Anemia. c. Respiratory distress syndrome. b. Hyponatremia. d. Sepsis.

c. Respiratory distress syndrome. IDMs are at risk for macrosomia, birth injury, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and polycythemia. They are not at risk for anemia, hyponatremia, or sepsis.

Which age group is most concerned with body integrity? a. Toddler c. School-age child b. Preschooler d. Adolescent

c. School-age child School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to children in the toddler, preschooler, and adolescent age groups.

With regard to basic care of the breastfeeding mother, nurses should be able to advise her that she: a. Will need an extra 1000 calories a day to maintain energy and produce milk. b. Can go back to prepregnancy consumption patterns of any drinks, as long as she ingests enough calcium. c. Should avoid trying to lose large amounts of weight. d. Must avoid exercising because it is too fatiguing.

c. Should avoid trying to lose large amounts of weight. Large weight loss would release fat-stored contaminants into her breast milk. It would also likely involve eating too little and/or exercising too much. A breastfeeding mother need add only 200 to 500 extra calories to her diet to provide extra nutrients for the infant. The mother can go back to her consumption patterns of any drinks as long as she ingests enough calcium, only if she does not drink alcohol, limits coffee to no more than two cups (caffeine in chocolate, tea, and some sodas), and reads the herbal tea ingredients carefully. The mother needs her rest, but moderate exercise is healthy.

An infant is to receive gastrostomy feedings. What intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise? a. Rapid bolusing of the entire amount in 15 minutes b. Warm cloths to the abdomen for the first 10 minutes c. Slow, small, warm bolus feedings over 30 minutes d. Cold, medium bolus feedings over 20 minutes

c. Slow, small, warm bolus feedings over 30 minutes Feedings by gravity are done slowly over 20- to 30-minute periods to prevent adverse reactions. Rapid bolusing of the entire amount in 15 minutes would most likely lead to the adverse reactions listed. Temperature stability in the newborn is critical. Warm cloths to the abdomen for the first 10 minutes would not be appropriate because it is not a thermoregulated environment. Additionally, abdominal warming is not indicated with feedings of any kind. Small feedings at room temperature are recommended to prevent adverse reactions.

The nurse assessing a young school-aged child finds that this child has the skill of classification. Having this skill means the child will be able to do which of the following? a. Add by 2s up to 10 and subtract back to 0. b. Name the capitals of the 50 states in the United States. c. Sort animals according to dogs, cats, horses, and other types. d. Understand and use the Dewey decimal system in the library.

c. Sort animals according to dogs, cats, horses, and other types. The skill of classification means the child has the ability to group items according to common characteristics.

Which of the following actions by a community will most help in reducing the incidence of adolescent obesity? a. Provide access to computer programs and information on obesity. b. Provide guest speakers on obesity to classrooms of adolescents. c. Sponsor sports activities for adolescents after school and in the summer. d. Restrict the number of new building permits for fast-food restaurants in the community.

c. Sponsor sports activities for adolescents after school and in the summer. Sponsoring sports activities for adolescents after school and in the summer will most help in reducing the incidence of adolescent obesity.

The nurse practitioner is presenting the mother of a preschooler with a bottle of vitamins. The nurse most importantly needs to instruct the mother to do which of the following things? a. Give the vitamins with sips of milk. b. Give preschoolers half a vitamin and grade-school children a whole vitamin. c. Store the vitamins in a locked cabinet that the child cannot access. d. Teach the child how to be independent and self-administer the vitamins.

c. Store the vitamins in a locked cabinet that the child cannot access. The nurse presenting the mother of a preschooler with a bottle of vitamins will most importantly instruct the mother to store the vitamins in a locked cabinet that the child cannot access.

The normal term infant has little difficulty clearing the airway after birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretions, the mouth and nasal passages can be cleared easily with a bulb syringe. When instructing parents on the correct use of this piece of equipment, it is important that the nurse teach them to: a. Avoid suctioning the nares. b. Insert the compressed bulb into the center of the mouth. c. Suction the mouth first. d. Remove the bulb syringe from the crib when finished.

c. Suction the mouth first. The mouth should be suctioned first to prevent the infant from inhaling pharyngeal secretions by gasping as the nares are suctioned. The nasal passages should be suctioned one nostril at a time. After compression of the bulb it should be inserted into one side of the mouth. If the bulb is inserted into the center of the mouth, the gag reflex is likely to be initiated. When the infant's cry no longer sounds as though it is through mucus or a bubble, suctioning can be stopped. The bulb syringe should remain in the crib so that it is easily accessible if needed again.

A plan of care for an infant experiencing symptoms of drug withdrawal should include: a. Administering chloral hydrate for sedation. b. Feeding every 4 to 6 hours to allow extra rest. c. Swaddling the infant snugly and holding the baby tightly. d. Playing soft music during feeding.

c. Swaddling the infant snugly and holding the baby tightly. The infant should be wrapped snugly to reduce self-stimulation behaviors and protect the skin from abrasions. Phenobarbital or diazepam may be administered to decrease central nervous system (CNS) irritability. The infant should be fed in small, frequent amounts and burped well to diminish aspiration and maintain hydration. The infant should not be stimulated (such as with music) because this will increase activity and potentially increase CNS irritability.

The caregivers ask what activities are appropriate for preschoolers. The nurse will recommend which of the following activities? a. cross-country skiing c. T-ball, karate, and gymnastics b. volleyball d. football and baseball

c. T-ball, karate, and gymnastics T-ball, karate, and gymnastics are age-appropriate activities for preschoolers.

What is the single most important factor to consider when communicating with children? a. The child's physical condition b. Presence or absence of the child's parent c. The child's developmental level d. The child's nonverbal behaviors

c. The child's developmental level The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children but may be detrimental when speaking with adolescents. Nonverbal behaviors will vary in importance, based on the child's developmental level.

What is the single most important factor to consider when communicating with children? a. The child's physical condition b. The presence or absence of the child's parent c. The child's developmental level d. The child's nonverbal behaviors

c. The child's developmental level The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children, but it may be detrimental when speaking with adolescents. Nonverbal behaviors vary in importance based on the child's developmental level.

With regard to the newborn's developing cardiovascular system, nurses should be aware that: a. The heart rate of a crying infant may rise to 120 beats/min. b. Heart murmurs heard after the first few hours are cause for concern. c. The point of maximal impulse (PMI) often is visible on the chest wall. d. Persistent bradycardia may indicate respiratory distress syndrome (RDS).

c. The point of maximal impulse (PMI) often is visible on the chest wall. The newborn's thin chest wall often allows the PMI to be seen. The normal heart rate for infants who are not sleeping is 120 to 160 beats/min. However, a crying infant temporarily could have a heart rate of 180 beats/min. Heart murmurs during the first few days of life have no pathologic significance; an irregular heart rate past the first few hours should be evaluated further. Persistent tachycardia may indicate RDS; bradycardia may be a sign of congenital heart blockage.

Context specificity suggests which of the following beliefs? a. Bad caregivers raise bad kids, and good caregivers raise good kids. b. Children develop according to an internal time clock that is set for certain milestones. c. There are differences in child development related to cultural values, beliefs, and experiences. d. Climate has a lot to do with the rate at which children develop.

c. There are differences in child development related to cultural values, beliefs, and experiences. Context specificity suggests there are differences in child development related to cultural values, beliefs, and experiences.

As part of Standard Precautions, nurses wear gloves when handling the newborn. The chief reason is: a. To protect the baby from infection. b. That it is part of the Apgar protocol. c. To protect the nurse from contamination by the newborn. d. the nurse has primary responsibility for the baby during the first 2 hours.

c. To protect the nurse from contamination by the newborn. Gloves are worn to protect the nurse from infection until the blood and amniotic fluid are cleaned off the newborn.

The major cause of death for children older than 1 year is: a. Cancer. c. Unintentional injuries. b. Infection. d. Congenital abnormalities.

c. Unintentional injuries. Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year and are less significant in this age group. There have been major declines in deaths attributed infection as a result of improved therapies. Cancer is the second leading cause of death in this age group.

An appropriate approach to performing a physical assessment on a toddler is to: a. Always proceed in a head-to-toe direction. b. Perform traumatic procedures first. c. Use minimal physical contact initially. d. Demonstrate use of equipment.

c. Use minimal physical contact initially. Parents can remove the child's clothing, and the child can remain on the parent's lap. The nurse should use minimal physical contact initially to gain the child's cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group.

Which is most likely to encourage parents to talk about their feelings related to their child's illness? a. Be sympathetic. b. Use direct questions. c. Use open-ended questions. d. Avoid periods of silence.

c. Use open-ended questions. Closed-ended questions should be avoided when attempting to elicit parents' feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in helping the relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.

Which action is most likely to encourage parents to talk about their feelings related to their child's illness? a. Be sympathetic. c. Use open-ended questions. b. Use direct questions. d. Avoid periods of silence.

c. Use open-ended questions. Closed-ended questions should be avoided when attempting to elicit parents' feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.

In assisting the breastfeeding mother position the baby, nurses should keep in mind that: a. The cradle position usually is preferred by mothers who had a cesarean birth. b. Women with perineal pain and swelling prefer the modified cradle position. c. Whatever the position used, the infant is "belly to belly" with the mother. d. While supporting the head, the mother should push gently on the occiput.

c. Whatever the position used, the infant is "belly to belly" with the mother. The infant inevitably faces the mother, belly to belly. The football position usually is preferred after cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

The mother asks the nurse to explain smegma to her. This is a term she heard the doctor mention. The nurse replies that smegma is: a. the oil used in the nursery to lubricate the baby's skin after birth b. a collection of dead cells under the fingernails of the newborn infant c. a collection of cells that shed from the outer layer of skin and gathered under the foreskin d. the hormonal reaction to withdrawal from the maternal placental support

c. a collection of cells that shed from the outer layer of skin and gathered under the foreskin Smegma is a collection of cells that shed from the outer layer of skin and gather under the foreskin. Odor and infection may develop if the smegma is not removed.

The general treatment of common reactions to immunizations is: a. cool alcohol sponges for 15 minutes of every hour b. heat to the injection site c. acetaminophen every 4 to 6 hours for a total of 3 doses d. Benadryl 50 mg every 4 to 6 hours for a total of 3 doses

c. acetaminophen every 4 to 6 hours for a total of 3 doses The general treatment of common reactions to immunizations is acetaminophen every 4 to 6 hours for a total of 3 doses.

During adolescence the heart will: a. increase slightly in size b. decrease in size by 1/10 and in weight by 5% c. almost double in weight and increase in size by about 1/2 d. stay the same size and weight as previously

c. almost double in weight and increase in size by about 1/2 During adolescence the heart will almost double in weight and increase in size by about 1/2.

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered: a. unnecessary information because child is age 3 years. b. an important part of the family history. c. an important part of the child's past history. d. an important part of the child's review of systems.

c. an important part of the child's past history. Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the past history. Developmental milestones provide important information about the child's physical, social, and neurologic health and should be included in the history for a 3-year-old child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones.

The pediatric nurse is working with the parents of a school-aged child who has growing pains. The nurse recommends that the parents try which of the following as comfort measures? a. sandal-type shoes without enclosed toes or backs b. ice packs, cold showers, and no heat c. analgesics, gentle massage, and warm baths d. exercise, hot packs, and herbal teas

c. analgesics, gentle massage, and warm baths Treatment measures for growing pains include analgesics, gentle massage, and warm baths.

The best way for the nurse to help caregivers prevent sleep problems in a baby is to: a. advise caregivers to cosleep (have the baby sleep with caregivers) b. tell caregivers to respond immediately if baby awakes and begins to cry c. assist caregiver to understand the infant's individual needs d. limit napping during the day and keep the baby up later at night

c. assist caregiver to understand the infant's individual needs The best way to prevent sleep problems is to assist the caregiver in understanding the infant's individual needs.

A type of fat found primarily in the subscapular, axillary, adrenal, and mediastinal regions of the newborn is which of the following? a. pure fat c. brown fat b. triglycerides d. glycerol

c. brown fat Brown fat is a type of fat found primarily in the subscapular, axillary, adrenal, and mediastinal regions of the newborn, and serves as the primary form of heat production.

According to child psychoanalyst Erik Erikson, newborns develop basic trust when: a. they reach the age of 1 month b. the mind matures sufficiently to conceptualize c. caregivers meet the needs of the newborn d. more needs are met than not met

c. caregivers meet the needs of the newborn According to child psychoanalyst Erik Erikson, newborns develop basic trust when caregivers meet the needs of the newborn, trust versus mistrust.

Sullivan believed that personality development is mainly the result of: a. biochemical types and amounts and being either in balance or out of balance b. genetic inheritance c. childhood experiences, interpersonal encounters, and the mother-child relationship d. extended family influences

c. childhood experiences, interpersonal encounters, and the mother-child relationship Sullivan believed personality development was largely the result of childhood experiences, interpersonal encounters, and the mother-child relationship.

An assessment of a child's nutritional status reveals the child is alert, with shiny hair, firm gums, firm mucous membranes, and regular elimination. How would this child's nutritional status be described? a. Overnourished b. Undernourished c. Well nourished d. Borderline

c. Well nourished Well-nourished children show steady gains in height and weight and have shiny hair, firm gums and mucous membranes, and regular elimination.

Which of the following behaviors by caregivers most helps a child internalize a specific gender? a. telling boys that big boys don't cry b. buying and encouraging wearing the clothing and accessories of the gender c. continual rewards for responding in a manner consistent with a specific gender d. asking a daughter to do the dishes and a son to mow the lawn

c. continual rewards for responding in a manner consistent with a specific gender Continual rewards for responding in a manner consistent with a specific gender internalizes that identity.

An appropriate screening test for hearing that can be administered by the nurse to a 5-year-old child is: a. the Rinne test. b. the Weber test. c. conventional audiometry. d. eliciting the startle reflex.

c. conventional audiometry. Conventional audiometry is a behavioral test that measures auditory thresholds in response to speech and frequency-specific stimuli presented through earphones. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants.

The baby teeth or primary teeth of a baby are also called: a. cuspids c. deciduous b. incisors d. molars

c. deciduous The baby teeth or primary teeth of a baby are also called deciduous.

In looking at continuity versus discontinuity in human development, theorists who use discontinuity believe that: a. there is a connection between early and later development b. a shy adult was shy as a child c. development is a series of discrete steps or stages d. once an introvert, always an introvert

c. development is a series of discrete steps or stages Discontinuity suggests development is a series of discrete steps or stages that elevate the child to a more advanced or high level of functioning with increased age.

The nurse is assessing neonatal reflexes. As the nurse moves the neonate's head slowly to the right or left, the eyes move more slowly than the head and do not immediately adjust to the position of the head. This reflex is called: a. cat's eye c. doll's eye b. head lag reflex d. eye delay

c. doll's eye Correct. As the nurse moves the neonate's head slowly to the right or left, the eyes move more slowly than the head and do not immediately adjust to the position of the head. This reflex is called doll's eye

The nurse advises the mother to give fruit juices along with fruit during the baby's feedings. The purpose of this fruit juice is mainly to: a. prevent constipation b. hydrate the baby c. enhance absorption of iron in the cereal d. minimize leaching of calcium from the body

c. enhance absorption of iron in the cereal The nurse does advise the mother to give fruit juices along with fruit to enhance absorption of iron in the cereal.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: a. ask her why she wants to know. b. determine why she is so anxious. c. explain in simple terms how it works. d. tell her she will see how it works as it is used.

c. explain in simple terms how it works. School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure.

The mother of an 8-month-old infant tells the nurse that the baby is eating almost no baby cereal or baby food but nurses very well. The nurse would advise the mother to: a. not worry, as this is perfectly normal with a breastfed baby b. remove the breast halfway through the feeding, give semisolid foods, then resume breastfeeding c. feed the baby the baby food when the infant is hungry and follow this with breastfeeding d. gradually decrease breastfeeding in number and length of time until the baby is eating sufficient baby food and cereal

c. feed the baby the baby food when the infant is hungry and follow this with breastfeeding If a mother of an 8-month-old infant tells the nurse the baby nurses well but doesn't eat baby cereal or other baby food, the nurse would not advise the mother to feed the baby the baby food when the infant is hungry and follow this with breastfeeding.

The most fundamental peer relationship and the one most likely to be based on similar interests and emotional support is the: a. clique c. friendship dyad b. crowd d. gang

c. friendship dyad The most fundamental peer relationship and the one most likely to be based on similar interests and emotional support is the friendship dyad.

The caregivers ask the nurse for advice about their preschool child participating in some sports. The nurse shares that the main goal for children of this age engaging in sports is to: a. learn how to compete with others b. win whenever winning is possible c. have fun, exercise, and learn to enjoy a sport d. make their caregivers and relatives proud of them

c. have fun, exercise, and learn to enjoy a sport If caregivers ask the nurse for advice about their preschool child participating in some sports, the nurse shares that the main goal for children of this age engaging in sports is to have fun, exercise, and learn to enjoy a sport.

Caregivers of a preschooler ask the pediatric nurse how they can tell if their preschooler is ready for school. The nurse would most likely: a. refer them to a psychologist for specific tests to measure readiness b. conduct one of the tests with absolute indicators of school readiness c. instruct the caregivers on indicators of school success such as age, ability to play with other children, and attention span d. suggest they enroll their child just as soon as they can get the school to accept the child

c. instruct the caregivers on indicators of school success such as age, ability to play with other children, and attention span In an effort to predict readiness for school, the caregivers should evaluate the child's age, ability to plan with others, and attention span.

The nurse observes yellow staining in the sclera of eyes, soles of feet, and palms of hands. This should be interpreted as: a. normal. b. erythema. c. jaundice. d. ecchymosis.

c. jaundice. Jaundice is defined as the yellow staining of the skin, usually by bile pigments. Yellow staining is not a normal appearance of the skin. Erythema is redness that results from increased blood flow to the area. Ecchymosis is large, diffuse areas, usually black and blue, caused by hemorrhage of blood into the skin.

A mother asks you when her baby will be able to pick up and hold toys. You would explain to her that in order to be able to willingly grasp an object such as a toy, the baby must first: a. have the ability to release the object c. lose the involuntary grasp reflex b. double the birth weight d. be able to sit up

c. lose the involuntary grasp reflex During the first month of life, a primitive grasp reflex enables the infant to hold objects with a tightly clenched fist. Before the infant is able to willingly grasp a toy, it must first lose the involuntary grasp reflex.

Which of the following infants is at greatest risk of sudden infant death syndrome? a. male, full-term, 7 months old c. male twin, premature, 4 months old b. female, full-term, 8 months old d. female, single birth, 4 months old

c. male twin, premature, 4 months old A male twin born prematurely 4 months of age has four risk factors associated with sudden infant death syndrome: maleness, a twin, born prematurely and under 6 months of age.

In regard to safety, compared with the toddler the preschool-aged child is: a. more prone to falls and more reckless b. about the same, regarding falls and reckless behavior c. more apt to listen to rules and be aware of potential dangers d. less apt to listen to rules and be aware of potential dangers

c. more apt to listen to rules and be aware of potential dangers In regard to safety, compared with the toddler the preschool-aged child is more apt to listen to rules and be aware of potential dangers.

.In addition to the development of sphincter muscle control, what other physical development must be complete prior to beginning bowel and bladder training in order for training to be successful? a. full-size bladder b. muscle development of the bladder c. myelinization of the spinal cord d. full development of the abdominal muscles

c. myelinization of the spinal cord In addition to the development of sphincter muscle control, myelinization of the spinal cord needs to be complete prior to beginning bowel and bladder training in order for training to be successful.

Prior to discharge from the hospital, the newborn most often will receive a screening blood test to rule out which of the following conditions? a. Addison's disease and pituitary dysfunction b. Down syndrome and autism c. phenylketonuria and hypothyroidism d. Marfan's syndrome and cerebral palsy

c. phenylketonuria and hypothyroidism The newborn, prior to discharge from the hospital, does most often receive a screening blood test to rule out phenylketonuria and hypothyroidism.

Which of the following best describes the term parallel play? a. playing the same thing the entire time of play b. lining toys up in a linear fashion, one after another c. playing alongside, but not with, other children d. mimicking what other children are playing

c. playing alongside, but not with, other children Parallel play is best described as playing alongside, but not with, other children.

Development that proceeds from the inside out is called by which of the following terms? a. internal-external c. proximodistal b. inner-outer d. cellular-epidermal

c. proximodistal Proximodistal development proceeds from the inside out.Controlled movements closest to the body's center (trunk, arms) develop before controlled movements distant to the body (fingers).

In assessing an 18-year old college freshman, the nurse hears the adolescent talking about not declaring a major until he has time for exploring career options and making a final decision. The nurse realizes that Erikson had a term for this exploratory period before determining a life course: a. life anxiety stage c. psychosocial moratorium b. career delay d. life-planning plateau

c. psychosocial moratorium Erikson's term for the exploratory period before the 18-year old college freshman chooses a life course is the psychosocial moratorium.

The nurse is assessing an infant who is 10 months old to determine if the infant is in Piaget's fourth substage of sensorimotor development called coordination of secondary schema. Which of the following actions would indicate to the nurse that the infant is indeed in this fourth substage? a. banging a toy to produce a sound b. looking and grasping for a favorite toy c. putting blocks of different shapes into a container with matching holes of varied shapes d. putting objects and substances into the mouth and spitting out those that taste bad

c. putting blocks of different shapes into a container with matching holes of varied shapes Piaget's fourth stage of sensorimotor development, between 8 and 12 months of age, is marked by the infant's ability to put several events together to accomplish an end result, such as putting blocks of different shapes into a container with matching holes of varied shapes.

To help a preschooler sleep at night, the nurse will recommend to the caregivers that they: a. avoid milk drinks at bedtime b. have the child watch television until he or she falls asleep c. read a bedtime story and establish a firm bedtime d. provide soda or coffee with milk at bedtime

c. read a bedtime story and establish a firm bedtime To help a preschooler sleep at night, the nurse will recommend that the caregivers read a bedtime story and establish a firm bedtime.

The nurse assessing a young school-aged child finds that the child has the skill of conservation. When the nurse tells the parents that their child has the skill of conservation, they ask what this means. The nurse explains that conservation is the ability to: a. save objects or money b. recycle and take care of the environment c. recognize that a change in shape does not mean a change in amount d. recognize that actions can move in a reverse as well as forward manner

c. recognize that a change in shape does not mean a change in amount According to Piaget, conservation is the ability to acknowledge that a change in shape does not mean a change in amount.

The nurse is assessing a toddler of 18 months to see what skills the child has for dressing himself. The nurse expects to find that a toddler of this age can do which of the following tasks? a. put on his shoes c. remove his own shoes b. tie his own shoelaces d. tie others' shoelaces

c. remove his own shoes An 18 month old child can remove his own shoes.

Selman has theorized about adolescents' cognitive development between early and late childhood and has theorized that an adolescent will by late childhood develop the ability to: a. converse in a reasonable manner with adults b. make right choices 90% of the time c. see the reasoning behind others' behavior d. do more than one complex task at a time

c. see the reasoning behind others' behavior Selman has theorized about adolescents' cognitive development between early and late childhood and has theorized that an adolescent will by late childhood develop the ability to see the reasoning behind others' behavior.

According to Vygotsky, the greatest growth in cognitive development occurs then adolescents are: a. about the age of 18, then there is a cognitive growth spurt b. associated with adults for greater periods of time than with other adolescents c. stretched to perform at the upper level of their zone of proximal development d. challenged to do tasks that are normally completed only by those whose IQ is over 105

c. stretched to perform at the upper level of their zone of proximal development According to Vygotsky, the greatest growth in cognitive development occurs then adolescents are stretched to perform at the upper level of their zone of proximal development.

The usual recommended sleeping position for a normal newborn is which of the following positions? a. prone b. semi-Fowler's with the head elevated by a pillow c. supine d. feet elevated slightly

c. supine Supine or side-laying is the usual recommended sleeping position for a normal newborn.

Which of the following descriptions best represents one of the three essential components of successful and effective discipline, as identified by the American Academy of Pediatrics? a. negative reinforcement for negative behaviors b. punishment that is neither too harsh nor too soft for the rule infraction c. supportive and loving relationship(s) between caregiver(s) and child d. knowledge by the child that the caregivers are in charge and in control

c. supportive and loving relationship(s) between caregiver(s) and child Supportive and loving relationship(s) between caregiver(s) and child best represents one of the three essential components of successful and effective discipline, as identified by the American Academy of Pediatrics. The other two essential components are use of positive reinforcement to promote desired behaviors and removing reinforcement to reduce and eliminate undesired behaviors.

John Locke suggested that children are neither good nor bad but have inborn tendencies and are molded by life experiences. His doctrine was called: a. original sin c. tabula rasa b. innate purity d. carta blanca

c. tabula rasa The doctrine of tabula rasa (blank slate) proposed by John Locke suggests that children are neither good nor evil, but rather enter the world without inborn tendencies, and are molded through life experiences.

When a school-aged child has a malocclusion, the parents need to: a. advise the school nurse c. take the child to an orthodontist b. do nothing, as this will be outgrown d. take the child to the pediatrician

c. take the child to an orthodontist When a school-aged child has a malocclusion, the parents need to take the child to an orthodontist.

Bandura suggested that children acquire new behaviors from observational learning in which: a. teachers observe the child, without the child being aware of the observation, and base teaching on this observation b. caregivers spend more time observing their children and sharing these observations with behaviorists c. the child watches others who are pursuing their own interests with no attempt to teach, reward, or punish d. a teacher models the behavior, and the child demonstrates the behavior in return

c. the child watches others who are pursuing their own interests with no attempt to teach, reward, or punish Bandura suggests observational learning (learning that results from merely watching others), there children acquire a variety of new behaviors when "models" are merely pursuing their own interests and not attempting to teach, reward, or punish, is another important method of learning behaviors.

Which of the following factors is the best indicator of an infant's ability to adapt to the changes required in growth and development without creating undue stress on the body? a. the infant has been breastfed c. the infant's health status b. the caregivers are older d. the presence of siblings

c. the infant's health status The infant's health status is the best indicator of an infant's ability to adapt to the changes required in growth and development without creating undue stress on the body.

Which of the following best describes the term peak weight velocity (PWV)? a. the total amount of time it takes for an adolescent to reach his or her greatest weight b. the top of a graph of peaks and valleys of weight gain and weight loss c. the period of greatest growth in weight during the adolescent growth spurt d. the speed of weight gain to the maximum weight to date, after any weight loss

c. the period of greatest growth in weight during the adolescent growth spurt PWV is the time period in which weight gain is the most rapid.

The main goal of the activities of early childhood programs is to provide: a. caregivers a safe place to leave their children while they work b. the elementary schools with school-ready students c. the preschooler a mastery of skills and a sense of confidence and success d. teachers of elementary schools with a nucleus of students who can abide by rules

c. the preschooler a mastery of skills and a sense of confidence and success Early childhood programs desire to promote a sense of mastery, confidence, and success in the preschooler.

Which of the following best describes the ego, according to Freudian theory? a. the conscience b. the irrational, selfish, impulsive part of the personality c. the rational and controlling part of the personality d. the inner self

c. the rational and controlling part of the personality The ego, according to Freudian theory, is best described as the rational and controlling part of the personality.

A mother takes a small wrapped gift to the hospital with her. The people who will come to visit her are the husband, the mother, the mother-in-law, the mother's firstborn who is 2 years old, friends, and the health care practitioner. This gift is most likely for which of the following people and for which of the following purposes? a. the husband, to let him know his role as a father is greatly appreciated b. the mother-in-law, to let her know she is very important as the mother of the father c. the toddler, to let her know that the mother loves her and she is just as important to her as the new baby d. for the health care practitioner who got the mother safely through pregnancy and delivery with a healthy newborn

c. the toddler, to let her know that the mother loves her and she is just as important to her as the new baby The mother's gift is most likely for the toddler, to let her know that the mother loves her and she is just as important to her as the new baby.

The mother of a 7-year-old pediatric patient asks the nurse about her child's sleep requirement. What is the most accurate response by the nurse? a. "7 to 10 hours a night" b. "5 to 7 hours a night with one daytime nap" c. "11 to 13 hours a night" d. "4 to 6 hours a night with two daytime naps"

c. "11 to 13 hours a night" Sleep patterns vary with age. The neonate sleeps 8 to 9 hours per night and naps an equal amount of time during the day. The 2-year-old may sleep 10 hours during the night and have only one short daytime nap. The 7-year-old usually requires 11 to 13 hours of sleep and rarely has a daytime nap. These patterns may be altered by cultural practices.

The mother of a 7-month-old states, "The baby is eating food now. Should I give him regular milk, too?" What is the nurse's best response? a. "You should give the baby low-fat milk." b. "Try the milk. See if he has any digestive problems." c. "Continue breast milk or iron-fortified formula until 1 year of age." d. "At this age, infants can tolerate lactose-free or soy-based milk."

c. "Continue breast milk or iron-fortified formula until 1 year of age." Whole milk should not be introduced before 1 year of age. Low-fat milk should not be introduced before 2 years of age.

Which statement indicates the mother of an 8-month-old understands infant sleep patterns? a. "I put the baby in my bed until she falls asleep, then I put her in her crib." b. "I let the baby skip an afternoon nap so that she will fall asleep earlier." c. "I put the pacifier in the crib so that she can find it when she wakes up." d. "I rock the baby back to sleep if she wakes up at night."

c. "I put the pacifier in the crib so that she can find it when she wakes up." The parent should assist the infant to develop self-soothing behaviors so that the infant can get back to sleep on her own.

What statement indicates the parent understands the guidelines for bathing a newborn? a. "I'll use a mild soap to clean all of the body parts." b. "I am going to add bath oil to the water to keep the baby's skin soft." c. "I should shampoo the head after washing the rest of the body." d. "I'll wash from the feet upward and change the washcloth for the face."

c. "I should shampoo the head after washing the rest of the body." The shampoo is done last because the large surface area of the head predisposes the infant to heat loss.

The parent of a 24-month-old child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond? a. a. "Begin by reading to your child about toileting." b. b. "Most children are capable by age 2 years." c. c. "Tell me about your child's daily habits." d. d. "We should assess your child's motor skills."

c. "Tell me about your child's daily habits." To assess the parent's understanding of toilet readiness, the nurse practitioner will ask the parents about the child's daily habits and routines to see if the child has predictable patterns that can be the basis for toilet training. While providing storybooks about toileting can help children learn, the first step is to assess toilet readiness. Even though many children are capable at this age, evaluating personal readiness is key to beginning toilet training. Assessment of motor skills may be a second step.

What is the nurse's best response to a mother who is voicing concern about the molding of her 2-day-old infant? a. "Molding doesn't cause any problems. Don't worry about it." b. "Did you deliver vaginally or by cesarean section?" c. "The baby's head conformed to the shape of the birth canal. It will go away soon." d. "A traumatic delivery can cause molding."

c. "The baby's head conformed to the shape of the birth canal. It will go away soon." The newborn's head may be out of shape from molding. This refers to the shaping of the fetal head to conform to the size and shape of the birth canal.

Parents of a 6-month-old infant ask the nurse why it is necessary to offer iron-rich formula to their child. What is the correct response? a. "The infant has limited ability to produce red blood cells." b. "The infant has ineffective digestive enzymes." c. "The infant has exhausted maternal iron stores." d. "The infant has need of the iron to support dentition."

c. "The infant has exhausted maternal iron stores." Many pediatricians recommend iron-fortified formulas because maternal iron stores decrease by 6 months of age.

The mother of a 7-month-old reports that the first lower central incisor has erupted. She asks the nurse, "How many teeth will he have by his first birthday?" The nurse explains that the infant will have how many teeth by 1 year of age? a. 2 b. 4 c. 6 d. 8

c. 6 The 1-year-old infant usually has about 6 teeth, 4 above and 2 below.

What is the earliest age at which an infant is able to sit steadily alone? a. 4 months b. 5 months c. 8 months d. 15 months

c. 8 months The infant can sit alone without support at about 8 months of age.

How will the nurse safely ensure tube placement when preparing to initiate a gavage feeding? a. Check tube placement by injecting air into the stomach. b. Weigh the infant before the feeding. c. Aspirate stomach contents. d. Check serum glucose level.

c. Aspirate stomach contents. When the preterm infant is gavage fed, the contents of the stomach should be aspirated before the feeding is started. Aspiration of the stomach contents ensures tube placement and also allows the nurse to assess the amount of feeding in the stomach.

A preterm infant has a yellow skin color and a rising bilirubin level. The nurse knows that this infant is at risk for what? a. Skin breakdown b. Renal failure c. Brain damage d. Heart failure

c. Brain damage The higher the bilirubin level and the deeper the jaundice, the greater is the risk for neurological damage.

What type of development is the nurse assessing when an infant can lift his or her head before he or she can sit? a. Specific to general b. Proximodistal c. Cephalocaudal d. General to specific

c. Cephalocaudal Cephalocaudal development proceeds from head to toe.

While inspecting a newborn's head, the nurse identifies a swelling of the scalp that does not cross the suture line. How would the nurse refer to this finding when documenting? a. Molding b. Caput succedaneum c. Cephalohematoma d. Enlarged fontanelle

c. Cephalohematoma A cephalohematoma is caused by a collection of blood beneath the periosteum of the cranial bone. It does not cross the suture line.

The parent of a 6-year-old child expresses concern that the child may have ADHD. Which screening tool will the primary care pediatric nurse practitioner use to evaluate this possibility? a. Behavioral and Emotional Screening System for Children (BESS-2) b. Behavioral Assessment for Children - 2nd ed. (BASC-2) c. Conner's 3 Parent and Teacher Rating Scale d. Pediatric Symptom Checklist (PSC)

c. Conner's 3 Parent and Teacher Rating Scale The Conner's Parent and Teacher Rating Scale is used to assess ADHD symptoms in children aged 6 to 18 years. The BESS-2 is used to evaluate social emotional and mental health in children. The BASC-2 is used to further assess children who have positive findings on the BESS-2. The PSC is used to assess cognitive, emotional, and behavioral problems in children.

The nurse is assessing development in a 9-month-old infant. What would the nurse expect to observe? a. Speaking in 2-word sentences b. Grasping objects with palmar grasp c. Creeping along the floor d. Beginning to use a spoon rather sloppily

c. Creeping along the floor The 9-month-old tries to creep, has developed pincer movement, and can grasp a spoon without keeping food on it.

The nurse is going to use a bulb syringe to clear mucus from a newborn's nose and mouth. What is the nurse's first action? a. Place the tip in the nose and squeeze the bulb gently. b. Suction secretions from the nose before the mouth. c. Depress the bulb before inserting the syringe tip into the mouth. d. Insert the tip into the back of the mouth to reach mucus.

c. Depress the bulb before inserting the syringe tip into the mouth. The bulb is depressed, and then the tip is inserted into the mouth and then the nose. The depression is slowly released, creating the suction.

The primary care pediatric nurse practitioner sees a 3-year-old child who chronically withholds stools, in spite of the parents' attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate third-party reimbursement? a. Altered elimination pattern b. Elimination disorder c. Encopresis d. Parenting alteration

c. Encopresis Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized for reimbursement purposes. "Altered elimination pattern" and "Parenting alteration" are NANDA International diagnoses and are not recognized for reimbursement. "Elimination disorder" is a developmental diagnosis.

When meeting with a new family, the primary care pediatric nurse practitioner develops a database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information? a. CRAFFT b. Ecomap c. Genogram d. Pedigree

c. Genogram The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is used to identify relationships in the family and community that are supportive or harmful. The pedigree is used to identify potential genetic disorders.

What is an abnormal finding in an evaluation of growth and development for a 6-month-old infant? a. Weight gain of 4 to 7 ounces per week b. Length increase of 1 inch in 2 months c. Head lag present d. Can sit alone for a few seconds

c. Head lag present The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation.

The parent of a newborn infant asks the primary care pediatric nurse practitioner when to intervene to help the infant's future intellectual growth. What will the nurse practitioner tell the parent? a. Cognitive learning begins during the toddler years. b. Intellectual growth begin when speech develops. c. Language and literacy skills begin at birth. d. Preschool is an optimal time to begin general learning.

c. Language and literacy skills begin at birth. General learning and acquisition of skills for later reading and writing begin at birth, not in kindergarten or first grade, and these skills grow with everyday loving interactions between infants and caregivers. Cognitive learning changes during toddler years but begins at birth. Intellectual growth is not tied to speech alone.

When assessing a neonate born at 38 weeks of gestation, the nurse records his weight as 8 pounds, 10 ounces. What will the nurse consider this newborn? a. Term b. Small for gestational age c. Large for gestational age d. Late preterm

c. Large for gestational age Term infants over 4000 g (8.8 lb) may be classified as large for gestational age (LGA). For the preterm infant this is less than 38 weeks, for the term infant it is 38 to 42 weeks, and for the postterm infant it is beyond 42 weeks. A late preterm infant, also known as a near-term infant, is born between 34 and 36 weeks.

What nursing action will the nurse implement after feeding an infant with hydrocephalus? a. Position the infant sitting upright in an infant seat. b. Place the infant over the shoulder to burp. c. Leave the infant in a side-lying position. d. Stimulate the infant by rubbing its feet.

c. Leave the infant in a side-lying position. Because children with hydrocephalus are prone to vomiting, the child is fed and then positioned in the side-lying position in a quiet atmosphere to reduce the incidence of vomiting.

What would the nurse expect a 4-month-old to be able to accomplish? a. Hold a cup. b. Stand with assistance. c. Lift head and shoulders. d. Sit with back straight.

c. Lift head and shoulders. Because development is cephalocaudal, of these choices, lifting the head and shoulders is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months.

What toy is developmentally appropriate for the nurse to suggest to entertain a 5-year-old child? a. Jack-in-the-box b. Book of nursery rhymes c. Model airport with toy planes d. Model car construction kit

c. Model airport with toy planes At this age children are into creative play. The model airport with toy planes is the most developmentally appropriate.

The primary care pediatric nurse practitioner evaluates a school-age child whose body mass index (BMI) is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitioner document for this visit? a. Metabolic syndrome b. Nutritional alteration: more than required c. Obesity d. Rule out type 2 diabetes mellitus

c. Obesity A problem should never be included on the problem list that is not supported by subjective and objective data found and recorded in the database. This child has a BMI that suggests obesity, so this may be used as a diagnosis. Metabolic syndrome is a diagnosis that is determined by laboratory data, which has not been evaluated yet. Nutritional alteration is a NANDA diagnosis and not acceptable for reimbursement. "Rule out" should not be used as a diagnosis, but may be considered part of a plan.

During a well child assessment of an 18-month-old child, the primary care pediatric nurse practitioner observes the child becoming irritable and uncooperative. The parent tells the child to stop fussing. What will the nurse practitioner do? a. Allow the parent to put the child in a "timeout." b. Ask the parent about usual discipline practices. c. Offer the child a book or a toy to look at. d. Stop the exam since the child has reached a "meltdown."

c. Offer the child a book or a toy to look at. The child has exhibited early signs of misbehavior. At this stage, distraction and active engagement may be used to stop more problems from occurring. It is not necessary to use a timeout because the child hasn't reached the point where cooperation is impossible. The PNP should model appropriate interventions by offering the child a distraction and may ask the parent about discipline practices later in the visit. The child is not at a "meltdown" state.

During a well child exam on a 5-year-old child, the primary care pediatric nurse practitioner assesses the child for school readiness. Which finding may be a factor in limiting school readiness for this child? a. Adherence to daily family routines and regular activities b. Having two older siblings who attend the same school c. Parental concerns about bullying in the school d. The child's ability to recognize four different colors

c. Parental concerns about bullying in the school Parental expectation is the strongest predictor of school success in children. Parents who are worried about what may happen in school can transmit this anxiety to the child. Children who have a secure family life with daily routines will do better in school. Having older siblings who attend school increases success. Children at this age are expected to know four colors, so this is an indication of school readiness.

What is a unique organization of characteristics that determines an individual's pattern of behavior? a. Environment b. Heredity c. Personality d. Experience

c. Personality One definition of personality states that it is a unique organization of characteristics that determines the individual's typical or recurrent pattern of behavior.

What is the most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old? a. Ride a tricycle. b. Spend time in an infant swing. c. Play with push-pull toys. d. Read large picture books.

c. Play with push-pull toys. Push-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old child.

The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse practitioner do in this situation? a. Explain to the parent that developmental delays often do not manifest at first. b. Perform a developmental assessment and tell the parent which delays are evident. c. Point out the tasks that the infant can perform while conducting the assessment. d. Refer the infant to a developmental specialist for a complete evaluation.

c. Point out the tasks that the infant can perform while conducting the assessment. When discussing developmental delays with parents, it is important to be positive and to initially focus on strengths. Explaining that developmental delays develop over time is true but does not reassure the parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and may take time.

The primary care pediatric nurse practitioner works with families from a variety of cultures and socioeconomic classes. Which is an example of cultural humility in practice? a. Giving health care advice that takes cultural differences into account b. Identification of other cultures that may be superior to one's own culture c. Receptivity to learning about the perspectives of other cultures d. Respecting other cultures while maintaining the views of one's own

c. Receptivity to learning about the perspectives of other cultures Cultural humility is defined as the lifelong commitment to developing mutually beneficial, nonpaternalistic partnerships and is based on a model of passive volition, receptivity, and being open to learning from others. Practitioners who have cultural humility are always seeking to learn about other cultures. Cultural humility involves asking questions, rather than giving answers. Cultural humility does not mean identifying one's own culture as inferior. Practitioners who are culturally competent are open to the influence of other cultures.

The parent of a toddler is concerned that the child may have autism. The primary care pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (M-CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do? a. Administer a Childhood Autism Rating Scale (CARS) in the clinic. b. Consult a specialist to determine appropriate early intervention strategies. c. Refer the child to a behavioral specialist for further evaluation. d. Tell the parent that this result indicates that the child has autism.

c. Refer the child to a behavioral specialist for further evaluation. The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and significant positive predictive value. If these behaviors are detected, the PNP should refer the child to a specialist for further assessment, using more diagnostic tools. The CARS may be used but requires specialty training and proper credentials. Until the diagnosis is determined, strategies for intervention are not discussed. The M-CHAT is a screening tool and is not diagnostic.

What action does the nurse implement to protect newborns from infection while in the nursery? a. Keep the newborn dressed warmly. b. Adjust room temperature between 23.8° C (75° F) and 26.6° C (80° F). c. Wash hands before touching each infant. d. Wear a disposable gown when giving infant care.

c. Wash hands before touching each infant. Handwashing is the most reliable precaution available to prevent infection. The nurse washes his or her hands between handling different babies.

The primary care pediatric nurse practitioner performs a well baby examination on a 7-day-old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct? a. Follow up at the 2-month checkup. b. Refer to a lactation consultant. c. Schedule a weight check in 1 week. d. Suggest supplementing with formula.

c. Schedule a weight check in 1 week. This infant lost about 8% of its birth weight, which is normal and, since discharge home, has gained at least 15 grams per day, which is also normal. The PNP should schedule a weight check in a week to make sure the infant regains its birth weight, since most should regain this in 10 to 14 days and since this loss of birth weight is at the high end of normal. It is not necessary to refer to a lactation consultant or supplement with formula, since the infant is gaining weight adequately.

During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father's job layoff. What will the nurse practitioner do? a. Reassure them that the child is too young to understand. b. Recommend that they continue to not argue in front of the child. c. Suggest counseling to learn ways to handle stress. d. Tell them that the conflict will resolve when the situation changes.

c. Suggest counseling to learn ways to handle stress. Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict during stressful situations. Even when children do not understand, they pick up on cues from the parents about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation may indicate a pattern of response to stress and will only recur with each subsequent stressful period.

The primary care pediatric nurse practitioner is performing a well baby examination on a 2-month-old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her? a. She may not be making as much breastmilk as before. b. She should keep a log of the frequency and duration of each feeding. c. The infant may be going through an expected growth spurt. d. The infant should stay on the previously established nursing schedule.

c. The infant may be going through an expected growth spurt. Infants may have a growth spurt at 6 to 8 weeks, and mothers who are breastfeeding may be concerned that they are not making enough milk when they notice that the infant is fussy and wanting to nurse more often. The PNP should reassure the mother that this is expected. It is not necessary, since the infant is gaining weight appropriately, for the mother to keep a log. The mother should follow the infant's cues for feeding since the extra suckling will increase the milk supply to meet the growing infant's needs.

What is the rationale for placing a preterm infant born at 34 weeks of gestation in an incubator? a. The infant has a small body surface-to-weight ratio. b. Heat increases the flow of oxygen to the extremities. c. The infant's temperature control mechanism is immature. d. Heat within the incubator facilitates drainage of mucus.

c. The infant's temperature control mechanism is immature. The preterm infant is at risk for heat loss for several reasons, one of which is that the heat regulating center in the brain is immature.

Parents of a preterm infant come to the NICU every day to see their infant, who is being gavage fed. What will the nurse teaching about stimulating the infant tell the parents? a. To bring in colorful pictures and toys to place in the incubator b. That stimulating the infant during feedings increases intake c. To stroke the infant during feeding to increase intake d. Not to disturb the infant between feedings

c. To stroke the infant during feeding to increase intake During gavage feedings, stroking the infant gently can provide stimulation.

What should the nurse avoid when demonstrating a bath procedure to parents of Vietnamese origin? a. Talking directly to the mother b. Exposing the child's genitals c. Touching the child's head d. Using cool water

c. Touching the child's head The Vietnamese are very sensitive about anyone touching a child's head because that is where consciousness lies.

The primary care pediatric nurse practitioner understands that, to achieve the greatest world-wide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective? a. Antibiotics b. Optimal nutrition c. Vaccinations d. Water purification

c. Vaccinations Rotavirus is the most common cause of diarrhea globally and Strep pneumonia is the leading cause of pneumonia, and together these are the leading infectious causes of childhood morbidity and mortality globally. Both are vaccine-preventable diseases. Antibiotics to treat pneumonia, optimal nutrition, and clean water all help to reduce morbidity and mortality, but vaccination prevents the diseases from occurring.

Which behavior reported by a parent of an 18-month-old toddler would the nurse report to the pediatrician as a cause for concern? a. Has temper tantrums b. Feeds self sloppily c. Walks by holding onto furniture d. Speaks in short sentences

c. Walks by holding onto furniture

The mother of an infant born prematurely tells the nurse, "The baby is irritable. She cries during diaper changes and feedings. Can you make some suggestions about what I should do to soothe her?" What is the most appropriate recommendation to help this parent? a. Play the radio or TV while you feed the infant. b. Put the infant in a room with sunlight. c. Wrap the infant snugly when you hold them. d. Change the infant's position quickly.

c. Wrap the infant snugly when you hold them. A strategy that may be helpful is to swaddle the infant snugly in a light blanket with extremities flexed and hands near the face.

The primary care pediatric nurse practitioner provides well child care for a community of immigrant children from Central America. The pediatric nurse practitioner is surprised to learn that some of the families are Jewish and not Catholic. This response is an example of cultural : a. collectivism. b. constructivism. c. essentialism. d. individualism.

c. essentialism. An essentialist view of culture, which dominates the health care literature, portrays an ethnic minority group as having a static set of traits and oversimplifies cultural information, applying traits to all members of the group. Assuming that all people from Central America are Catholic is an example of this oversimplification. Collectivism refers to a member of an ethnic group who perceives himself or herself to be intrinsically part of that group. A constructive view recognizes culture as complex and dynamic and sees people as individuals who may belong to multiple cultures simultaneously. Individualism recognizes the individual, and not the group, as the basic unit of survival.

The primary care pediatric nurse practitioner learns that an African-American family lives in a neighborhood with a high crime rate and suggests that they try moving to another neighborhood for the safety of their children. This is an example of a. cultural sensitivity. b. group bias. c. individual privilege. d. racial awareness.

c. individual privilege. Privilege can be individual- or group-based and refers to the often unconscious lack of understanding of what other groups must deal with. The PNP is not aware that the family may lack the resources to move, may be fearful of moving to a "white" neighborhood, or may even feel safe around people that they know. Cultural sensitivity is an awareness of and respect for other cultures. Group bias is a prejudice, based on cultural, racial, or ethnic differences, toward a group of people. Racial awareness would describe an awareness of cultural differences based on race.

The primary care pediatric nurse practitioner understands that a major child health outcome associated with worldwide climate change is : a. cost of living. b. education. c. nutrition. d. pollution.

c. nutrition. There is growing evidence that climate change is having a dramatic effect on food crops that leads to food distribution issues and food insecurity among families.

The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old infant in a car seat on the exam table. The infant's mother is playing a game on her smart phone. The nurse practitioner interprets this behavior as : a. a sign that the mother has postpartum depression. b. extremely concerning for potential parental neglect. c. of moderate concern for parenting problems. d. within the normal range of behavior in early parenthood.

c. of moderate concern for parenting problems. A parent who seems disinterested in a child raises moderate concerns for parenting problems. It does not necessarily signal postpartum depression. It is not a mark for extreme concern. It is not within the expected range of behaviors.

When providing well child care for an infant in the first year of life, the primary care pediatric nurse practitioner is adhering to the most recent American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care guidelines by : a. focusing less on development and more on illness prevention and nutrition. b. following guidelines established by the Bright Futures publication. c. scheduling well-baby visits to coincide with key developmental milestones. d. seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due.

c. scheduling well-baby visits to coincide with key developmental milestones. In the most recent AAP Recommendations for Preventive Pediatric Health Care, there is a greater emphasis on behavioral and developmental issues and a recommendation that well child care be based on child and family development rather than the periodicity of immunization schedules. This will require a revision of the current recommendations in Bright Futures.

The primary care pediatric nurse practitioner is examining a 6-year-old child who attends first grade. The child reports "hating" school. The parent states that the child pretends to be sick frequently in order to stay home from school. To further assess this situation, the nurse practitioner will first ask the child : a. about school performance and grades. b. why school is so distressing. c. to name one or two friends. d. whether bullying is taking place.

c. to name one or two friends The earliest school-age psychosocial milestone occurs when children learn to separate easily from family, allowing them to go to school. Mastery of these skills enables them to develop and maintain peer friendships. Social interaction skills are necessary in order to develop mastery over school activities. Asking the child to describe why school is distressing may not elicit information, since the child may not be able to articulate this. Bullying is not the only reason for disliking school, but, if it is, will emerge during a discussion about friends and schoolmates.

A 12-year-old adolescent boy who was hospitalized with complications of diabetes is concerned that his 9-year-old sister is taller than he is and asks the nurse why he is so short compared to his sister. The nurse's best response would be: a. "When we get your diabetes under control, you may see yourself having a major growth spurt." b. "You may have inherited the genetic makeup for being short, while your sister got the tall genes." c. "Since she does not have diabetes, she is able to take in more food and put her food intake to maximum use." d. "Girls may begin their growth spurt as early as age 7-1/2, while boys typically start a growth spurt by age 13."

d. "Girls may begin their growth spurt as early as age 7-1/2, while boys typically start a growth spurt by age 13." In the adolescent growth spurt (AGS), girls may begin their growth spurt as early as 7-1/2 years of age, whereas boys may not begin their growth spurt until age 13.

The caregivers ask the nurse how long the time-out should be for their 5-year-old preschooler. The best reply by the nurse would be which of the following? a. "The time depends on the offense. The worse the offense, the longer the child needs to think about what he or she did or did not do." b. "About 20 minutes is time enough to think about what he or she needs to do next time to stay out of trouble." c. "Time-out ends when the child agrees to follow the rules, so the time varies." d. "No longer than 5 minutes, which is 1 minute per year of age."

d. "No longer than 5 minutes, which is 1 minute per year of age." A time-out should be limited to 1 minute per year of age. Therefore, for a 5-year-old child, the time-out should last no longer than 5 minutes.

The caregivers of a toddler are very concerned about the temper tantrums their child has. This child falls on the floor in public, kicks and screams, and holds his breath. The nurse would offer which of the following pieces of advice: a. "Don't move the child out of public attention." b. "Call EMS (emergency medical services) if the child is holding his breath." c. "Make sure someone knows CPR (cardiopulmonary resuscitation)." d. "The child may faint but it is nothing serious."

d. "The child may faint but it is nothing serious." The nurse would offer the following piece of advice: "The child may faint but it is nothing serious." A child who holds his breath may "faint," but will automatically begin breathing as soon as carbon dioxide builds up and stimulates the respiratory center.

The nurse is teaching children about teeth brushing and flossing. Which of the following statements can 11- to 12-year-olds best relate to and are more likely to agree with? a. "Bad kids fail to brush their teeth as they are told, and they won't floss either." b. "Your teeth are going to rot and fall out if you don't brush them at least twice a day and floss them before bedtime." c. "The dentist will be mad at you if you don't brush your teeth twice a day and floss before you go to bed at night." d. "The right thing to do is to take care of your teeth by brushing at least twice a day and flossing before bedtime."

d. "The right thing to do is to take care of your teeth by brushing at least twice a day and flossing before bedtime." 11- to 12-year-old children can best relate to and are more likely to agree with the statement "The right thing to do is to take care of your teeth by brushing at least twice a day and flossing before bedtime." At this age they may agree with suggestions in order to do the "right thing".

A mother asks the nurse when a soft spot on the baby's head will close. The best response by the nurse is which of the following responses? a. "It will close in about a year." b. "There are two soft spots called the anterior and posterior fontanels, which will close by the time the baby is about a year old." c. "It will close in 6 months." d. "The soft spot you are talking about will close by 12 to 18 months of age. Another soft spot will close by 2 months."

d. "The soft spot you are talking about will close by 12 to 18 months of age. Another soft spot will close by 2 months." There are two soft spots, posterior and anterior; the posterior closes in about 2 months; the anterior closes in 12-18 months.

A father asks the nurse why his 18-year-old daughter is so idealistic and is so often involved in political or social causes. The father is especially concerned because his daughter recently turned down a family outing to an amusement park in order to attend a rally to benefit indigenous people in a third-world country. Of the following, which response by the nurse would be best? a. "When children do not have enough limits set at home, they often fall in with peer groups who engage in these activities." b. "She has obvious talent for politics, and this may be something she will want to do as her life's fork." c. "This is your daughter's way of being different from you and exerting independence from her family." d. "This is a normal phase that adolescents go through. They interpret the world in an excessively idealistic perspective and often engage in causes."

d. "This is a normal phase that adolescents go through. They interpret the world in an excessively idealistic perspective and often engage in causes." The concerned father asking the nurse why his 18-year old daughter is so idealistic and so prone to join causes would best be told by the nurse: "This is a normal phase that adolescents go through. They interpret the world in an excessively idealistic perspective and often engage in causes."

The mother of a breastfed newborn tells the nurse that the baby's stool is golden yellow, is pasty instead of firm, and has a sour milk odor. The best response on the part of the nurse would be which of the following? a. "You probably need to feed this baby some cereal to firm up the stool." b. "Cut back on your fluid intake and be careful what you eat, as you pass this on to the baby." c. "I need to check your temperature and your breasts to determine if you have a breast abscess." d. "This is a normal stool for a newborn that is breastfed. Do not change anything about your breastfeeding."

d. "This is a normal stool for a newborn that is breastfed. Do not change anything about your breastfeeding." When the baby's stool is golden yellow, is pasty instead of firm, and has a sour milk odor, it is normal if the mother is breastfeeding.

The pediatrician is doing a routine physical exam on a school-aged child and tells the parents that their child has an innocent heart murmur. The parents ask the nurse what this means. The best answer is: a. "The mitral valve is not closing tightly and some blood is getting through when the heart is not contracting." b. "If the child's heart is not overworked for the next few years, this problem will cure itself." c. "This is a minor congenital anomaly and is nothing to worry about as it will cause no problems." d. "This is the sound of blood normally flowing through the heart and is not associated with any heart problem."

d. "This is the sound of blood normally flowing through the heart and is not associated with any heart problem." An innocent heart murmur is created from the sound of the blood flowing through the heart and can be heard if the child's chest wall is thin. They are not clinically significant.

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is: a. Unacceptable because of the risk of sudden infant death syndrome (SIDS). b. Unacceptable because it does not encourage achievement of developmental milestones. c. Unacceptable to encourage fine motor development. d. Acceptable to encourage head control and turning over.

d. Acceptable to encourage head control and turning over. These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and positioning on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development.

On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask whether they can hold their infant during his next gavage feeding. Given that this newborn is physiologically stable, what response would the nurse give? a. "Parents are not allowed to hold infants who depend on oxygen." b. "You may hold only your baby's hand during the feeding." c. "Feedings cause more physiologic stress, so the baby must be closely monitored. Therefore, I don't think you should hold the baby." d. "You may hold your baby during the feeding."

d. "You may hold your baby during the feeding." "You may hold your baby during the feeding" is an accurate statement. Parental interaction via holding is encouraged during gavage feedings so that the infant will associate the feeding with positive interactions. Nasal cannula oxygen therapy allows for easier feedings and psychosocial interactions. The parent can swaddle the infant during gavage feedings to help the infant associate the feeding with positive interactions. Some parents like to do kangaroo care while gavage feeding their infant. Swaddling or kangaroo care during feedings provides positive interactions for the infant.

Pulses can be graded according to certain criteria. Which is a description of a normal pulse? a. 0 b. +1 c. +2 d. +3

d. +3 A normal pulse is described as +3. A pulse that is easy to palpate and not easily obliterated with pressure is considered normal. A pulse graded 0 is not palpable. A pulse graded +1 is difficult to palpate, thready, weak, and easily obliterated with pressure. A pulse graded +2 is difficult to palpate and may be easily obliterated with pressure.

What is the average age of puberty for females in the United States? a. 9 c. 11 b. 10 d. 12

d. 12 The average age of puberty is 12 years for females in the United States.

The nurse should expect the anterior fontanel to close at age: a. 2 months c. 6 to 8 months b. 2 to 4 months d. 12 to 18 months

d. 12 to 18 months Ages 2 through 8 months are too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes at these earlier ages, the child should be referred for further evaluation.

The nutritional requirements of a newborn are how many kilocalories per kilogram per day? a. 90 c. 110 b. 100 d. 120

d. 120 The newborn requires 120 kilocalories per kilogram per day.

The caregivers of a colicky baby tell the nurse that they are getting exhausted trying to calm their baby and get the baby to stop crying. They ask the nurse when all this colicky behavior will stop. The best answer by the nurse is that colic stops at approximately: a. 6 weeks c. 10 weeks b. 8 weeks d. 16 weeks

d. 16 weeks The best answer the nurse can give caregivers about when colicky behavior might stop is about 16 weeks of age.

Most toddlers can climb stairs by how many months? a. 10 c. 15 b. 12 d. 18

d. 18 Most toddlers can climb stairs by 18 months.

Sullivan theorized that the "good me" and the "bad me" fuse around which age? a. 6 months c. 12 months b. 9 months d. 18 months

d. 18 months Sullivan theorized that the "good me" and the "bad me" fuse around age 18 months.

Early stages of faith as a foundation for other faith development may occur as early as: a. 9 months c. 15 months b. 1 year d. 2 years

d. 2 years Early stages of faith as a foundation for other faith development may occur as early as 2 years.

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

d. 21 In general birth, weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday. Weights of 14, 16, and 18 pounds are less what would be expected for an infant with a birth weight of 7 pounds.

Caregivers ask the nurse at what age their 1-year-old will be able to ride a tricycle. The most accurate response by the nurse would be which of the following? a. 13 months c. 18 months b. 16 months d. 24 months

d. 24 months A child can ride a tricycle between 19-30 months.

At what age do toddlers spend time engaging in symbolic play and domestic mimicry? a. 12 months c. 18 months b. 15 months d. 24 months

d. 24 months Toddlers spend time engaging in symbolic play and domestic mimicry at 24 months of age.

The neonatal or newborn period of life is defined as the first: a. 24 hours c. 7 days b. 48 hours d. 28 days

d. 28 days The neonatal or newborn period of life is not defined as the first 28 days.

All of a child's deciduous teeth usually erupt by how many months of age? a. 15 c. 24 b. 18 d. 30

d. 30 All of a child's deciduous teeth usually erupt by 30 months of age.

At which of the following months of age are toddlers able to acknowledge different points of view? a. 12 c. 24 b. 18 d. 36

d. 36 At 36 months of age toddlers can begin to acknowledge different points of view.

The period of toddlerhood is from 12 months to: a. 15 months c. 24 months b. 18 months d. 36 months

d. 36 months The period of toddlerhood is a 24 month span from 12 months to 36 months.

The difference in vocabulary between the 3-year-old child and the 4-year-old child is: a. 150 versus 400 words c. 300 versus 800 words b. 200 versus 500 words d. 900 versus 1,500 words

d. 900 versus 1,500 words The vocabulary of the 3-year-old child is about 900 words, the 4-year-old child has about 1,500 words.

A mother tells the nurse that she doesn't want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given.

d. A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given. Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. With preparation, the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to sense pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

According to Kohlberg, children develop moral reasoning as they mature. What is most characteristic of a preschooler's stage of moral development? a. Obeying the rules of correct behavior is important. b. Showing respect for authority is important behavior. c. Behavior that pleases others is considered good. d. Actions are determined as good or bad in terms of their consequences.

d. Actions are determined as good or bad in terms of their consequences. Preschoolers are most likely to exhibit characteristics of Kohlberg's preconventional level of moral development. During this stage they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying rules of correct behavior, showing respect for authority, and knowing that behavior that pleases others is considered good are characteristic of Kohlberg's conventional level of moral development.

The incidence of sudden infant death syndrome is highest in which of the following groups of people? a. Hispanics b. Northern Europeans c. Canadians and first-generation Asian-Americans d. American Indians and African Americans

d. American Indians and African Americans The incidence of sudden infant death syndrome is highest among American Indians and African Americans.

A 13-year-old girl asks the nurse how much taller she will become. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on knowing that: a. Growth cannot be predicted. b. The pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.

d. Approximately 95% of mature height is achieved when menarche occurs. Although growth cannot be definitely predicted, at the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Responding that the pubertal growth spurt last about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation.

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique may be most helpful? a. Suggest that the child keep a diary. b. Suggest that the parent read fairy tales to the child. c. Ask the parent whether the child is always uncommunicative. d. Ask the child to draw a picture.

d. Ask the child to draw a picture. Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the child's inner self. It would be difficult for a 6-year-old child to keep a diary because the child is most likely learning to read. Reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative.

Which is now referred to as the "new morbidity"? a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problems that alter health

d. Behavioral, social, and educational problems that alter health The new morbidity reflects the behavioral, social, and educational problems that interfere with the child's social and academic development. It is also referred to a "'pediatric social illness'." Limitations in major activities of daily living and unintentional injuries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time.

Which statement describing physiologic jaundice is incorrect? a. Neonatal jaundice is common, but kernicterus is rare. b. The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. c. Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help. d. Breastfed babies have a lower incidence of jaundice.

d. Breastfed babies have a lower incidence of jaundice. Breastfeeding is associated with an increased incidence of jaundice. Neonatal jaundice occurs in 60% of newborns; the complication called kernicterus is rare. Jaundice in the first 24 hours or that persists past day 7 is cause for medical concern. Parents need to know how to assess for jaundice in their newborn.

Which statement concerning the benefits or limitations of breastfeeding is inaccurate? a. Breast milk changes over time to meet changing needs as infants grow. b. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. c. Breast milk/breastfeeding may enhance cognitive development. d. Breastfeeding increases the risk of childhood obesity.

d. Breastfeeding increases the risk of childhood obesity. Breastfeeding actually decreases the risk of childhood obesity. There are multiple benefits of breastfeeding. Breast milk changes over time to meet changing needs as infants grow. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. Breast milk/breastfeeding may enhance cognitive development.

Premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration are: a. Suffering from sleep or wakeful apnea. b. Experiencing severe swings in blood pressure. c. Trying to maintain a neutral thermal environment. d. Breathing in a respiratory pattern common to premature infants.

d. Breathing in a respiratory pattern common to premature infants. This pattern is called periodic breathing and is common to premature infants. It may still require nursing intervention of oxygen and/or ventilation. Apnea is a cessation of respirations for 20 seconds or longer. It should not be confused with periodic breathing.

One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the: a. Incompletely developed neuromuscular system. b. Primitive reflex system. c. Presence of various sleep-wake states. d. Cerebellum growth spurt.

d. Cerebellum growth spurt. The vulnerability of the brain likely is to the result of the cerebellum growth spurt. The neuromuscular system is almost completely developed at birth. The reflex system is not relevant. The various sleep-wake states are not relevant.

Three children playing a board game would be an example of: a. Solitary play c. Associative play b. Parallel play d. Cooperative play

d. Cooperative play Using a board game requires cooperative play. The children must be able to play in a group and carry out the formal game. In solitary, parallel, and associative play, children do not play in a group with a common goal.

Austin, age 6 months, has six teeth. The nurse should recognize that this is: a. Normal tooth eruption. c. Unusual and dangerous. b. Delayed tooth eruption. d. Earlier-than-normal tooth eruption.

d. Earlier-than-normal tooth eruption. This is earlier than expected. Most infants at age 6 months have two teeth. Six teeth at 6 months is not delayed; it is early tooth eruption. Although unusual, it is not dangerous.

The school nurse talks with caregivers of grade-school children about serving healthy foods and modeling eating healthy foods. How will this activity by the nurse help these children avoid obesity in the future? a. Slim children will become slim adults, as they have less fat cells to fill up and the excess fat is excreted. b. The body metabolism is altered to be much slower on a long-term basis then children eat healthy foods at an early age. c. Eating healthy foods early allows the consumption of less healthy foods later without much harm. d. Early exposure to healthy foods will set up a preference for these foods, as adolescents tend to choose foods they are familiar with.

d. Early exposure to healthy foods will set up a preference for these foods, as adolescents tend to choose foods they are familiar with. The nurse will teach the caregivers about serving healthy foods and modeling healthy eating, that early exposure to healthy foods will set up a preference for these foods, as adolescents tend to choose foods they are familiar with.

Trauma to which site can result in a growth problem for children's long bones? a. Matrix c. Calcified cartilage b. Connective tissue d. Epiphyseal cartilage plate

d. Epiphyseal cartilage plate The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.

While completing a newborn assessment, the nurse should be aware that the most common birth injury is: a. To the soft tissues. b. Caused by forceps gripping the head on delivery. c. Fracture of the humerus and femur. d. Fracture of the clavicle.

d. Fracture of the clavicle. The most common birth injury is fracture of the clavicle (collarbone). It usually heals without treatment, although the arm and shoulder may be immobilized for comfort.

Which is a function of brown adipose tissue (BAT) in the newborn? a. Provides ready source of calories in the newborn period b. Insulates the body against lowered environmental temperature c. Protects the newborn from injury during the birth process d. Generates heat for distribution to other parts of body

d. Generates heat for distribution to other parts of body Brown fat is a unique source of heat for the newborn. It has a larger content of mitochondrial cytochromes and a greater capacity for heat production through intensified metabolic activity than does ordinary adipose tissue. Heat generated in brown fat is distributed to other parts of the body by the blood. It is effective in heat production only. The newborn has a thin layer of subcutaneous fat, which does not provide for conservation of heat. Brown fat is located in superficial areas such as between the scapulae, around the neck, in the axillae, and behind the sternum. These areas would not protect the newborn from injury during the birth process.

Which is the most appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll head side to side. c. Hold by feet upside down with head supported. d. Gently stimulate trunk by patting or rubbing.

d. Gently stimulate trunk by patting or rubbing. If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. The infant should not be shaken vigorously, have the head rolled side to side, or be held by the feet upside down with the head supported. These actions can cause injury.

All parents are entitled to a birthing environment in which breastfeeding is promoted and supported. The Baby Friendly Hospital Initiative endorsed by WHO and UNICEF was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which instruction is not included in the "Ten Steps to Successful Breastfeeding for Hospitals"? a. Give newborns no food or drink other than breast milk. b. Have a written breastfeeding policy that is communicated to all staff. c. Help mothers initiate breastfeeding within one half hour of birth. d. Give artificial teats or pacifiers as necessary.

d. Give artificial teats or pacifiers as necessary. No artificial teats or pacifiers (also called dummies or soothers) should be given to breastfeeding infants. No other food or drink should be given to the newborn unless medically indicated. The breastfeeding policy should be routinely communicated to all health care staff. All staff should be trained in the skills necessary to maintain this policy. Breastfeeding should be initiated within one half hour of birth, and all mothers need to be shown how to maintain lactation even if they are separated from their babies.

When assessing the preterm infant the nurse understands that compared with the term infant, the preterm infant has: a. Few blood vessels visible through the skin. b. More subcutaneous fat. c. Well-developed flexor muscles. d. Greater surface area in proportion to weight.

d. Greater surface area in proportion to weight. Preterm infants have greater surface area in proportion to their weight. More subcutaneous fat and well-developed muscles are indications of a more mature infant.

What bacterial infection is definitely decreasing because of effective drug treatment? a. Escherichia coli infection c. Candidiasis b. Tuberculosis d. Group B streptococcal infection

d. Group B streptococcal infection Penicillin has significantly decreased the incidence of group B streptococcal infection. E. coli may be increasing, perhaps because of the increasing use of ampicillin (resulting in a more virulent E. coli resistant to the drug). Tuberculosis is increasing in the United States and Canada. Candidiasis is a fairly benign fungal infection.

A postpartum woman telephones about her 4-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Effective breastfeeding is indicated by the newborn who: a. Sleeps for 6 hours at a time between feedings. b. Has at least one breast milk stool every 24 hours. c. Gains 1 to 2 ounces per week. d. Has at least six to eight wet diapers per day.

d. Has at least six to eight wet diapers per day. After day 4, when the mother's milk comes in, the infant should have six to eight wet diapers every 24 hours. Sleeping for 6 hours between feedings is not an indication of whether the infant is breastfeeding well. Typically infants sleep 2 to 4 hours between feedings, depending on whether they are being fed on a 2- to 3-hour schedule or cluster fed. The infant should have a minimum of three bowel movements in a 24-hour period.

The parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurse's reply should be based on knowing that: a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

d. Hot dogs must be cut into small, irregular pieces to prevent aspiration. Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut into irregularly shaped pieces.

The predominant characteristic of the intellectual development of the child ages 2 to 7 years is egocentricity. What best describes this concept? a. Selfishness c. Preferring to play alone b. Self-centeredness d. Inability to put self in another's place

d. Inability to put self in another's place According to Piaget, this age child is in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another's place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.

An Apgar score of 10 at 1 minute after birth would indicate a(n): a. Infant having no difficulty adjusting to extrauterine life and needing no further testing. b. Infant in severe distress who needs resuscitation. c. Prediction of a future free of neurologic problems. d. Infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth.

d. Infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth. An initial Apgar score of 10 is a good sign of healthy adaptation; however, it must be repeated at the 5-minute mark.

When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. The best explanation for this is: a. Some form of cancer. b. Local scalp infection common in children. c. Infection or inflammation distal to the site. d. Infection or inflammation close to the site.

d. Infection or inflammation close to the site. Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location. Tender lymph nodes do not usually indicate cancer. A scalp infection usually does not cause inflamed lymph nodes. The lymph nodes close to the site of inflammation or infection would be inflamed.

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is: a. Closure of fetal shunts in the circulatory system. b. Full function of the immune defense system at birth. c. Maintenance of a stable temperature. d. Initiation and maintenance of respirations.

d. Initiation and maintenance of respirations. The most critical adjustment of a newborn at birth is the establishment of respirations. The cardiovascular system changes markedly after birth as a result of fetal respiration, which reduces pulmonary vascular resistance to the pulmonary blood flow and initiates a chain of cardiac changes that support the cardiovascular system. The infant relies on passive immunity received from the mother for the first 3 months of life. After the establishment of respirations, heat regulation is critical to newborn survival.

Which statement describing the first phase of the transition period is inaccurate? a. It lasts no longer than 30 minutes. b. It is marked by spontaneous tremors, crying, and head movements. c. It includes the passage of meconium. d. It may involve the infant's suddenly sleeping briefly.

d. It may involve the infant's suddenly sleeping briefly. The first phase is an active phase in which the baby is alert. Decreased activity and sleep mark the second phase. The first phase is the shortest, lasting less than 30 minutes. Such exploratory behaviors include spontaneous startle reactions. In the first phase the newborn also produces saliva.

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) is to: a. Explain how SIDS could have been predicted and prevented. b. Interview parents in depth concerning the circumstances surrounding the infant's death. c. Discourage parents from making a last visit with the infant. d. Make a follow-up home visit to parents as soon as possible after the infant's death.

d. Make a follow-up home visit to parents as soon as possible after the infant's death. A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their infant.

In order to help an infant accomplish the basic task of infancy (according to Erikson's stages of psychosocial development), caregivers must consistently do which of the following things? a. Provide entertainment and stimulation for psychological growth. b. Talk with the child during the child's waking hours. c. Hold the baby in a way that the baby prefers. d. Meet need for comfort, security, predictability, food, and warmth.

d. Meet need for comfort, security, predictability, food, and warmth. In order to help an infant accomplish the basic task of infancy (according to Erikson's stages of psychosocial development), caregivers must consistently meet the infant's need for comfort, security, predictability, food, and warmth.

An African-American woman noticed some bruises on her newborn girl's buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called: a. Lanugo. c. Nevus flammeus. b. Vascular nevi. d. Mongolian spots.

d. Mongolian spots. A Mongolian spot is a bluish black area of pigmentation that may appear over any part of the exterior surface of the body. It is more commonly noted on the back and buttocks and most frequently is seen on infants whose ethnic origins are Mediterranean, Latin American, Asian, or African. Lanugo is the fine, downy hair seen on a term newborn. A vascular nevus, commonly called a strawberry mark, is a type of capillary hemangioma. A nevus flammeus, commonly called a port-wine stain, is most frequently found on the face.

A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). The nurse's most appropriate action is to: a. Leave the infant in the room with the mother. b. Take the infant immediately to the nursery. c. Perform a gestational age assessment to determine whether the infant is large for gestational age. d. Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.

d. Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia. This infant is macrosomic (more than 4000 g) and is at high risk for hypoglycemia. Blood glucose levels should be monitored frequently, and the infant should be observed closely for signs of hypoglycemia. Observation may occur in the nursery or in the mother's room, depending on the condition of the fetus. Regardless of gestational age, this infant is macrosomic.

While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive: a. Tonic neck reflex. c. Babinski reflex. b. Glabellar (Myerson) reflex. d. Moro reflex.

d. Moro reflex. The characteristics displayed by the infant are associated with a positive Moro reflex. The tonic neck reflex occurs when the infant extends the leg on the side to which the infant's head simultaneously turns. The glabellar reflex is elicited by tapping on the infant's head while the eyes are open. A characteristic response is blinking for the first few taps. The Babinski reflex occurs when the sole of the foot is stroked upward along the lateral aspect of the sole and then across the ball of the foot. A positive response occurs when all the toes hyperextend, with dorsiflexion of the big toe.

*A parent asks the nurse whether her infant is susceptible to pertussis. The nurse's response should be based on which statement concerning susceptibility to pertussis? a. Neonates will be immune the first few months. b. If the mother has had the disease, the infant will receive passive immunity. c. Children younger than 1 year seldom contract this disease. d. Most children are highly susceptible from birth.

d. Most children are highly susceptible from birth. The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age-group.

During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is: a. Abnormal and requires further investigation. b. Abnormal unless it occurs in conjunction with knock-knee. c. Normal if the condition is unilateral or asymmetric. d. Normal because the lower back and leg muscles are not yet well developed.

d. Normal because the lower back and leg muscles are not yet well developed. Lateral bowing of the tibia (bowlegged) is common in toddlers when they begin to walk, not an abnormal finding. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children.

Which is the most critical physiologic change required of the newborn? a. Closure of fetal shunts in the heart b. Stabilization of fluid and electrolytes c. Body-temperature maintenance d. Onset of breathing

d. Onset of breathing The onset of breathing is the most immediate and critical physiologic change required for transition to extrauterine life. Factors that interfere with this normal transition increase fetal asphyxia, which is a condition of hypoxemia, hypercapnia, and acidosis. This affects the fetus's adjustment to extrauterine life. Closure of fetal shunts in the heart, stabilization of fluid and electrolytes, and body-temperature maintenance are important changes that must occur in the transition to extrauterine life, but breathing and the exchange of oxygen for carbon dioxide must come first.

The nurse must assess a child's capillary filling time. This can be accomplished by: a. Inspecting the chest. b. Auscultating the heart. c. Palpating the apical pulse. d. Palpating the skin to produce a slight blanching.

d. Palpating the skin to produce a slight blanching. Capillary filling time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary filling time.

In teaching the mother how to remove the newborn from the breast, the nurse would offer which of the following instructions? a. Gently slap the newborn's cheek or hand to get him or her distracted enough to stop feeding. b. Pull on the baby's ear that is opposite the breast there the baby is feeding. c. Push on the baby's cheeks to open the baby's mouth. d. Place a finger in the side of the baby's mouth and between the jaws to release suction.

d. Place a finger in the side of the baby's mouth and between the jaws to release suction. After nursing, release the suction before removing the newborn from the breast by placing a finger in the side of the mouth and between the jaws.

As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Which statement is incorrect? a. Prevent exposure to people with upper respiratory tract infections. b. Keep the infant away from secondhand smoke. c. Avoid loose bedding, water beds, and beanbag chairs. d. Place the infant on his or her abdomen to sleep.

d. Place the infant on his or her abdomen to sleep. The infant should be laid down to sleep on his or her back for better breathing and to prevent sudden infant death syndrome. Infants are vulnerable to respiratory infections; infected people must be kept away. Secondhand smoke can damage lungs. Infants can suffocate in loose bedding, and furniture that can trap them. Per AAP guidelines, infants should always be placed "back to sleep" and allowed tummy time to play, to prevent plagiocephaly.

How much of a relationship is there between how adolescents feel about themselves and how they feel about their bodies? a. none c. a moderate relationship b. very little d. a strong relationship

d. a strong relationship There is a strong relationship between how adolescents feel about themselves and how they feel about their bodies.

During life in utero, oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory center in the medulla. The initiation of respiration then follows. Which is not one of these essential factors? a. Chemical c. Thermal b. Mechanical d. Psychologic

d. Psychologic A psychologic factor is not one of the essential factors in the initiation of breathing; the fourth factor is sensory. The sensory factors include handling by the provider, drying by the nurse, lights, smells, and sounds. Chemical factors are essential for the initiation of breathing. During labor, decreased levels of oxygen and increased levels of carbon dioxide seem to have a cumulative effect that is involved in the initiation of breathing. Clamping of the cord may also contribute to the start of respirations. Prostaglandins are known to inhibit breathing, and clamping of the cord results in a drop in the level of prostaglandins. Mechanical factors also are necessary to initiate respirations. As the infant passes through the birth canal, the chest is compressed. With birth the chest is relaxed, which allows for negative intrathoracic pressure that encourages air to flow into the lungs. The profound change in temperature between intrauterine and extrauterine life stimulates receptors in the skin to communicate with the receptors in the medulla. This also contributes to the initiation of breathing.

A child's skeletal age is best determined by: a. Assessment of dentition. c. Facial bone development. b. Assessment of height over time. d. Radiographs of the hand and wrist.

d. Radiographs of the hand and wrist. The most accurate measure of skeletal age is radiologic examination of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption varies considerably in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child's height, not skeletal age. Facial bone development does not reflect the child's skeletal age, which is determined by radiographic assessment.

When teaching parents about mandatory newborn screening, it is important for the nurse to explain that the main purpose is to: a. Keep the state records updated. b. Allow accurate statistical information. c. Document the number of births. d. Recognize and treat newborn disorders early.

d. Recognize and treat newborn disorders early. Early treatment of disorders will prevent morbidity associated with inborn errors of metabolism or other genetic conditions. Keeping records and reporting for statistical purposes are not the primary reason for the screening test. The number of births recorded is not reported from the newborn screening test.

Because of the premature infant's decreased immune functioning, what nursing diagnosis should the nurse include in a plan of care for a premature infant? a. Delayed growth and development c. Ineffective infant feeding pattern b. Ineffective thermoregulation d. Risk for infection

d. Risk for infection The nurse needs to understand that decreased immune functioning increases the risk for infection. Growth and development, thermoregulation, and feeding may be affected, although only indirectly.

A toddler playing with sand and water would be participating in _____ play. a. Skill c. Social-affective b. Dramatic d. Sense-pleasure

d. Sense-pleasure The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.

Which function of play is a major component of play at all ages? a. Creativity c. Intellectual development b. Socialization d. Sensorimotor activity

d. Sensorimotor activity Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.

A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats/min with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. On the basis of the maternal history, the cause of this newborn's distress is most likely to be: a. Hypoglycemia. c. Respiratory distress syndrome. b. Phrenic nerve injury. d. Sepsis.

d. Sepsis. The prolonged rupture of membranes and the tachypnea (before and after birth) both suggest sepsis. An FHR of 180 beats/min is also indicative. This infant is at high risk for sepsis.

Nurses should be able to teach breastfeeding mothers the signs that the infant has latched on correctly. Which statement indicates a poor latch? a. She feels a firm tugging sensation on her nipples but not pinching or pain. b. The baby sucks with cheeks rounded, not dimpled. c. The baby's jaw glides smoothly with sucking. d. She hears a clicking or smacking sound.

d. She hears a clicking or smacking sound. The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. The tugging sensation without pinching is a good sign. Rounded cheeks are a positive indicator of a good latch. A smoothly gliding jaw is a good sign.

he most frequently used test for measuring visual acuity is the: a. Denver Eye Screening test. c. Ishihara vision test. b. Allen picture card test. d. Snellen letter chart.

d. Snellen letter chart. The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. Single cards (Denver—letter E; Allen—pictures) are used for children age 2 years and older who are unable to use the Snellen letter chart. The Ishihara vision test is used for color vision.

In teaching the family about caring for the newborn, you would advise the caregiver to: a. place the neonate directly on a scale b. place the newborn's crib close to the window c. expose baby completely, bathing in as few a motions as possible d. block sunlight from the newborn while the newborn is in the car

d. block sunlight from the newborn while the newborn is in the car In teaching the family about caring for the newborn, you would advise the caregiver to block sunlight from the newborn while the newborn is in the car.

The teacher refers a 9-year-old student to the school nurse for a sleep assessment. The student is often asleep in class and is failing in several areas. The teacher suspects the child is not getting enough sleep. The nurse finds out that the child is going to bed at midnight and getting up at 7 AM. Which of the following is the best action for the nurse to take? a. Have the child take a nap sometime during the day at school. b. Tell the child to get more sleep on the weekend to catch up on sleep. c. Ask the child to go to bed earlier at night, if at all possible, so the child won't fall asleep in class and will be able to pay attention. d. Talk to the family about a 9-year-old's need for 9 to 10 hours of sleep per night so the child will grow and can pay attention at school.

d. Talk to the family about a 9-year-old's need for 9 to 10 hours of sleep per night so the child will grow and can pay attention at school. Nine hours a night is the recommended amount of sleep for the school-age child. Therefore, this is the best action for the nurse to take.

The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that: a. This growth chart should not be used. b. Growth patterns of African-American children are the same as for all other ethnic groups. c. A correction factor is necessary when the NCHS growth chart is used for non-Caucasian ethnic groups. d. The NCHS charts are accurate for U.S. African-American children.

d. The NCHS charts are accurate for U.S. African-American children. The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American-children were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists.

With regard to hemolytic diseases of the newborn, nurses should be aware that: a. Rh incompatibility matters only when an Rh-negative child is born to an Rh-positive mother. b. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia. c. Exchange transfusions frequently are required in the treatment of hemolytic disorders. d. The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth.

d. The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth. An indirect Coombs' test may be performed on the mother a few times during pregnancy. Only the Rh-positive child of an Rh-negative mother is at risk. ABO incompatibility is more common than Rh incompatibility but causes less severe problems; significant anemia, for instance, is rare with ABO. Exchange transfers are needed infrequently because of the decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.

Which of the following statements best describes object permanence? a. An object is always within eyesight. b. Materials do not get eaten or thrown away. c. The mother makes certain that favorite toys remain with a child. d. The infant realizes an object continues to exist even when out of sight.

d. The infant realizes an object continues to exist even when out of sight. Object permanence is best described as the infant realizes an object continues to exist even when out of sight.

Early this morning, an infant boy was circumcised using the PlastiBell method. The nurse tells the mother that she and the infant can be discharged after: a. The bleeding stops completely. b. Yellow exudate forms over the glans. c. The PlastiBell rim falls off. d. The infant voids.

d. The infant voids. The infant should be observed for urination after the circumcision. Bleeding is a common complication after circumcision. The nurse will check the penis for 12 hours after a circumcision to assess and provide appropriate interventions for prevention and treatment of bleeding. Yellow exudates cover the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The PlastiBell remains in place for about a week and falls off when healing has taken place.

When providing an infant with a gavage feeding, which of the following should be documented each time? a. The infant's abdominal circumference after the feeding b. The infant's heart rate and respirations c. The infant's suck and swallow coordination d. The infant's response to the feeding

d. The infant's response to the feeding Documentation of a gavage feeding should include the size of the feeding tube, the amount and quality of the residual from the previous feeding, the type and quantity of the fluid instilled, and the infant's response to the procedure. Abdominal circumference is not measured after a gavage feeding. Vital signs may be obtained before feeding. However, the infant's response to the feeding is more important. Some older infants may be learning to suck, but the important factor to document would be the infant's response to the feeding (including attempts to suck).

A newly delivered mother who intends to breastfeed tells her nurse, "I am so relieved that this pregnancy is over so I can start smoking again." The nurse encourages the client to refrain from smoking. However, this new mother insists that she will resume smoking. The nurse will need to adapt her health teaching to ensure that the client is aware that: a. Smoking has little or no effect on milk production. b. There is no relation between smoking and the time of feedings. c. The effects of secondhand smoke on infants are less significant than for adults. d. The mother should always smoke in another room.

d. The mother should always smoke in another room. The new mother should be encouraged not to smoke. If she continues to smoke, she should be encouraged to always smoke in another room removed from the baby. Smoking may impair milk production. When the products of tobacco are broken down, they cross over into the breast milk. Tobacco also results in a reduction of the immunologic properties of breast milk. Research supports that mothers should not smoke within 2 hours before a feeding. The effects of secondhand smoke on infants include sudden infant death syndrome.

When responding to the question "Will I produce enough milk for my baby as she grows and needs more milk at each feeding?" the nurse should explain that: a. The breast milk will gradually become richer to supply additional calories. b. As the infant requires more milk, feedings can be supplemented with cow's milk. c. Early addition of baby food will meet the infant's needs. d. The mother's milk supply will increase as the infant demands more at each feeding.

d. The mother's milk supply will increase as the infant demands more at each feeding. The amount of milk produced depends on the amount of stimulation of the breast. Increased demand with more frequent and longer breastfeeding sessions results in more milk available for the infant. Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times. Supplementation will decrease the amount of stimulation of the breast and decrease the milk production. Solids should not be added until about 4 to 6 months, when the infant's immune system is more mature. This will decrease the chance of allergy formations.

Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on the knowledge that: a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.

d. This is a common and accepted practice, especially in some cultural groups. Co-sleeping or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently underway; no evidence at this time supports or abandons the practice for safety reasons. This is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon.

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stool. The nurse bases her explanation on knowing that: a. Children should not be given fibrous foods until the digestive tract matures at age 4 years. b. The infant should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

d. This is normal because of the immaturity of digestive processes at this age. The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is a normal part of the maturational process, and no further investigation is necessary.

HIV may be perinatally transmitted: a. Only in the third trimester from the maternal circulation. b. From the use of unsterile instruments. c. Only through the ingestion of amniotic fluid. d. Through the ingestion of breast milk from an infected mother.

d. Through the ingestion of breast milk from an infected mother. Postnatal transmission of HIV through breastfeeding may occur. Transmission of HIV from the mother to the infant may occur transplacentally at various gestational ages. This is highly unlikely because most health care facilities must meet sterility standards for all instrumentation. Transmission of HIV may occur during birth from blood or secretions.

Human immunodeficiency virus (HIV) may be perinatally transmitted: a. Only in the third trimester from the maternal circulation. b. By a needlestick injury at birth from unsterile instruments. c. Only through the ingestion of amniotic fluid. d. Through the ingestion of breast milk from an infected mother.

d. Through the ingestion of breast milk from an infected mother. Postnatal transmission of HIV through breastfeeding may occur. Transmission of HIV from the mother to the infant may occur transplacentally at various gestational ages. Transmission close to or at the time of birth is thought to account for 50% to 80% of cases.

Lymphoid tissues such as lymph nodes are: a. Adult size by age 1 year. b. Adult size by age 13 years. c. Half their adult size by age 5 years. d. Twice their adult size by age 10 to 12 years.

d. Twice their adult size by age 10 to 12 years. Lymph nodes increase rapidly and reach adult size at approximately age 6 years. They continue growing until they reach maximal development at age 10 to 12 years, which is twice their adult size. A rapid decline in size occurs until they reach adult size by the end of adolescence.

A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes c. Celiac disease b. Respiratory disease d. Type II diabetes

d. Type II diabetes Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity.

What infant response to cool environmental conditions is either not effective or not available to them? a. Constriction of peripheral blood vessels b. Metabolism of brown fat c. Increased respiratory rates d. Unflexing from the normal position

d. Unflexing from the normal position The newborn's flexed position guards against heat loss because it reduces the amount of body surface exposed to the environment. The newborn's body is able to constrict the peripheral blood vessels to reduce heat loss. Burning brown fat generates heat. The respiratory rate may rise to stimulate muscular activity, which generates heat.

Which parameter correlates best with measurements of the body's total protein stores? a. Height c. Skin-fold thickness b. Weight d. Upper arm circumference

d. Upper arm circumference Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skin-fold thickness is a measurement of the body's fat content.

The nurse is doing some teaching with caregivers who are trying to toilet train their 26-month-old child. When teaching toilet-training methods, which of the following behaviors would the nurse most likely recommend to the caregivers? a. Have the child go without diapers and clean up any feces or urine on the floor themselves. b. Use time-out and withdrawal of privileges for not using the toilet. c. Remind the child as frequently as every 15 minutes about the availability of the toilet. d. Use a calm, relaxed approach, praise for success, and no punishment at all.

d. Use a calm, relaxed approach, praise for success, and no punishment at all. When teaching toilet-training methods, the nurse would most likely recommend that the caregivers use a calm, relaxed approach, praise for success, and no punishment at all.

A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. The nurse can facilitate the infant's correct latch-on by helping the woman hold the infant: a. With his arms folded together over his chest. b. Curled up in a fetal position. c. With his head cupped in her hand. d. With his head and body in alignment.

d. With his head and body in alignment. The infant's head and body should be in correct alignment with the mother and the breast during latch-on and feeding. Holding the infant with his arms folded together over his chest, curled up in a fetal position, or with his head cupped in her hand are not ideal positions to facilitate latch-on.

A mother discovers that her baby is suddenly listless. Which of the following actions would best indicate that she understood the information the nurse gave her before she was discharged from the hospital with her baby? a. bathing the baby in alcohol b. gently shaking the baby and calling the baby's name c. observing the baby for 2 hours to see if the baby gets better or worse d. calling the pediatrician or nurse practitioner immediately

d. calling the pediatrician or nurse practitioner immediately Discovering the baby is listless, calling the pediatrician or nurse practitioner immediately is the desired action by the mother.

How might a nurse's approach to health screening differ in forking with early adolescents (ages 12 to 14) and late adolescents (ages 18 to 21)? a. dietary assessment for the early adolescent, but no dietary assessment for the late adolescent b. sexual activity screening for the late adolescent and not for the early adolescent c. screening for sufficient hours of sleep for early adolescents and not for late adolescents d. caregivers interviewed with early adolescents and not interviewed with late adolescents

d. caregivers interviewed with early adolescents and not interviewed with late adolescents Nursing care should be provided in settings, sometimes away from the caregivers, there the self-conscious adolescent feels welcome and comfortable, free to share openly.

The father asks a nurse for advice on how to deal with his child's nightmares. The best advice from the nurse would be: a. have the child get into bed with the father b. sleep in the child's bed with him c. have the child get up and play a game d. comfort and reassure the child that nightmares are not real

d. comfort and reassure the child that nightmares are not real When the father asks a nurse for advice on how to deal with his child's nightmares, the best advice from the nurse will be to comfort and reassure the child that nightmares are not real.

When teaching the caregivers about the selection of a baby's semisolid food, the nurse would tell them to: a. select jars of baby food with salt content under 400 micrograms (mcg) per jar b. add a little regular refined white sugar to the baby food, as babies prefer sweet-tasting foods c. buy baby foods with added artificial sweetener or add one packet per jar d. do not add sugar or salt to a baby's food and select products preferably with no added salt or sugar

d. do not add sugar or salt to a baby's food and select products preferably with no added salt or sugar When teaching about the selection of a baby's semisolid food, the nurse would not tell them: do not add sugar or salt to a baby's food and select products preferably with no added salt or sugar.

The nurse in the pediatric clinic measures a 9-year-old child's height and finds that the child has grown 4 inches in 1 year. The nurse will discuss this increase in height with the caregivers, keeping in mind that an increase of 4 inches in 1 year, when compared to the usual increase for a school-aged child, is: a. just below average c. slightly above average b. average d. double the average

d. double the average The average child's height increases by 2 inches per year. Therefore, an increase of 4 inches in 1 year is twice the average increase.

The nurse is assessing a newborn and finds a rash that has a red macular base with a white vesicular center. This rash is most likely which of the following conditions? a. desquamation c. petechiae b. telangiectatic nevi d. erythema toxicum

d. erythema toxicum Some newborns may experience a transient newborn rash that is characterized by a red macular base with a white vesicular center. This rash is referred to as erythema toxicum.

According to Piaget, a child whose thinking is characterized by systematic and abstract thinking and who is able to consider alternative solutions is in which of the following stages? a. abstract stage c. systematic operations stage b. parable stage d. formal operations stage

d. formal operations stage A child in the formal operations stage is capable of systematic and abstract thinking and is able to consider alternative solutions.

Which of the following best identifies how Piaget described play during the school-age years? a. work that is fun c. a moral character builder b. interactive socialization d. games with rules

d. games with rules Piaget described play during the school-age years as games with rules as the child is able to think more objectively, thus making group activities a possibility.

During the school-age years a child will lose 20 deciduous or baby teeth. Which of the following factors determine the rate at which children lose these teeth? a. calcium in the diet c. regularity of brushing and flossing b. how much sugar the child eats d. genetics and gender

d. genetics and gender When children start to lose their teeth, the rate of loss is determined by genetics and gender. It is common for girls to lose their teeth earlier than boys.

A caregiver calls the pediatrician's office and is desperate to talk with the pediatrician or the nurse. The baby has red swollen gums and is teething and fussy. The caregiver wants to know what intervention to take to soothe the irritable baby. The nurse will most likely suggest: a. applying a small heated pad to the face b. chewing on ice chips c. applying an alcohol rub to the gums d. giving an ice cube in a washcloth or zwieback toast

d. giving an ice cube in a washcloth or zwieback toast When a baby has red swollen gums and is teething and fussy, the nurse will more likely suggest giving an ice cube in a washcloth or zwieback toast.

The normal newborn uses what behavior or ability to protect him- or herself from overstimulation and to free energy to meet physiologic demands? a. deep sleeping c. constitution b. crying d. habituation

d. habituation Habituation, the ability to decrease responses to disturbing stimuli, is a defensive state that the newborn may enter to protect him- or herself from over\-stimulation and to free energy to meet physiologic demands.

If a newborn is not dried thoroughly after a bath, it is most likely that the newborn will: a. have increased susceptibility to seizure c. become increasingly anxious b. develop a severely dried skin d. have a body temperature drop

d. have a body temperature drop Improper or inadequate drying of a newborn after a bath will not most likely mean the newborn will have a body temperature drop as the water evaporates from the skin.

In Freudian psychodynamic theory, which of the following best describes the Oedipus complex? a. a child becoming the center of attention b. extreme jealousy of one or more siblings c. believing that one is actually the child of royalty d. incestuous desire of a boy for his mother

d. incestuous desire of a boy for his mother In Freudian psychodynamic theory, children in the phallic stage (3-6 years) develop a strong incestuous desire for the caregiver of the opposite sex. In boys, Freud labels it the Oedipus complex.

Eccrine and apocrine glands mature during adolescence. These glands cause: a. increased interest in sexuality and finding a mate b. a darkening and toughening of the skin in males c. the breasts to enlarge and the nipples to darken d. increased amounts of, and a distinct odor to, perspiration

d. increased amounts of, and a distinct odor to, perspiration The maturation of the eccrine and apocrine glands leads to increased amounts of and a distinct odor to perspiration.

The nurse is talking with caregivers regarding the introduction of new foods to their baby, who has been on cereals and is now ready to start on vegetables and fruits. The most important advice the nurse will give the caregivers is to: a. place up to three foods on the spoon at one time with an old favorite on the front of the spoon b. introduce vegetables first, introduce one new vegetable per day until all vegetables are introduced, and then introduce fruits c. start feeding fruits and vegetables very slowly, one spoon per day d. introduce one new food at a time at 4- to 7-day intervals

d. introduce one new food at a time at 4- to 7-day intervals Regarding the introduction of new foods to the baby, the most important advice the nurse will give the caregivers is to introduce one new food at a time at 4- to 7-day intervals.

The nurse is assessing a school-aged child and finds that this child is involved in working on a school project with peers, is on a swimming team, and collects dolls from around the world. The child mentions an interest in learning karate. The nurse's initial impression is that this child: a. is over-scheduled, as children this age need more rest and sleep b. is an extreme extrovert engaging in extrovert behaviors c. may be hypomanic and the family psychiatric history should be explored d. is meeting Erikson's major developmental task of this age period

d. is meeting Erikson's major developmental task of this age period The major developmental task of this age period is industry versus inferiority. Energy is channeled into activities such as school projects, sports, and hobbies. Therefore, this child is meeting Erikson's major developmental task.

A school-aged child is repeatedly sent to the nurse's office for complaints of headache, sleep disturbances, and stomachache. The nurse will most likely suspect that this child: a. just wants to spend time with the nurse because the nurse is nice b. is trying to get out of class because of difficulty with schoolwork c. has school phobia d. is the victim of bullying

d. is the victim of bullying Reactions to bullying can include physical scratches and bruises, requests for extra money for school, and resistance to attend school. If bullying continues, the child may become depressed, withdrawn, and suicidal. This child's complaints could result from being the victim of bullying.

In assessing flexion of the elbows of the newborn, the nurse would flex them by holding for 5 seconds and when extending them. The elbows of a term newborn will form an angle of: a. 120 degrees with an extended position following the angle b. 100 degrees with a semiflexed position c. less than 90 degrees with a rapid recoil back to an extended position d. less than 90 degrees and rapidly recoil back to a flexed position

d. less than 90 degrees and rapidly recoil back to a flexed position In assessing flexion of the elbows of the newborn, the nurse would flex them by holding for 5 seconds and when extending them. The elbows of a term newborn will form an angle of less than 90 degrees and rapidly recoil back to a flexed position.

The nurse is working with the caregivers of a 32-month-old child. They are very concerned that their child and one of the child's playmates were discovered undressed. On questioning the children, it was clear that these children had been comparing and inspecting their bodies. The nurse would advise the caregivers that because of their child's stage of development and age, their best response would be: a. timely and logical consequences for unacceptable behavior b. punishment severe enough to prevent recurrence of behavior c. constant one-on-one supervision during all waking hours d. matter-of-fact manner by caregivers in responding

d. matter-of-fact manner by caregivers in responding The nurse would advise the caregivers that because of their child's stage of development and age, their best response would be matter-of-fact manner by caregivers in responding.

The pediatric nurse working with preschoolers will find which of the following problems to be more common at this age than at any other age? a. appendicitis and tonsillitis requiring day surgeries or one-day hospitalization b. accidents, cuts, bruises, and major traumas requiring emergency room care c. poisoning with lead, plants, household chemicals, and other sources d. minor illnesses such as colds, otitis media, and gastrointestinal disturbances

d. minor illnesses such as colds, otitis media, and gastrointestinal disturbances The pediatric nurse working with preschoolers will find that minor illnesses such as colds, otitis media, and gastrointestinal disturbances are more common at this age.

When the caregivers of an adolescent divorce and then remarry, the adolescent's adjustment to the new family structure compared to that of younger children will be: a. much easier c. about the same b. slightly easier d. more difficult

d. more difficult When the caregivers of an adolescent divorce and then remarry, the adolescent's adjustment to the new family structure compared to that of younger children will be more difficult.

Compared to children or adults, adolescents' gender attitudes and behavior are found to be: a. about the same c. somewhat more liberal b. far more liberal d. more traditional

d. more traditional Compared to children or adults, adolescents' gender attitudes and behavior are found to be more traditional.

A nurse is instructing the mother of a 3-year-old about diet. The nurse will recommend that the mother look at the amount of fat in the child's diet and ensure that the fat in the diet is: a. at least 40% c. less than 15% b. around 10% d. no more than 30%

d. no more than 30% The nurse instructing the mother of a 3-year-old about diet will recommend that the mother ensure that the fat in the diet is no more than 30%.

The nurse assessing a typical family with an adolescent child would more often than not find the arguments between caregivers and child to be about: a. adolescent sexuality c. drugs and drug abuse b. religion or politics d. ordinary family matters

d. ordinary family matters The nurse assessing a typical family with an adolescent child would more often than not find the arguments between caregivers and child to be about ordinary family matters.

Elkind had a term for adolescents' exaggerated notion of their own uniqueness. He said that adolescents either experience an extreme sense of isolation, thinking no one has experienced what they have and therefore cannot understand, or think they are immortal and that bad things only happen to other people. The term Elkind used for these two beliefs was: a. immortality and isolation complex c. Eros versus Thanatos b. paradox of life and death d. personal fable

d. personal fable Personal fables Elkind's term for adolescents' exaggerated notion of their own uniqueness.

The most common reasons toddlers in this country have a potbelly appearance is because of underdeveloped abdominal muscles or: a. eating too much at any one given meal c. drinking too many sugary drinks b. overconsumption of fatty foods d. poor nutrition intake or constipation

d. poor nutrition intake or constipation The most common reasons toddlers in this country have a potbelly appearance is because of underdeveloped abdominal muscles or poor nutrition intake or constipation.

The pediatric nurse spends time teaching caregivers about prevention of dental caries. Later a caregiver correctly tells the pediatric nurse that he paid careful attention to daily brushing and flossing with his preschooler because he had learned from the nurse that dental caries can cause: a. extreme mouth and jaw pain b. loss of a majority of the taste buds c. a serious loss of appetite, weight loss, and anorexia or other eating disorders in childhood d. premature loss of teeth, alteration of the dental arch, and compromised development of permanent teeth

d. premature loss of teeth, alteration of the dental arch, and compromised development of permanent teeth The number one dental problem in the preschool years is dental cavities or tooth decay, which can result in premature loss of teeth, alteration of the dental arch, and compromised development of permanent teeth.

The nurse instructs the caregivers of a newborn to notch the diapers or fold them in such a way as to expose the cord. The major purpose of exposing the cord is to: a. allow visualization at all times c. remind the caregivers to do cord care b. keep the diaper from rubbing the cord d. provide air circulation for the cord

d. provide air circulation for the cord Correct. The nurse instructs the caregivers of a newborn to notch the diapers or fold them in such a way as to expose the cord. The major purpose of exposing the cord is to provide air circulation for the cord.

Which of the following behaviors by the caregivers would facilitate a child learning to trust when the child is hospitalized? a. having the child stay with a variety of other people soon after discharge from the hospital to help the child overcome anxiety around new people b. establishing a solid good-bye routine c. letting the child know they will miss him or her d. providing a list of the child's usual home routines, cues given when frustrated, response to comforting methods, and favorite games and music to the health team

d. providing a list of the child's usual home routines, cues given when frustrated, response to comforting methods, and favorite games and music to the health team Behaviors by the caregivers that would facilitate a child learning to trust when the child is hospitalized will focus upon providing a list of the child's usual home routines, cues given when frustrated, response to comforting methods, and favorite games and music to the health team.

The nurse is working with the caregivers of a toddler. In teaching the caregivers about growth and development, the nurse provides information about the fact that depth perception is developing during the toddler years. Since their child is just entering the toddler stage, the caregivers will realize that developing depth perception will affect their child in which of the following ways? a. cause the child to have an increased fear of heights and of falling out of bed at night b. bring about an unusual sense of dizziness at times c. cause the child difficulty in learning to swim and in swimming d. put the toddler at risk for frequent falls when learning to walk, run, and climb stairs

d. put the toddler at risk for frequent falls when learning to walk, run, and climb stairs Caregivers of a toddler will realize that developing depth perception will put their child at risk for frequent falls when learning to walk, run, and climb stairs.

When the nurse detects a hydrocele on a newborn, the nurse will talk with the caregivers and get them to: a. sign the surgical permit after a full explanation of the surgical procedure b. express their feelings about this abnormality in their newborn son c. decide on a specialist to correct this deformity in their newborn d. reassure them that this usually disappears within the first year of life

d. reassure them that this usually disappears within the first year of life When the nurse detects a hydrocele on a newborn, the nurse will talk with the caregivers and reassure them that this usually disappears within the first year of life.

The newborn is less capable of absorbing fat than older children and adults because of: a. natural allergies to fat b. lack of stomach acid c. shorter large and small intestines with shorter emptying time d. reduced bile salt secretion and less efficient pancreas

d. reduced bile salt secretion and less efficient pancreas The newborn is less capable of absorbing fat than older children and adults because of reduced bile salt secretion from the liver and less efficient pancreas.

It is documented that infants who lived in an impoverished orphanage and who were adopted into nurturing homes grew up without identifiable intellectual defects. This occurrence best supports which of the following views of development? a. shared parenting c. critical period b. correctional d. sensitive period

d. sensitive period The sensitive period is a time span that is optimal for certain capacities to emerge when the individual is especially receptive to environmental influences. For example, infants reared in an impoverished orphanage grew up without identifiable intellectual deficits if they were later placed in a stimulative and nurturing adoptive homes.

Bandura proposed a kind of behaviorism called: a. model learning c. cognitive learning b. new learning d. social learning

d. social learning Bandura proposed a kind of behaviorism called social learning.

The school nurse has identified a school-aged girl who has been bullying other children on the way home from school. The nurse realizes that this girl most needs which of the following interventions? a. punishment c. talk therapy b. anger management training d. social skills training

d. social skills training Developing social skills is one of the primary tasks of the school-age child. For children who lack such skills, one of the ways to express their anger is by bullying others or inflicting verbal or physical harm on another. Children who bully should be provided with alternative means of interacting with peers, including social skills training.`

The nurse is working with the caregivers of a 6-month-old baby. Both caregivers are extremely neat and have talked about the difficult adjustment to changes the baby has brought to their orderly and scheduled lives. In giving anticipatory guidance, at some appropriate point, the nurse will talk about what it will be like when the child wants to eat semisolid foods. The nurse's most important focus in this anticipatory guidance will be: a. how messy the baby will be during feeding time b. ways to keep the mealtime messes to a minimum c. the caregivers' psychological needs and support of each other during this time d. the baby's need to increase autonomy and to explore the texture and smell of food

d. the baby's need to increase autonomy and to explore the texture and smell of food In giving anticipatory guidance to a couple who have spoken of issues about neatness in preparation for the introduction of semisolid foods to the 6-month-old baby, the most important focus will be the baby's need to increase autonomy and to explore the texture and smell of food.

Studies based on attention time given to an image have shown that infants prefer which of the following images? a. small animals c. geometric shapes b. large animals d. the human face

d. the human face Infants prefer the human face, demonstrated by visual attentiveness when interacting with the caregiver.

The umbilical cord, which connects the fetus to the placenta, contains: a. one vein and one artery c. one artery and two veins b. two veins and two arteries d. two arteries and one vein

d. two arteries and one vein The umbilical cord, which connects the fetus to the placenta, does contains two arteries and one vein.

When may the nurse legally use corporal punishment with a child? a. when the child has done something that is dangerous b. if the caregivers give verbal permission and rules for punishment c. if the agency the nurse works for has a protocol for corporal punishment d. when the child receiving corporal punishment is the nurse's own child

d. when the child receiving corporal punishment is the nurse's own child The nurse may legally use corporal punishment when the child receiving corporal punishment is the nurse's own child.

At a well-baby visit, parents of a 6-month-old ask when to take the infant for the first dental visit. What is the nurse's best response? a. "If the teeth are brushed regularly, the child should see a dentist by 3 years of age." b. "The first dental visit should be arranged after the first tooth erupts." c. "The child should have a dental examination when all deciduous teeth have erupted." d. "A dental visit by 1 year of age is recommended by the American Academy of Pediatric Dentistry."

d. "A dental visit by 1 year of age is recommended by the American Academy of Pediatric Dentistry." The Academy of Pediatric Dentistry recommends that the first dental visit occur by 1 year of age.

What statement made by a parent indicates correct understanding of infant feeding? a. "I've been mixing rice cereal and formula in the baby's bottle." b. "I switched the baby to low-fat milk at 9 months." c. "The baby really likes little pieces of chocolate." d. "I give the baby any new foods before he takes his bottle."

d. "I give the baby any new foods before he takes his bottle." New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods.

The mother of a 4-month-old infant, born prematurely, asks the nurse if her daughter will always be small for her age. What is the most appropriate nursing response? a. "Preterm infants usually remain smaller than term infants throughout childhood." b. "Your daughter will be the same size as other children by the time she is 1 year old." c. "Prematurity is associated with short stature but does not affect weight gain." d. "It takes about two years for the preterm infant to catch up to a full-term infant."

d. "It takes about two years for the preterm infant to catch up to a full-term infant." In the absence of severe birth defects and complications, the growth rate of the preterm newborn nears that of the term infant by about the second year.

The mother of a 2-week-old infant tells the nurse, "I think the baby is constipated. I've noticed she strains when she has a bowel movement." What is nurse's most helpful response? a. "Give the baby one serving of fruit per day." b. "Increase the amount and frequency of her feedings." c. "It sounds like the baby is uncomfortable because she is constipated." d. "Newborns might strain with bowel movements because their muscles aren't fully developed."

d. "Newborns might strain with bowel movements because their muscles aren't fully developed." Straining in the newborn period is normal. It results from underdeveloped abdominal musculature. No treatment is required.

The nurse is assessing a preterm infant. To what does the infant's level of maturation refer? a. Actual time the fetus remained in the uterus b. Age on the Dubowitz scoring system c. Infant's weight as compared to the gestational age d. Ability of the organs to function outside of the uterus

d. Ability of the organs to function outside of the uterus Level of maturation refers to how well developed the infant is at birth and the ability of the organs to function outside of the uterus.

The pediatric clinic nurse receives lab results on several newborn patients. Which of the following should be brought to the physician's attention first? a. White blood cell count of 18,000 b. Hemoglobin of 18.5 c. Hematocrit of 56 d. Bilirubin of 15

d. Bilirubin of 15 A bilirubin of 15 is elevated and requires further immediate investigation.

The nurse explains to a patient in preterm labor that what may be ordered by the physician to accelerate fetal lung maturity? a. Prostaglandins b. Oxytocin c. Magnesium sulfate d. Corticosteroids

d. Corticosteroids Surfactant production can be increased by administering corticosteroids to the mother before delivery.

Why is the postterm neonate at risk for cold stress? a. Inadequate vernix caseosa b. Hypoxia from a deteriorated placenta c. Polycythemia d. Fat stores have been used in utero for nourishment

d. Fat stores have been used in utero for nourishment Fat stores have been used in utero for nourishment during the extended pregnancy.

A mother is concerned because her 10-month-old is lethargic. What is the best action the nurse can advise this mother to implement? a. Keep the infant's room well lit. b. Rub the infant's soles vigorously. c. Offer the infant a pacifier. d. Handle the infant slowly and gently.

d. Handle the infant slowly and gently. Some infants respond to stimulating environments by shutting down. Move and handle infants slowly and gently.

What occurrence results from obstruction within the ventricles of the brain or inadequate reabsorption of cerebrospinal fluid? a. Meningitis b. Meningocele c. Spina bifida occulta d. Hydrocephalus

d. Hydrocephalus Hydrocephalus is characterized by an increase in cerebrospinal fluid in the ventricles of the brain.

The nurse observes that the infant's anterior fontanelle is bulging after placement of a ventriculoperitoneal shunt. How should the nurse position this infant? a. Prone, with the head of the bed elevated b. Supine, with the head flat c. Side-lying on the operative side d. In a semi-Fowler's position

d. In a semi-Fowler's position If the fontanelles are bulging, the child will be positioned in a semi-Fowler's position to promote drainage from the ventricles through the shunt.

What symptoms of cold stress might the nurse recognize in a preterm infant? a. Tremors and weak cry b. Plasma glucose level below 40 mg/dL c. Warm skin with low core temperature d. Increased respiratory rate and periods of apnea

d. Increased respiratory rate and periods of apnea Signs of cold stress include increased respiratory rate with periods of apnea, decreased skin temperature, bradycardia, mottling of skin, and lethargy.

Which statement indicates the parents understand when to contact the pediatrician or nurse practitioner? a. Infant refuses a feeding b. Infant has an axillary temperature of 97° F c. Infant has three pasty, yellow-brown stools in 24 hours d. Infant's diaper is not wet after 8 hours

d. Infant's diaper is not wet after 8 hours Decreased or lack of voiding by the newborn should be reported to the pediatrician or nurse practitioner to prevent dehydration.

What will the nurse advise a parent to do when introducing solid foods? a. Begin with one tablespoon of food. b. Mix foods together. c. Eliminate a refused food from the diet. d. Introduce each new food 4 to 7 days apart.

d. Introduce each new food 4 to 7 days apart. Only one new food is offered in a 4- to 7-day period to determine tolerance.

What will the nurse advise a parent to do when introducing solid foods?a. Begin with one tablespoon of food. b. Mix foods together. c. Eliminate a refused food from the diet. d. Introduce each new food 4 to 7 days apart.

d. Introduce each new food 4 to 7 days apart. Only one new food is offered in a 4- to 7-day period to determine tolerance.

Parents express concern about the milia on the face and nose of their infant. What is the nurse's most helpful response when instructing the parents? a. Contact a pediatric dermatologist for topical medication. b. Squeeze out the white material after cleansing the face. c. Wash the infant's face with a mild astringent several times a day. d. Leave the milia alone; it will disappear spontaneously. No treatment is needed.

d. Leave the milia alone; it will disappear spontaneously. No treatment is needed. Milia require no treatment. This skin manifestation will disappear spontaneously.

The nurse is caring for an infant born at 35 weeks of gestation. What physical characteristic might the nurse expect this infant to exhibit? a. Thin, long extremities b. Large genitals for its size c. Minimal vernix caseosa d. Loose, transparent skin

d. Loose, transparent skin The growth and development of the fetus are abruptly halted by a preterm birth. One of the characteristics of the preterm infant is skin that is loose and transparent.

Parents of a newborn are worried about dark areas over the sacrum of the newborn. What does the nurse explain this transitory skin discoloration is called? a. Epstein's pearls b. Milia c. Stork bites d. Mongolian spots

d. Mongolian spots Bluish skin discoloration over the sacral area of a newborn is a transitory condition called Mongolian spots.

The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 12-month-old child. The parents are bilingual in Spanish and English and have many Spanish-speaking relatives nearby. They are resisting exposing the child to Spanish out of concern that the child will not learn English well. What will the pediatric nurse practitioner tell the parents? a. a. Children who learn two languages simultaneously often confuse them in conversation. b. b. Children with multi-language proficiency do not understand that others cannot do this. c. c. Learning two languages at an early age prevents children from developing a dominant language. d. d. Most bilingual children are able to shift from one language to another when appropriate.

d. Most bilingual children are able to shift from one language to another when appropriate. Most children who are bilingual are able to sort out the languages in conversation but may "code switch" at times for clarity as they speak. They seem to understand that not everyone has this ability. Most children who are bilingual develop a dominant language.

On what knowledge would the nurse base a response to a mother who questions, "Do you think my baby recognizes my voice?" a. Voice recognition is delayed because the ears are not well developed at birth. b. Infants respond to voice by increasing movements and sucking. c. Infants initially respond to low-pitched voices. d. Neonates can distinguish a mother's voice from other sounds in the first days of life.

d. Neonates can distinguish a mother's voice from other sounds in the first days of life. The ability to discriminate between a mother's voice and other voices may occur as early as in the first 3 days of life.

What will the nurse expect when assessing the anterior fontanelle of a healthy, full-term newborn? a. Depressed and sunken b. Triangular shaped c. Smaller than the posterior fontanelle d. Open and diamond shaped

d. Open and diamond shaped The anterior fontanelle is diamond shaped and located at the junction of the two parietal and two frontal bones. It should not be raised or sunken, and it closes between 12 and 18 months of age.

A mother tells the nurse, "My 11-month-old son is not as active as my other children were at this age. He is the youngest of four and the older children love to dote on him." Which factor is influencing this child's language development? a. Heredity b. Sex c. Mother's health during pregnancy d. Ordinal position

d. Ordinal position Motor development of the youngest child may be prolonged if the child is babied by others in the family.

The primary care pediatric nurse practitioner is assessing a toddler whose weight and body mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem? a. Failure to thrive b. Home care resources inadequate c. Nutrition alteration - less than required d. Parenting alteration

d. Parenting alteration Because the PNP is planning to intervene by helping the parents to provide appropriate food habits, the correct diagnosis should be "Parenting alteration." "Failure to thrive" is a medical diagnosis and requires a medical and social evaluation to rule out organic causes or detect neglect. "Home care resources inadequate" would be used if the PNP suspects that the family lacks adequate funds to purchase food. "Nutrition alteration" is a NANDA diagnosis and would be used if the PNP planned to consult with a dietician or give nutritional information.

A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner notes that the child's last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially? a. Ask the child's parent why the child is so anxious. b. Perform a physical assessment to rule out shortness of breath. c. Reassure the child that there is nothing to be afraid of. d. Review the purpose of this visit and any anticipated procedures.

d. Review the purpose of this visit and any anticipated procedures. The PNP should remember that young children are learning "scripts" for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease.

A mother calls the pediatrician's office because her infant is "colicky." What is the most helpful measure the nurse can suggest to the mother? a. Sing songs to the infant in a soft voice. b. Place the infant in a well-lit room. c. Walk around and massage the infant's back. d. Rock the fussy infant slowly and gently.

d. Rock the fussy infant slowly and gently. One technique the nurse can offer parents of a fussy infant is to rock the infant gently and slowly while being careful to avoid sudden movements.

The primary care pediatric nurse practitioner learns that the mother of a 3-year-old child has been treated for depression for over 5 years. Which aspect of this child's development will be of the most concern to the nurse practitioner? a. Fine motor b. Gross motor c. Social/emotional d. Speech and language

d. Speech and language Maternal depression in the first year of life has been associated with poorer language development at 3 years of age.

The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history? a. Complementary medications, alternative health practices, and chief complaint b. Developmental delays, nutritional status, and linear growth patterns c. Medication currently taking, allergy information, and family medical history d. Speech and language development, beliefs about health, and previous illnesses

d. Speech and language development, beliefs about health, and previous illnesses An assessment model that integrates the nursing and medical aspects of primary care uses three domains: developmental problems (speech and language development), functional health problems (beliefs about health), and diseases (chief complaint). The other examples all use domains associated with the traditional medical model and do not contain nursing aspects associated with functional health problems.

What symptom assessed in the newborn shortly after delivery should be reported? a. Cyanosis of the hands and feet b. Irregular heart rate c. Mucus draining from the nose d. Sternal or chest retractions

d. Sternal or chest retractions Sternal retractions are evidence that the newborn is in respiratory distress and should be reported immediately.

What deficiency causes a preterm infant respiratory distress syndrome? a. Protein b. Estrogen c. Hyaline d. Surfactant

d. Surfactant The production of surfactant, necessary for the absorption of oxygen by the lungs, is deficient in the preterm infant.

The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend? a. Consult a developmental specialist for a more complete evaluation. b. Prepare the parents for a potentially serious developmental disorder. c. Refer the infant to an early intervention program for physical therapy. d. Teach the parents to provide exercises to encourage motor development.

d. Teach the parents to provide exercises to encourage motor development. The child who has mild delays in only one area may be managed initially by having the parent provide appropriate exercises. If this is not effective, or if delays become more severe, referrals for evaluation or early intervention services are warranted. A mild delay does not necessarily signal a serious disorder, so this action is not indicated.

The parents of a 12-year-old child are concerned that some of the child's older classmates may be a bad influence on their child, who, they say, has been raised to believe in right and wrong. What will the primary care pediatric nurse practitioner tell the parent? a. Allowing the child to make poor choices and accept consequences is important for learning values b. Children at this age have a high regard for authority and social norms, so this is not likely to happen c. Moral values instilled in the early school-age period will persist throughout childhood d. The pressures from outside influences may supersede parental teachings and should be confronted

d. The pressures from outside influences may supersede parental teachings and should be confronted Although early school-age children learn values from their parents, these may be challenged as children learn that others have different values. Parents must confront and negotiate these issues daily with their children. While children may make poor choices and subsequently learn from the consequences, it is best for parents to actively discuss these issues with their children. Children do have a high regard for authority and social norms but may easily transfer this authority to other, less reliable people, such as peers. Moral values may not persist if other sources of authority become prominent.

The mother of a 6-week-old breastfeeding infant tells the primary care pediatric nurse practitioner that her baby, who previously had bowel movements with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? a. Her baby is probably constipated. b. It may be related to her dietary intake. c. She should consume more water. d. This may be normal for breastfed babies.

d. This may be normal for breastfed babies. Infants begin to have fewer bowel movements and may have bowel movements ranging from once or twice daily to once every other day when breastfed. Unless there are other signs, the baby is probably not constipated. The mother does not need to change her intake of foods or water, unless constipation is present.

How might the nurse demonstrate the parachute reflex with an infant?a. Lifting the infant high in the air above her head b. Holding the infant in a football hold, cradling the head c. Seating the infant in a stroller in an upright position d. Thrusting the infant downward into the crib

d. Thrusting the infant downward into the crib The infant, when thrust downward in a prone position, will protectively extend the arms.

The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? a. a. To begin brushing the infant's teeth with toothpaste b. b. To consider weaning the infant from breastfeeding c. c. To discontinue giving fluoride supplements d. d. To make an appointment for an initial dental examination

d. To make an appointment for an initial dental examination The American Academy of Pediatric Dentistry recommends a first dental examination at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride supplements should not be discontinued.

The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? a. To begin brushing the infant's teeth with toothpaste b. To consider weaning the infant from breastfeeding c. To discontinue giving fluoride supplements d. To make an appointment for an initial dental examination

d. To make an appointment for an initial dental examination The American Academy of Pediatric Dentistry recommends a first dental examination at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride supplements should not be discontinued.

The mother of a 4-day-old calls the pediatrician's office because she is concerned about her infant's skin. Which finding needs to be reported promptly to the child's pediatrician? a. The hands and feet feel cooler than the rest of the body. b. Skin is peeling on several parts of the infant's body. c. There is a small pink patch on the left eyelid and one on the neck. d. Today, the infant's skin has a yellowish tinge.

d. Today, the infant's skin has a yellowish tinge. Physiological jaundice becomes evident between the second and third days of life and lasts for about 1 week. Evidence of jaundice is reported and the newborn is evaluated.

What is the best nursing action when an 8-year-old child comes to the school nurse with his central incisor in his hand and reports he knocked his tooth out on the water fountain? a. Give him an ice cube to suck on. b. Have him wash his mouth out with peroxide and water. c. Wrap the tooth in a clean tissue. d. Wash off the tooth and place it in a container of milk.

d. Wash off the tooth and place it in a container of milk. The tooth should be washed off and put in a container of milk to preserve it for possible reimplantation.

The parent of a 4-year-old points to a picture and says, "That's your sister." The child responds by saying, "No! It's my baby!" This is an example of which type of thinking in preschool-age children? a. a. Animism b. b. Artificialism c. c. Egocentrism d. d. Realism

d. d. Realism Children at this age are developing their ability to establish causality. Nominal realism occurs when children think that one type of thing can only be called by one name. All dogs are dogs and not various breeds. Animism refers to the belief that objects possess person-like qualities. Artificialism occurs when children think things are caused by a controlling force. Egocentrism is when children see things only as they relate to themselves.

Ivan Pavlov is known for his studies involving which of the following? a. behavior modification of small children b. stress levels of maze rats and the rise of these levels as more rats are added to the maze c. mental illness among the homeless d. dogs that salivated not only at the sight of food but also at the sound of the bell that rang before the food appeared

d. dogs that salivated not only at the sight of food but also at the sound of the bell that rang before the food appeared Ivan Pavlov initially discovered linkages between a stimulus and a response while studying a dog's response to food. He observed that dogs salivated not only at the sight of food but also at the sound of the bell that rang before the food appeared.

The nurse is giving the caregivers general advice on how to talk to their toddler when the child is intrusive and needs redirection. The nurse would advise the caregivers to: a. speak as firmly and as loudly as necessary to let the child know that he or she has done something to displease you b. send the child to time-out to think about how he or she needs to interact nicely with others without interrupting c. let the child know that he or she can have an appointment to talk with the caregiver later and give the child a time d. get at eye level with the toddler and touch him or her gently on the shoulder to get his or her attention before speaking

d. get at eye level with the toddler and touch him or her gently on the shoulder to get his or her attention before speaking The nurse is giving the caregivers general advice on how to talk to their toddler when the child is intrusive and needs redirection. The nurse would advise them to get at eye level with the toddler and touch him or her gently on the shoulder to get his or her attention before speaking.

During a well child assessment of an 18-month-old child, the primary care pediatric nurse practitioner observes the child point to a picture of a dog and say, "Want puppy!" The nurse practitioner recognizes this as an example of a. a. holophrastic speech. b. b. receptive speech. c. c. semantic speech. d. d. telegraphic speech.

d. telegraphic speech. Syntax, or the structure of words in sentences or phrases, is developed in stages between the ages of 8 months and 3.5 years. Telegraphic speech begins at about 18 months of age when children speak in phrases with many words omitted, so that the sentence sounds like a telegram. Holophrastic speech is the use of a single word to express a complete idea. Receptive speech refers to the ability to understand a word without necessarily being able to use the word. Semantics is the understanding that words have specific meanings.

The primary care pediatric nurse practitioner in a community health center meets a family who has recently immigrated to the United States who speak only Karon. They arrive in the clinic with a church sponsor, who translates for them. The pediatric nurse practitioner notices that the sponsor answers for the family without giving them time to speak. The pediatric nurse practitioner will : a. ask the sponsor to allow the family to respond. b. develop the plan of care and ask the sponsor to make sure it is followed. c. request that the sponsor translate written instructions for the family. d. use the telephone interpreter service to communicate with the family.

d. use the telephone interpreter service to communicate with the family. Federally funded managed care networks and community health centers are required to have interpreters accessible for clients with limited English proficiency. A commercial telephone interpreter service has been shown to be as effective as an "in-person" interpreter. Relying on family members or community members may not be reliable and may jeopardize patient confidentiality. This interpreter is answering for the clients without hearing what they have to say, which can compromise care.

Vygotsky's concept of the zone of proximal development (ZPD) is based on the idea that the ZPD is made up of tasks that are: a. too difficult for individuals to master alone but can be mastered with the help of adults or more skilled adolescents b. close to the basic interests and instincts of the adolescent, and these are mastered first and best c. easily identified and easily discovered, as they are obvious and central to daily functioning d. easily completed and are done before the more difficult tasks, which require different types of thinking

too difficult for individuals to master alone but can be mastered with the help of adults or more skilled adolescents Vygotsky's concept of the zone of proximal development (ZPD) is based on the idea that the ZPD is made up of tasks that are too difficult for individuals to master alone but can be mastered with the help of adults or more skilled adolescents.