PEDIATRICS - PERRY/CH 28, 31-35

Based on Piaget's theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life? A. If an object is hidden, that does not mean that it is gone. B. He or she cannot be fooled by changing shapes. C. Parents are not perfect. D. Most procedures can be reversed.

A. If an object is hidden, that does not mean that it is gone. Part of learning permanence is learning that although an object is no longer visible, it still exists. At 1 year of age, a child may not be able to understand that an object that changes shape is still the same object. Understanding conservation occurs between ages 7 to 11 years.

When discussing pubertal growth changes with an adolescent male, the nurse will be sure to include what information? A. In girls, puberty occurs about 1 year before it appears in boys. B. In girls puberty occurs about 3 years before it appears in boys. C. In boys puberty occurs about 1 year before it appears in girls. D. The onset of puberty is about the same in both boys and girls.

A. In girls, puberty occurs about 1 year before it appears in boys. Average age of onset is 9.5 years for girls and 10.5 years for boys. Although this may be true on an individual basis, the average difference is 1 year. Usually girls begin their pubertal growth spurt earlier than boys. Usually girls begin their pubertal growth spurt earlier than boys.

The nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8-week-old make which statement? (Select all that apply.) A. "I only smoke in the kitchen." B. "I put my baby to sleep on her back." C. "I have my baby sleep with me instead of alone in the crib." D. "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." E. "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night."

A. "I only smoke in the kitchen." C. "I have my baby sleep with me instead of alone in the crib." D. "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." E. "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night." Maternal smoking increases the risk of SIDS. Smoking anywhere in the home with an infant present is not recommended. The "Back to Sleep" Campaign is given credit for reducing the rate of SIDS in the United States. Co-sleeping increases the risk of SIDS. D. Overheating increases the risk of SIDS. Leaving a stuffed animal in the crib is a suffocation risk but still needs to be addressed as a safety hazard.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? A. Vitamin B B. Vitamin D C. Vitamin C D. Vitamin K

B. Vitamin D The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 200 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency. Vitamin B is not needed. Vitamin C is not needed. Vitamin K is not needed.

The nurse would expect that most children would be using sentences of six to eight words by age: A. 18 months. B. 24 months. C. 3 years. D 5 years.

D .5 years.

The parents of a toddler express frustration to the nurse because their child is a "fussy eater." The nurse's BEST response is: A. "You should provide larger servings of different foods. B. "Provide more bland food varieties as toddlers have few food preferences." C. "Table manners will improve if you provide finger foods." D. "Becoming a fussy eater is expected during the toddler years."

D. "Becoming a fussy eater is expected during the toddler years." Toddlers have a decrease in appetite. They have strong taste preferences. Use of finger foods contributes to unpredictable table manners. Toddlers have physiologic anorexia that contributes to fussy eating.

The nurse is talking to a group of parents about different types of play in which children engage. Which statement made by a parent would indicate a correct understanding of the teaching? A. "Parallel-play children borrow and lend play materials and sometimes attempt to control who plays in the group." B, "In associative play, children play independently but among other children." C, "During onlooker play, children play alone with toys different from those used by other children in the same area." D. "Cooperative play is organized, and children play in a group with other children."

D. "Cooperative play is organized, and children play in a group with other children." Play in which children borrow and lend play materials and attempt to control who plays in the group is known as associative play. Parallel play occurs when children play independently but among other children. Onlooker play is described as play in which children watch but make no attempt to enter into play with other children. Cooperative play is play that is organized; children play in a group with other children and plan activities for purposes of accomplishing an end.

A 3-month-old bottle-fed infant is allergic to cow's milk. The nurse's BEST option for a substitute is: A. goat's milk. B. soy-based formula. C. skim milk diluted with water. D. casein hydrolysate milk formula.

D. casein hydrolysate milk formula. The milk protein in goat's milk cross-reacts with cow's milk protein. This is avoided because of the cross-reaction with soy. The cow's milk protein is also found in skim milk. The milk protein is broken down in these formulas.

Which best describes Piaget's cognitive stage of formal operations? A. Deductive and abstract reasoning B. Inductive reasoning and beginning logic C. Transductive reasoning and egocentrism D. Cause-and-effect reasoning and object permanence

A. Deductive and abstract reasoning Piaget's cognitive stage of formal operations occurs between the ages of 11 and 15; deductive and abstract reasoning are developed. Inductive reasoning and beginning logic begin in the concrete operations stage between the ages of 7 and 11. Transductive reasoning and egocentrism occur in the preoperational stage at age 2 to 7. Cause-and-effect and object permanence occur during the sensorimotor stage from birth to 2 years.

Girls experience an increase in weight and fat deposition during puberty. Nursing considerations related to these changes include: A. giving reassurance that these changes are normal. B. suggesting dietary measures to control weight gain. C. recommending increased exercise to control weight gain. D. encouraging low-fat diet to prevent fat deposition.

A. giving reassurance that these changes are normal. A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the child's gender. A healthy balance must be achieved between expected healthy weight gain and obesity. Such advice would not be given unless weight gain were excessive; eating disorders can develop in this group. Such advice would not be given unless weight gain were excessive; eating disorders can develop in this group. Some fat deposition is essential for normal hormone regulation. Menarche is delayed in girls with body fat contents that are too low.

During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. Based on the nurse's knowledge of developmental levels, the most appropriate toys to suggest are: (Select all that apply.) A. push-pull toys. B. toys with black-white patterns. C. pop-up toys, such as a Jack-in-the-box. D. soft toys that can be put in the mouth. E. toys that pop apart and go back together.

A. push-pull toys. C. pop-up toys, such as a Jack-in-the-box. E. toys that pop apart and go back together. Both gross and fine motor skills are becoming more developed and children at this age enjoy toys that can help refine these skills. Children at this age enjoy more colorful toys. Children at this age are less interested in placing toys in the mouth and more interested in toys that can be manipulated.

The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem? A. Putting her in parents' bed to cuddle B. Beginning to put her to bed while still awake C. Letting her cry herself back to sleep D. Giving her a bottle of formula instead of breastfeeding her so often at night

B. Beginning to put her to bed while still awake The nurse needs to discuss the issue of co-sleeping with parents. Having the infant in bed with them may still interfere with their sleep. Parents need to develop bedtime rituals that involve putting the child in bed when awake. If the child is put in bed awake, she will be able to return to sleep more easily if she awakens at night. Providing formula at night contributes to bottle-mouth caries.

The nurse should teach volunteers in the after school program that which characteristic is MOST descriptive of the social development of school-age children? A. Identification with peers is minimal. B. Children frequently have "best friends." C. Boys and girls play equally well with children of either gender. D. Peer approval is not yet an influence toward conformity.

B. Children frequently have "best friends." Identification with peer group is an important factor toward gaining independence from families. Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. During the school-age years there are more gender-specific groups. Conforming to the rules is an essential part of group membership.

Infants most at risk for sudden infant death syndrome (SIDS) are those: (Select all that apply.) A. who sleep supine B. who sleep prone C. who were premature D. with prenatal drug exposure E. with a cousin that died of SIDS

B. who sleep prone C. who were premature D. with prenatal drug exposure Infants at increased risk for SIDS are low birth weight, have low Apgar scores, sleep prone, cosleep, were premature, and have a mother who smokes. It is recommended that infants sleep supine to reduce the risk of SIDS. A cousin dying of SIDS does not present an increased risk for the infant.

A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention? A. "Never shake baby powder directly on your infant because it can be aspirated into his lungs." B. "Do not permit your child to chew paint from window ledges because he might absorb too much lead." C. "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall." D. "Keep doors of appliances closed at all times."

C. "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall." This is appropriate guidance for a first-month appointment. This information should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand. Rolling over from abdomen to back occurs between 4 and 7 months. This is the appropriate anticipatory guidance for this age. This information should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand.

A 12-year-old child being seen in the clinic has not received the hepatitis B (HBV) vaccine. The nurse should recommend that: A. only one dose of HBV will be needed sometime during adolescence. B. one dose of HBV is needed at age 14. C. the three-dose series of HBV should be started. D. the three-dose series of HBV should be started at age 16 or sooner if the adolescent becomes sexually active.

C. the three-dose series of HBV should be started. Three doses are necessary to achieve immunity. Three doses are necessary to achieve immunity. Adolescents should be vaccinated against hepatitis B at this age if not done previously. The recommendation is that the hepatitis B vaccine series be started at birth. The American Academy of Pediatrics recommends vaccination by age 13.

What is an important consideration related to childhood stress? A. Children should be protected from stress. B. Children do not have coping strategies. C. Parents cannot prepare children for stress. D. Some children are more vulnerable to stress than others.

D. Some children are more vulnerable to stress than others. Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. What is the nurse's BEST reply? A. A pacifier should be substituted for the thumb. B. Thumb-sucking should be discouraged by age 12 months. C. Thumb-sucking should be discouraged when the teeth begin to erupt. D. There is no need to restrain nonnutritive sucking during infancy.

D. There is no need to restrain nonnutritive sucking during infancy. Evidence is inconclusive regarding whether a pacifier or thumb is better for satisfying sucking needs. Thumb-sucking and the use of pacifier should be stopped after 4 years of age. Thumb-sucking and the use of pacifier should be stopped after 4 years of age. Nonnutritive sucking reaches its peak at about 18 to 20 months of age.

The parent of a 12-month-old infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much of a mess." The nurse's BEST response is: A. "It's important not to give in to this kind of temper tantrum at this age. Simply ignore the behavior and the mess." B. "You need to try different types of utensils, bowls, and plates. Some are specifically designed for young children." C. "It's important to let him make a mess. Just try not to worry about it so much." D. "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."

D. "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable." The child is developmentally ready for self-feeding. Ignoring the behavior and not allowing the child to self-feed is not fostering the child's development. The child is developmentally ready for self-feeding. The parent should not force the use of the spoon but should substitute finger foods. This response minimizes the parent's concerns about the mess created by self-feeding. At 12 months the child should be self-feeding. Since children this age eat primarily finger foods, it is useful to offer the parent suggestions for keeping the mess to a minimum.

Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, the toddler can gradually achieve: A. throwing a ball without falling. B. slowing of gastrointestinal transit time. C. visual acuity of 20/20. D. control of anal and urethral sphincters.

D. control of anal and urethral sphincters. Casting and throwing a ball occurs at approximately 15 months. Increased capacity is responsible for the decreased number of bowel movements each day. Visual acuity is 20/40. The voluntary control of elimination occurs between 18 and 24 months.

The school nurse is teaching a class on safety. Which activities require protective athletic gear? (Select all that apply.) A. Lacrosse B. Football C. Swimming D. Gymnastics E. Skateboarding

A. Lacrosse B. Football E. Skateboarding Any sport that involves body contact such as lacrosse, football, and skateboarding requires a child to wear protective equipment. Swimming does not involve body contact and requires no protective equipment. Gymnastics does not require protective equipment.

What should the nurse recommend to help a toddler cope with the birth of a new sibling? A. Give the toddler a doll on which he or she can imitate parenting. B. Discourage the toddler from helping with care of new sibling. C. Prepare the toddler for upcoming changes about 1 to 2 weeks before birth of the sibling. D. Explain to the toddler that a new playmate will soon come home.

A. Give the toddler a doll on which he or she can imitate parenting. The toddler can participate in the activity of caring for a new family member. The child should be encouraged to participate in accordance with his or her abilities. Preparation should begin as soon as changes in the mother's physical appearance and the home setting occur. This will establish unrealistic expectations.

Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. When teaching the parents about the infant's care, what is the most important information the nurse should include in the discharge teaching plan? A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous (IV) fluids C. Reassurance that the infant cannot be electrocuted during monitoring D. Advice that the infant not be left with other caretakers such as baby-sitters

A. Cardiopulmonary resuscitation (CPR) CPR is essential for parent and caregivers to know. Most likely the child will not have venous access; thus home IV therapy is not necessary. The monitor is insulated and grounded. The parents should arrange for other caregivers to help out. All need to be taught how to use the monitoring equipment and how to perform CPR.

A nurse is presenting a class on injury prevention to parents of preschoolers. Which injuries should the nurse identify as occurring in this age group? (Select all that apply.) A. Falls B. Drowning C. Poisoning D. Sports injuries E. Tricycle and bicycle accidents

A. Falls B. Drowning C. Poisoning E. Tricycle and bicycle accidents Falls occur frequently in preschoolers. Closely monitor playground activities such as climbing a jungle-gym. Closely supervise around any water and ensure swimming pools are securely fenced to prevent near-drowning. Place all medications and poisons out of reach and in locked cabinets. Administer medications as a drug, not "candy." Keep poison control phone number by telephone. When riding tricycles and bicycles, children often forget not to ride in the streets. Sports injuries occur in older children.

A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group? A. The amount of medicine is less. B. The amount of medicine did not change, only its appearance. C. Pouring medicine makes the medicine hot. D. The glass changed shape to accommodate the medicine.

A. The amount of medicine is less. A preschool child does not have the ability to understand the concept of conservation. This concept is not developed until school age. Understanding conservation occurs between 7 to 10 years of age, when a child begins to realize that physical factors, such as volume, weight, and number, remain the same even though outward appearances are changed. Children are able to deal with a number of different aspects of a situation simultaneously. This is not an expected response by a child. A preschool child will not typically believe the glass changed shape to accommodate the medicine but rather that the amount of medicine is less in the short, wide glass.

The nurse preparing a nutritional teaching plan for the parents of a preschool child should include which information? A. The quality of the food consumed is more important than the quantity. B. Nutrition requirements for preschoolers are very different from requirements for toddlers. C. Requirement for calories per unit of body weight increases slightly during the preschool period. D. Average daily intake of preschoolers should be about 3000 calories.

A. The quality of the food consumed is more important than the quantity. It is essential that the child eat a balanced diet with essential nutrients. Requirements are similar. Caloric requirement decreases slightly. Average intake is about 1800 calories each day.

Which statement is correct about young children who report sexual abuse? A. They may exhibit various behavioral manifestations. B. In most cases the child has fabricated the story. C. Their stories are not believed unless other evidence is apparent. D. They should be able to retell the story the same way to another person.

A. They may exhibit various behavioral manifestations. There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited. Adults are reluctant to believe children, and sexual abuse goes unreported. The physical examination is normal in 80% of the abused children. The child will usually try to protect parents and may accept responsibility for the act.

The parents of a toddler state their child is having trouble sleeping. What is the nurse's BEST suggestion to improve sleep habits? A. Using a transitional object. B. Varying the bedtime ritual. C. stimulating activities during the day. D. Explaining away fears.

A. Using a transitional object. A transitional object may help the child ease anxiety and facilitate sleep. A consistent ritual will facilitate sleep. The child should have stimulating physical activity during the daytime. Verbal explanations are not understood by a child this age.

The primary goals in the nutritional management of children with failure to thrive (FTT) are: (Select all that apply.) A. allow for catch-up growth. B. correct nutritional deficiencies. C. achieve ideal weight for height. D. restore optimum body composition. E. educate the parents or primary caregivers on child's nutritional requirements. F. educate the parents or primary caregivers that the child will need tube feedings first.

A. allow for catch-up growth. B. correct nutritional deficiencies. C. achieve ideal weight for height. D. restore optimum body composition. E. educate the parents or primary caregivers on child's nutritional requirements. The goal is to provide sufficient calories to support "catch-up" growth, which is a rate of growth greater than the expected rate for age. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating any coexisting medical problems. Accurate assessment of the child's initial weight and height are important, as well as the daily recording of weight, food intake, and feeding behavior. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating coexisting medical problems to optimize body composition. A goal is to provide education to the parents or primary caregiver of the child's nutritional requirements along with appropriate feeding methods.

A hospitalized teenager and family are praying at the bedside. The nurse is aware that the most accurate description of the spiritual development of the older adolescent is that: A. beliefs become more abstract. B. rituals and practices become increasingly important. C. strict observance of religious customs is common. D. emphasis is placed on external manifestations, such as whether a person goes to church.

A. beliefs become more abstract. Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbol. These become less important as the adolescent questions values and ideals of families. These become less important as the adolescent questions values and ideals of families. Adolescents question external manifestations when they are not supported by adherence to supportive behaviors.

The nurse is assessing a preschool age child who is stuttering when answering the nurse's questions. The nurse should offer alternate methods of responding to the stuttering when observing the parent: A. completing the child's sentences. B. listening attentively. C. encouraging the child to speak slowly. D. helping the child relax.

A. completing the child's sentences. The National Institute on Deafness and Other Communication Disorders (2010) encourages parents and caregivers of children who stutter to speak slowly and relaxed, refrain from criticizing the child's speech, resist completing the child's sentences, and take time to listen attentively.

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as: A. concrete operations. B. preoperational. C. school-age rhetoric. D. formal operations.

A. concrete operations. Black-and-white reasoning involves a situation in which only two alternatives are considered, when in fact there are additional options. Preoperational thinking is concrete and tangible. During the school-age years, children deal with thoughts and learn through observation. They do not have the ability to do abstract reasoning and learn best with illustration. Thought at this time is dominated by what the school-age child can see, hear, or otherwise experience. School-age rhetoric simply refers to the type of ideas that arise out of the years children attend school. Formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years.

When completing the health assessment for a 2-year-old child, the nurse should expect the child to: A. engage in parallel play. B. fully dress self with supervision. C. have a vocabulary of at least 500 words. D. be one third of the adult height.

A. engage in parallel play. Two-year-olds typically play alongside each other (p. 1023). The child still needs help with clothing at 2 years of age. A vocabulary of 300 words is expected at this age. The child typically has grown to one half of adult height.

The mother of a 3-month-old breastfed infant asks about giving her baby water since it is summer and very warm. The nurse should recommend that: A. fluids in addition to breast milk are not needed. B. water should be given if the infant seems to nurse longer than usual. C. water once or twice a day will make up for losses caused by environmental temperature. D. clear juices would be better than water to promote adequate fluid intake.

A. fluids in addition to breast milk are not needed. The child will nurse according to needs. Additional fluids are not necessary for the breastfed baby. Supplemental water should not be given. It may cause water intoxication. Supplemental water should not be given. It may cause water intoxication. Clear juices do not provide sufficient caloric or nutrient intake and may interfere with breastfeeding.

When preparing to administer Hepatitis B vaccine to a newborn, the nurse should: (Select all that apply.) A. initiate an immunization record. B. confirm the hepatitis B status of the newborn's mother. C. obtain a syringe with a 25-gauge, 5/8-inch needle. D. assess the dorsogluteal muscle as the preferred site for injection. E. confirm that the newborn's mother has signed the informed consent.

A. initiate an immunization record. B. confirm the hepatitis B status of the newborn's mother. C. obtain a syringe with a 25-gauge, 5/8-inch needle. E. confirm that the newborn's mother has signed the informed consent. An immunization record is important for the nurse to initiate and give to the mother so that a continuous record of immunizations is maintained. Hepatitis B vaccine is the primary prevention for the disease. If the mother is positive for the hepatitis B virus, the newborn will need to receive the hepatitis B immunoglobulin (HBIG) in addition to the hepatitis B vaccine. The dose of hepatitis B vaccine is 0.5 mL, to be given with a 25-gauge, 5/8 inch needle, intramuscularly (IM) in the newborn. Signed informed consent must be obtained from the mother before administration of the vaccine. The only safe intramuscular injection site for the newborn is the vastus lateralis muscle.

The nurse is preparing the playroom on a newly opened pediatric unit. The nurse should include which items to foster the development of the preschool child? (Select all that apply.) A. large blocks B. alphabet flash cards C. 100-piece puzzles D. dolls E. hand puppets

A. large blocks B. alphabet flash cards D. dolls E. hand puppets Manipulative, constructive, creative, and educational toys provide for quiet activities, fine motor development, and self-expression. Easy construction sets, large blocks of various sizes and shapes, a counting frame, alphabet or number flash cards, paints, crayons, simple carpentry tools, musical toys, illustrated books, simple sewing or handicraft sets, large puzzles, and clay are suitable. Probably the most characteristic and pervasive preschool activity is imitative, imaginative, and dramatic play. Dress-up clothes, dolls, housekeeping toys, dollhouses, play store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, and medical kits provide hours of self-expression toys. Large puzzles are appropriate for preschoolers, but 100-piece puzzles are likely too small and may cause frustration for the preschooler.

An adolescent asks the nurse, "How will I know if I'm going through puberty?" The nurse discusses physical changes that usually occur, the first change being: A. testicular enlargement. B. voice changes. C. growth of dark pubic hair. D. increased size of penis

A. testicular enlargement. Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9.5 and 14 years during Tanner stage 2. Voice change occurs between Tanner stages 3 and 4. Fine pubic hair may occur at the base of the penis; darker hair occurs during Tanner stage 3. Penis enlarges during Tanner stage 3.

The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: A. trust. B. industry. C. initiative. D. separation

A. trust. The task of infancy is the development of trust. Industry vs. inferiority is the developmental task of school-age children. Initiative vs. guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage as described by Piaget.

Which statement about early childhood caries (ECC) is correct? A. The syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. B. Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. C. The syndrome can be prevented by breastfeeding. D. Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

B. Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. This may result from pacifier use or thumb-sucking. Sweet liquids pooling in the mouth during sleep cause dental caries. Frequent breastfeeding before sleep can also cause bottle-mouth caries. Juice in bottles before sleep contributes to bottle-mouth caries.

The nurse is preparing a health teaching session for school age children. The nurse should include which information about injury prevention in the plan? A. Peer pressure is not strong enough to affect risk-taking behavior. B. Most injuries occur in or near school or home. C. Injuries from burns are the highest at this age because of fascination with fire. D. Lack of muscular coordination and control results in an increased incidence of injuries.

B. Most injuries occur in or near school or home. Peer pressure is significant in this age group. This is where most injuries occur. Automobile accidents account for the majority of severe accidents, either as a pedestrian or passenger. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents.

The nurse is providing education to a parent of a 10-month-old infant receiving iron supplements. What will be included in the teaching? (Select all that apply.) A. Administer iron with meals. B. Place iron toward the back side of the mouth with a dropper. C. Mix iron with milk for greater absorption. D. Report black, tarry stools to health care provider. E. Apply barrier ointment if needed to buttocks.

B. Place iron toward the back side of the mouth with a dropper. E. Apply barrier ointment if needed to buttocks. Administration of Iron Supplements includes: Ideally iron supplements should be administered between meals for greater absorption. Liquid iron supplements may stain the teeth, therefore administer with a dropper. toward the back of the mouth (side). In older children, administer liquid iron. supplements through a straw or rinse mouth thoroughly after ingestion. Avoid administration of liquid iron supplements with whole cow's milk or milk. products as these bind free iron and prevent absorption. Educate parents that iron supplements will turn stools black or tarry green. Iron supplements may cause transient constipation. Caution parents not to switch to a low-iron containing formula or whole milk, which are poor sources of iron and may lead to iron deficiency anemia (see Iron Deficiency Anemia, Chapter 43). In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz). Avoid administration of iron supplements with food or drinks that bind iron and prevent absorption.

The parents of a toddler ask the nurse how to handle their child's increasing number of temper tantrums. The nurse should include which positive reinforcement methods of reducing the number of tantrums? (Select all that apply.) A. Suggest that parents provide the child an "all or none" position. B. Suggest that parents ignore the behavior as long as child is not harming self. C. Encourage the parents to provide comfort once the child has calmed down. D. Ask parents to praise the child for positive behavior when not having a tantrum. E. Tell parents not to give in to the original request that started the temper tantrum.

B. Suggest that parents ignore the behavior as long as child is not harming self. C. Encourage the parents to provide comfort once the child has calmed down. D. Ask parents to praise the child for positive behavior when not having a tantrum. E. Tell parents not to give in to the original request that started the temper tantrum. During tantrums ignore the behavior, provided the behavior is not injurious to the child. During periods of no tantrums, practice developmentally appropriate positive reinforcement. Other suggestions for handling tantrums include (Needlman, Howard, & Zuckerman, 1995): • Offering the child options instead of an "all or none" position • Picking one's battles carefully and ignoring small skirmishes over unimportant issues • Giving comfort once the child is able to control emotions but not giving in to the original request • Praising the child for positive behavior when he or she is not having a tantrum

A hospitalized toddler clings to a worn, tattered blanket. She screams when anyone tries to take it away. What is the nurse's BEST explanation to the parents for the child's attachment to the blanket? A. The blanket encourages immature behavior. B. The blanket is an important transitional object. C. She has not mastered the developmental task of individuation-separation. D. She has not bonded adequately with her mothe

B. The blanket is an important transitional object. Transitional objects are important to help toddlers separate. The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are helpful when the child is experiencing an increased stress situation such as hospitalization. This does not reflect bonding behavior.

A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child's development is on target? A. The child has not gained weight for 3 months. B. The child can throw a large ball but not a small ball. C. The child's arms are the most rapidly growing part of the child's body. D. The child can pull herself or himself to her or his feet before the child is able to sit steadily.

B. The child can throw a large ball but not a small ball. Development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large objects before small ones. Not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child's development may not be on target. In children, the legs are normally the most rapidly growing part of the body; if this is not the case, the child's development may not be on target. A child whose development is on target can sit steadily before pulling herself or himself up to her or his feet.

At the beginning of the school year, the school nurse identifies several new children at the school. The nurse knows that which factors place the children at high risk adjustment problems? (Select all that apply.) A. The child is from a middle class family B. The child has not attended a preschool program C. The child exhibits signs of emotional immaturity D. The parents of a child demonstrate warm, loving behaviors E. The child appears physically immature

B. The child has not attended a preschool program C. The child exhibits signs of emotional immaturity E. The child appears physically immature Successful adjustment is related to the child's physical and emotional maturity and the parent's readiness to accept the separation associated with school entrance. Unfortunately, some parents express their unconscious attempts to delay the child's maturity by clinging behavior, particularly with their youngest child. Middle-class children have fewer adjustments to make and less to learn about expected behavior because schools tend to reflect dominant middle class customs and values. If the child has attended a preschool program, the focus of the preschool program also affects the child's adjustment. Some preschool programs provide custodial care only, but others emphasize emotional, social, and intellectual development.

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child maltreatment? (Select all that apply.) A. The child's bruises are located only on the right arm and leg. B. The child is brought to the emergency department by an unrelated adult. C. The child has a history of a broken arm last year from falling off a swing. D. The child's caregiver is anxious that the child get immediate medical attention. E. The child has red, green, and yellow bruises on more than one plane of the body.

B. The child is brought to the emergency department by an unrelated adult. E. The child has red, green, and yellow bruises on more than one plane of the body. A child brought to a health care provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse. Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse. Falling down stairs can be an unintentional injury. A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse. An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.

Which statement helps explain the growth and development of children? A. Development proceeds at a predictable rate. B. The sequence of developmental milestones is predictable. C. Rates of growth are consistent among children. D. At times of rapid growth, there is also acceleration of development.

B. The sequence of developmental milestones is predictable. There is a fixed, precise order to development. There are periods of both accelerated and decelerated growth and development. Each child develops at his or her own rate. Physical growth and development proceed at differing rates.

The nurse is teaching the parents of a 24-month-old about motor skill development. The nurse should include which statement in the teaching? A. The toddler walks alone but falls easily. B. The toddler's activities begin to produce purposeful results. C. The toddler is able to grasp small objects but cannot release them at will. D. The toddler's motor skills are fully developed but occur in isolation from the environment.

B. The toddler's activities begin to produce purposeful results. The child is able to walk up and down stairs at this age. Gross and fine motor mastery occur with other activities. This is a task of infancy. Interaction with the environment is essential at this age.

Parents are often confused by the terms growth and development and use the terms interchangeably. Based on the nurse's knowledge of growth and development, the most appropriate explanation of development is: A. a child grows taller all through early childhood. B. a child learns to throw a ball overhand. C. a child's weight triples during the first year. D. a child's brain increases in size until school age.

B. a child learns to throw a ball overhand. Development is the mental and cognitive attainment of skills. Growth is the increase in physical size—both height and weight.

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. Based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to: A. feed lunch. B. allow the toddler to start making choices about what to wear. C. allow the toddler to pull a talking-duck toy. D. turn on a TV show with bright colors and loud songs

B. allow the toddler to start making choices about what to wear. A toddler is developing autonomy and is able to start making some choices about what he or she can wear. A toddler is developing autonomy and focusing on doing things for himself or herself and therefore would not want the mother to feed him or her. The child is at the stage of autonomy versus shame and doubt, as defined by Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys the child can control will help achieve this stage. A toddler might easily become overstimulated by images from TV and loud sounds. Toddlers are more interested in manipulating and learning from objects in the environment.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: A. nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. C. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. D. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. There is no universal right age to begin toilet training or an absolute deadline to complete training. One of the nurse's most important responsibilities is to help parents identify the readiness signs in their child.

A mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. She plays "house" in it with her toddler brother. Based on the nurse's knowledge of growth and development, the nurse recognizes that this is: A. unsafe play that should be discouraged. B. creative play that should be encouraged. C. suggestive of limited family resources. D. suggestive of limited adult supervision.

B. creative play that should be encouraged. This type of play should be encouraged. After children create something new, they can then transfer it to other situations. There should be some supervision to prevent injury or accidents. As long as the play is supervised, it should be encouraged. This is not considered unsafe play. There is no indication of limited resources. There is no indication of limited adult supervision.

A parent phones the nurse and says that her child just knocked out a permanent tooth. The nurse's instructions to the parent should include: A. rinsing the tooth in hot water. B. holding tooth by the crown and not by the root area. C. taking the child and tooth to a dentist within 48 hours. D. taking the child to the hospital emergency room if mouth is bleeding.

B. holding tooth by the crown and not by the root area. Only if dirty should the tooth be rinsed with running water. The root area should not be touched. Reimplantation should occur within 30 minutes by the child, parent, or nurse and stabilized by a dentist as soon as possible. The child needs to be seen by a competent dentist as soon as possible.

The causative agent for erythema infectiosum (fifth disease) is: A. paramyxovirus. B. human herpes virus type 6. C. human herpes virus types 1 and 2. D. group A β-hemolytic streptococci.

B. human herpes virus type 6. Paramyxovirus causes mumps. Human parvovirus B19 is the causative agent. Human herpes virus types I and 2 are the major causes of herpetic infections in humans. Group A β-hemolytic streptococci is the causative agent for scarlet fever.

The nurse is developing a teaching plan about preventing fetal exposure to teratogens. The nurse should include which teratogenic agents or conditions? (Select all that apply.) A. acetaminophen (Tylenol) B. isotretinoin (Accutane) C. Cocaine D. Hyperthermia E. Ethyl alcohol F. phenytoin (Dilantin)

B. isotretinoin (Accutane) C. Cocaine D. Hyperthermia E. Ethyl alcohol F. phenytoin (Dilantin) Teratogens, agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors. Types of teratogens include drugs (phenytoin [Dilantin], warfarin [Coumadin], isotretinoin [Accutane]); chemicals (ethyl alcohol, cocaine, lead); infectious agents (rubella, cytomegalovirus); physical agents (maternal ionizing radiation, hyperthermia); and metabolic agents (maternal PKU). Many of these teratogenic exposures and the resulting effects are completely preventable, such as ingestion of alcohol resulting in fetal alcohol syndrome or fetal alcohol effects, which causes severe birth defects, including cognitive impairment. The incidence of fetal alcohol syndrome is estimated at 5.2 per 10,000 live births (American Academy of Pediatrics, 2000).

A 16-year-old adolescent male tells the school nurse that he is gay. The nurse's MOST appropriate response should be based on knowledge that: A. he is too young to have had enough sexual activity to determine this. B. it is important to provide a nonthreatening environment in which he can discuss this. C. the nurse should be open to discussing his or her own beliefs about homosexuality. D. homosexual adolescents do not have concerns that differ from heterosexual adolescents.

B. it is important to provide a nonthreatening environment in which he can discuss this. Adolescence is when sexual identity develops. The nurse needs to be open and nonjudgmental in interactions with adolescents. This will provide a safe environment in which to provide appropriate health care. The nurse's own beliefs should not bias the interaction with this student. Homosexual adolescents face very different challenges as they grow up because of society's response to homosexuality.

When preparing parents to teach their preschool child about human sexuality, the nurse should emphasize that: A. a parent's words may have a greater influence on the child's understanding than the parent's actions. B. parents should determine exactly what the child wants to know before answering a question about sex. C. parents should avoid using correct anatomic terms because they are confusing to the preschooler. D. parents should allow children to satisfy their sexual curiosity by playing "doctor."

B. parents should determine exactly what the child wants to know before answering a question about sex. A. The actions may have a greater influence because language is not fully developed. B. It is important that the parent answer the question that the child is asking. C. Using correct terminology lays the foundation for later discussion. D. Parents should encourage the asking of questions to resolve curiosity without undue investigation on the child's part.

During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. His birthday is close to the cutoff date, and he has not attended preschool. The nurse's BEST recommendation is to: A. start kindergarten. B. perform developmental screening. C. observe a kindergarten class. D. postpone kindergarten and go to preschool.

B. perform developmental screening. This does not address the father's concern about readiness. A developmental screening will provide the necessary information to help the family determine readiness. Observing will provide information about kindergarten but not whether the child is ready. If the child is ready for kindergarten, preschool may lead to boredom.

The nurse's BEST approach for effective communication with a preschool age child is through: A. speech. B. play. C. drawing. D. actions.

B. play. Language is not specific for children. Play is the child's way to learn to understand and adjust to situations. Drawing is not developed at this age. Actions are not effective for communication.

A 4-year-old boy has been having increasingly more frequent angry outbursts in preschool. He is very aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. The MOST appropriate intervention is to: A. explain that this is normal in preschoolers, especially boys. B. refer the child for professional help. C. talk to the preschool teacher to obtain validation for the behavior the parent reports. D. encourage the parent to try more consistent and firm discipline.

B. refer the child for professional help. This is not normal behavior. This is not expected behavior; the child should be referred to a competent professional to deal with his aggression. The validation will be helpful for the referral, but the referral is the priority action. This may be recommended by the professional.

A 4-year-old female child sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened. Yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This is MOST likely described as: A. a nightmare. B. sleep terror. C. seizure activity. D. sleep apnea.

B. sleep terror. A nightmare is a frightening dream followed by full awakening. In sleep terrors the child is only partially aroused; therefore she does not remember her parents' presence. This does not resemble seizure activity. Sleep apnea is a cessation of breathing during sleep.

Poisoning in toddlers can best be prevented by: A. consistently using safety caps. B. storing poisonous substances in a locked cabinet. C. keeping ipecac syrup in the home. D. storing poisonous substances out of reach.

B. storing poisonous substances in a locked cabinet. Not all poisonous substances have safety caps. This is an appropriate action. Ipecac does not prevent poisoning and is not recommended. Toddlers can climb; therefore little is out of reach.

The exhausted parents of a 2-month-old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse's initial action is to: A. advise the mother to follow a milk-free diet for 3 to 5 days. B. take a thorough, detailed history of usual daily events. C. administer simethicone drops to provide relief from gas pains. D. explain that the parents need to stay calm so the infant will remain calm.

B. take a thorough, detailed history of usual daily events. The initial step in managing colic is to take a thorough, detailed history of the usual daily events including: diet, time of day when child cries, presence of family members, type of cry, etc. Before suggesting formula changes or medications to relieve symptoms, a detailed history is needed. It is important that the nurse convey an empathetic and compassionate attitude and reassure the parents that they are not doing anything wrong.

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that: A. the infant is most likely spoiled. B. this is a normal reaction for this age C. this is an abnormal reaction for this age. D. grandparents are not responsive to that infant.

B. this is a normal reaction for this age These are developmentally appropriate. The infant is experiencing stranger anxiety, which is expected for this age child. These are developmentally appropriate. No data have been shown to support this.

At what age would the nurse advise parents to expect their infant to be able to say "mama" and "dada" with meaning? A. 4 months B. 6 months C. 10 months D. 14 months

C. 10 months Consonants are added to infant vocalizations. Babbling resembles one-syllable sounds. At this age infants say sounds with meaning. This is late for the development of sounds with meaning.

Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake? A. Using developmental stimulation by a specialist during feedings B. Avoiding solids until after the bottle is well accepted C. Being persistent through 10 to 15 minutes of food refusal D. Varying schedule of routine activities on a daily basis

C. Being persistent through 10 to 15 minutes of food refusal Feeding times should have a nonstimulating environment so the focus is on the meal. Solids should be introduced slowly to decrease dependence on the bottle. Calm perseverance is important. Parents often fail to persist through the child's refusals. Daily schedule should be structured to provide consistency for the child.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which of the following should be included? A. Flossing is not recommended at this age. B. The child is old enough to brush teeth effectively. C. Brush teeth with plain water if child does not like toothpaste. D. Toothbrush should be small and have hard, rounded, nylon bristles.

C. Brush teeth with plain water if child does not like toothpaste. Flossing should be done after brushing. Two-year-olds cannot effectively brush their own teeth; parental assistance is necessary. Some children do not like the flavor of toothpaste or the foam; water alone can be used. Soft, multitufted, bristled toothbrushes are recommended.

What information should the nurse include when giving parents guidelines about helping their children in school? A. Help children as much as possible with their homework. B. Punish children who fail to perform adequately. C. Communicate with teachers if there appears to be a problem. D. Accept responsibility for children's successes and failures.

C. Communicate with teachers if there appears to be a problem. Children need to do their own homework. This cultivates responsibility. Discipline should be used to help children control behaviors. School-age children can use reasoning skills. Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. School-age children need to develop responsibility. This helps with keeping promises and meeting deadlines, thereby laying successful foundations for adulthood.

The school nurse is discussing dental health with some children in first grade. What should the nurse include in the discussion? A. Teaching how to floss teeth properly B. Recommending a toothbrush with hard nylon bristles C. Emphasizing the importance of brushing before bedtime D. Recommending nonfluoridated toothpaste approved by the American Dental Association

C. Emphasizing the importance of brushing before bedtime Parents should help with flossing until children develop the dexterity required, which occurs at about the time of third grade. A toothbrush with soft nylon bristles is recommended. Children should be taught to brush their teeth after meals, after snacks, and before bedtime. The American Dental Association recommends fluoridated toothpaste for this age group.

The nurse notices that a toddler is more cooperative when taking medicine from a small cup rather than from a large cup. This is an example of which characteristic of preoperational thought? A. Egocentrism B. Irreversibility C. Inability to conserve D. Transductive reasoning

C. Inability to conserve The inability to see situations from other perspectives does not facilitate medication administration. The inability to reverse actions physically initiated does not facilitate medication administration. The smaller cup makes it look like less medicine. Focusing on particulars does not explain the cooperation with the smaller medication cup.

A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory? A. Erikson B. Fowler C. Kohlberg D. Freud

C. Kohlberg Kohlberg developed the theory of moral development sequence for children. It includes how children acquire moral reasoning and is based on cognitive developmental theory. Erikson developed the theory of psychosocial development. Fowler developed the theory of spiritual development. Freud developed the theory of psychosexual development.

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which of the following suggestions should the nurse include? A. Send the child to his or her room. B. If the child cries, refuses, or is more disruptive, try another approach. C. Select an area that is safe and nonstimulating, such as a hallway. D. The general rule for length of time is 1 hour per year of age.

C. Select an area that is safe and nonstimulating, such as a hallway. The area must be nonstimulating and safe. The child becomes bored in this environment and then changes his or her behavior to rejoin activities. The child's room may have toys and other forms of amusement that may negate the effect of being separated from family activities. When the child engages in this type of behavior, the timeout begins when the child becomes quiet. The general rule is 1 minute per year. An hour per year is excessive.

The nurse in the pediatric clinic identifies which infants at risk for developing vitamin D-deficient rickets? A. Lacto-ovo vegetarians B. Those who are breastfed exclusively C. Those using yogurt as primary source of milk D. Those exposed to daily sunlight

C. Those using yogurt as primary source of milk Individuals who follow this diet include milk and its products in their diet. Breast milk has sufficient vitamin D if the mother is not deficient in this vitamin. Yogurt may not be supplemented with vitamin D. Lack of sunlight contributes to vitamin D-deficient rickets.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? A. Changing self-esteem is difficult after about 5 years old. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of lowered self-esteem are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

C. Transitory periods of lowered self-esteem are expected developmentally. Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.

The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. The nurse should recognize that: A. this assessment is normal. B. the child is probably cognitively impaired. C. developmental/neurologic evaluation is needed. D. the parent needs to work with the infant to stop head lag.

C. developmental/neurologic evaluation is needed. A 6-month-old infant should have social interaction beyond smiling and cooing. The child requires evaluation. The head lag should be almost gone by 4 months of age. This child requires evaluation. The child requires evaluation before interventions can be determined.

Nursing interventions to promote health during middle childhood include: A. stressing the need for increased calorie intake to meet increased demands. B. instructing parents to defer questions about sex until the child reaches adolescence. C. educating the child and parents to the need for good dental hygiene because these are the years in which permanent teeth erupt. D. advising parents that the child will need decreasing amounts of rest toward the end of this period

C. educating the child and parents to the need for good dental hygiene because these are the years in which permanent teeth erupt. Caloric needs are diminished; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex education with a lifespan approach and respond to a child's questions with an answer appropriate to the child's age. Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. School-age children often need to be reminded to go to sleep.

A 2-year-old child has recently started having temper tantrums during which she holds her breath and sometimes faints. The nurse should: A. refer the child for respiratory evaluation. B. refer the child for psychologic evaluation. C. explain to the parent that this is not harmful. D. explain to the parent that the child is spoiled.

C. explain to the parent that this is not harmful. This is not a respiratory issue. Temper tantrums are part of this developmental stage; if they persist, an evaluation may be indicated. The rising carbon dioxide levels in the child will automatically restart the breathing process. No data have been shown to support this

When caring for a preschool age child, the nurse should incorporate knowledge that body image has developed to include: A. a well-defined body boundary. B. knowledge about his or her internal anatomy. C. fear of intrusive procedures. D. anxiety and fear of separation.

C. fear of intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers are able to separate.

An appropriate intervention to provide comfort for the child with itching associated with chickenpox is to: A. encourage frequent warm baths. B. give aspirin or acetaminophen. C. give an antipruritic medication such as Benadryl. D. apply thick coat of Caladryl lotion over open lesions.

C. give an antipruritic medication such as Benadryl. Cool baths are recommended for relief of itching. Neither drug has antiitching effects. Antipruritic medicines such as diphenhydramine (Benadryl) are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Caladryl lotion (contains Benadryl) should be applied sparingly over open lesions to minimize absorption.

The MOST appropriate recommendation for relief of teething pain is to instruct the parents to: A. rub gums with aspirin to relieve inflammation. B. apply hydrogen peroxide to gums to relieve irritation. C. give child a frozen teething ring to relieve inflammation. D. have child chew on a warm teething ring to encourage tooth eruption.

C. give child a frozen teething ring to relieve inflammation. Gums should not be rubbed with aspirin. It can be dangerous if the child aspirates aspirin. Hydrogen peroxide would not be effective. Cold reduces inflammation and should be used for relief of teething irritation. Cold, not warmth, reduces inflammation.

The parents of a 4-year-old girl are worried because she has an imaginary playmate. The nurse's BEST response is to tell the parents: A. a psychosocial evaluation is indicated. B. an evaluation of possible parent-child conflict is indicated. C. having imaginary playmates is normal and useful at this age. D. having imaginary playmates is abnormal after about age 2 years.

C. having imaginary playmates is normal and useful at this age. Since an imaginary playmate is part of normal development, an evaluation is not necessary. Since an imaginary playmate is part of normal development, an evaluation is not necessary. Imaginary playmates are a part of normal development at this age. The peak incidence of imaginary playmates occurs at 2.5 to 3 years of age. These "playmates" usually are not present once school starts.

The nurse is giving anticipatory guidance to the parent of a 5-year-old. In this guidance, it is MOST important to: A. prepare the parent for increased aggression. B. encourage the parent to offer the child choices. C. inform the parent to expect a more tranquil period at this age. D. advise parents that this is the age when stuttering may develop.

C. inform the parent to expect a more tranquil period at this age. This indicates age 4 anticipatory guidance. These actions are indicative of age 3 anticipatory guidance. The end of preschool/beginning of school age is a more tranquil period. These actions are indicative of age 3 anticipatory guidance.

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of: A. identity. B. intimacy. C. initiative. D. industry

C. initiative. Identity is the stage associated with adolescence. Intimacy is an adult stage. Preschoolers focus on developing initiative. The stage is known as initiative vs. guilt. Industry is an adult stage.

The parents of 9-year-old twin children tell the nurse, "They have filled their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is: A. indicates giftedness. B. indicates typical "twin" behavior. C. is characteristic of cognitive development at this age. D. is characteristic of psychosocial development at this age.

C. is characteristic of cognitive development at this age. This is characteristic of the age group, not giftedness. This is characteristic of the age group, not their twin status. Classification skills are developed during the school-age years. This age group enjoys sorting objects according to shared characteristics. Psychosocial development at this age is focused on accomplishment.

A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for: A. rickets. B. marasmus. C. kwashiorkor. D. pellagra.

C. kwashiorkor. Kwashiorkor is defined as primarily a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The nurse should explain to this parent that this is: A. unusual and requires further evaluation of the son. B. unusual because the onset of pubescence is usually the same in siblings. C. normal because the onset of pubescence is usually earlier in girls than it is in boys. D. abnormal because the onset of pubescence is usually earlier in boys than it is in girls.

C. normal because the onset of pubescence is usually earlier in girls than it is in boys. The average age of onset for puberty in boys is 12 years old. Age of pubescence is gender related. Girls begin puberty an average of approximately 2 years before boys. The average age of onset for puberty in boys is 12 years old.

The nurse observes that a 13-year-old male has gynecomastia (breast enlargement). The nurse should explain that this is a: A. sign of too much body fat. B. sign of hormone imbalance. C. normal occurrence during puberty. D. symptom of precocious puberty.

C. normal occurrence during puberty. Although this may be true in overweight children, in children of normal body weight it is a normal occurrence. If the gynecomastia persists beyond the 2 years, then a hormonal cause may need to be investigated. Gynecomastia is common during midpuberty in about one third of boys. For most the breast enlargement disappears within 2 years. Precocious puberty is the early onset of puberty, before age 9 in boys.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse's suggestions regarding participation in sports at this age should include: A. organized sports such as soccer are not appropriate at this age. B. competition is detrimental to the establishment of a positive self-image. C. sports participation is encouraged if the sport is appropriate to the child's abilities. D. girls should compete only against girls because at this age boys are larger and have more muscle mass.

C. sports participation is encouraged if the sport is appropriate to the child's abilities. Organized sports can provide safe, appropriate activities with supportive parents and coaches. School-age children enjoy competition. Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely. The parent should help the child select a sport that is suitable to her capabilities and interests. These changes occur at puberty. Before that boys and girls can compete on the same teams

A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? A. "We locked all the medicines in the bathroom cabinet." B. "We turned the thermostat down on our hot water heater." C. "We placed gates at the top and bottom of the basement steps." D. "We stopped using the car seat now that my child is older."

D. "We stopped using the car seat now that my child is older." These are appropriate actions. These are appropriate actions. These are appropriate actions. A car seat should be used until child weighs 40 pounds, at approximately 4 years of age.

The nurse expects which characteristic of fine motor skills in a 5-month-old infant? A. Strong grasp reflex B. Neat pincer grasp C. Able to build a tower of two cubes D. Able to grasp object voluntarily

D. Able to grasp object voluntarily This is characteristic of a 1-month-old infant. This is characteristic of an 11-month-old infant. This is characteristic of a 15-month-old infant. This is appropriate for a 5-month-old infant.

The school nurse knows that which attribute is characteristic of the psychosocial development of school-age children? A. A developing sense of initiative is very important. B. Peer approval is not yet a motivating power. C. Motivation comes from extrinsic rather than intrinsic sources. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. Developing initiative is characteristic of preschoolers. Peer group formation is one of the major characteristics of this age group. School-age children gain satisfaction from independent behaviors. This age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feeling of inferiority.

A 4-year-old female child is afraid of dogs. What should the nurse recommend to her parents to help her with this fear? A. Keep her away from dogs B. Buy her a stuffed dog toy C. Force her to touch a dog briefly D. Let her watch other children play with a dog

D. Let her watch other children play with a dog These actions avoid the object of fear rather than approaching it and finding solutions. These actions avoid the object of fear rather than approaching it and finding solutions. Forcing the child to interact with the dog may increase the level of fear. The parents should actively seek ways to deal with fear. By observing other children at play with dogs, the child can learn to adapt.

A 9-month-old infant is seen in the emergency department after developing a urticaric rash with cough and wheezing. When collecting the history of events before the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant? A. Potatoes B. Green beans C. Spinach D. Peanut butter

D. Peanut butter Nuts of any type, including peanuts, have a high allergy index in children and infants. The infant has demonstrated the cutaneous and respiratory type of reaction after possible ingestion of peanut butter. Potatoes are not a highly allergenic food. Green beans are not a highly allergenic food. Spinach is not a highly allergenic food.

A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse's knowledge of breastfed infants, what type of stool is expected? A. Dark brown and small hard pebbles B. Loose with green mucus streaks C. Formed and with white mucus D. Semiformed, seedy, yellow

D. Semiformed, seedy, yellow Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow. Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant. Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant. Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant.

The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues to cover in the sessions include: A. bicycle helmets need to be worn only if the child is planning to ride in traffic. B. reflectors should be installed only on bicycles that are to be ridden at night. C. bicycles should be ridden against the traffic so that the rider can see the cars. D. bicycles should be walked through busy intersections.

D. bicycles should be walked through busy intersections. Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries. Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response should be based on knowledge that: A. bullying at this age is considered normal. B. children who bully others usually join gangs. C. children who bully others usually have low self-esteem. D. bullies often have difficulties developing and maintaining relationships.

D. bullies often have difficulties developing and maintaining relationships. Bullying is a maladaptive response to poor relationships with peers and lack of group identification. Bullying is a maladaptive response to poor relationships with peers and lack of group identification. These individuals usually have strong self-esteem and little anxiety. Children who bully are defiant toward adults, antisocial, and likely to break school rules. They have little anxiety, strong self-esteem, and may come from homes where physical punishment is used and there is a lack of parental involvement and warmth. Long-term this negativity continues into adulthood, causing difficulties developing and maintaining relationships.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? A. help the toddler complete tasks. B. provide opportunities for the toddler to play with other children. C. help the toddler learn the difference between right and wrong. D. encourage the toddler to do things for himself or herself when he or she is capable of doing them.

D. encourage the toddler to do things for himself or herself when he or she is capable of doing them. Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy.

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include: A. wearing safety belts snugly over the toddler's abdomen. B. placing the car seat in the front passenger seat if there is an airbag. C. using lap and shoulder belts when the child is over 3 years of age. D. placing the car seat in the back seat of the car facing forward.

D. placing the car seat in the back seat of the car facing forward. Car seats are required for toddlers to prevent injury in case of a motor vehicle accident. The car seat should be placed in the back seat, forward facing. Safety belts can cause injuries if they are placed over a toddler's abdomen. Car seats should be in the rear of the car because airbags can injure the toddler. Three-year-olds should be restrained in car seats.

Characteristics of physical development of a 30-month-old child are the: (Select all that apply.) A. anterior fontanel is open. B. birth weight has doubled. C. genital fondling is noted. D. sphincter control is achieved. E. primary dentition is complete.

D. sphincter control is achieved. E. primary dentition is complete Sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age. Primary dentition is usually completed by 30 months of age. The anterior fontanel closes between 12 to 18 months of age. Birth weight should double at 5 to 6 months of age and quadruple by 2½ years of age. Genital fondling is not a characteristic of physical development of this age group. This is part of the development of gender identity.

The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib already asleep. The nurse should suspect his death was caused by: A. suffocation. B. child abuse. C. infantile apnea. D. sudden infant death syndrome (SIDS).

D. sudden infant death syndrome (SIDS). Although the child was found under the blanket, the bloody fluid is consistent with SIDS, not suffocation. No other injuries are reported. No previous acute life-threatening events had been reported. The death is consistent with the characteristics of SIDS.