Pediatrics Test 1

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? A.1 month B.2 months C.3 months D.4 months

ANS: B 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.

What is a normal characteristic of the language development of a preschool-age child? Lisp Stammering Echolalia Repetition without meaning

ANS: B Stammering and stuttering are normal disfluencies in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.

Match the sequence of cephalocaudal development that the nurse expects to find in the normal infant with the appropriate step numbers. Begin with the first development expected, sequencing to the final. a. Crawl b. Creep c. Stand d. Walk

ABCD

A parent of an 18 month old tells the nurse that the child says "no" to everything and has rapid mood swings. If scolded, the child shows anger and then immediately wants to be held. What is the nurse's best interpretation of this behavior? A.This is normal behavior for the child's age. B.This is unusual behavior for the child's age. C.The child is not effectively coping with stress. D.The child is showing the need for more attention.

ANS A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18 month old.

When is the best age for solid food to be introduced into the infant's diet? A.2 to 3 months B.4 to 6 months C.When birth weight has tripled D.When tooth eruption has started

ANS B: Physiologically and developmentally, the 4 to 6 months 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 three 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.

Preschoolers' fears can best be dealt with by which intervention? A.Actively involving them in finding practical methods to deal with the frightening experience. B.Forcing them to confront the frightening object or experience in the presence of their parents. C.Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are. D.Ridiculing their fears so they understand that there is no need to be afraid.

ANS: A Actively involving the child in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away.

A child has an avulsed (knocked-out) tooth. In which medium should the nurse instruct the parents to place the tooth for transport to the dentist? Cold milk Cold water Warm salt water A dry, clean jar

ANS: A An avulsed tooth should be placed in a suitable medium for transport, either cold milk or saliva (under the child's or parent's tongue). Cold milk is a more suitable medium for transport than cold water, warm salt water, or a dry, clean jar.

Which is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? A.Playing peek-a-boo. B.Playing pat-a-cake. C.Imitating animal sounds. D.Showing how to clap hands.

ANS: A 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.

The nurse is interviewing the father of 10-month-old. When the child, playing on the floor and notices an electrical outlet and reaches up to touch it, the father says "No" firmly and removes the child away from the outlet. The nurse should use this opportunity to teach the father that the child is capable of understanding what association? A.Understand the word "No." B.Father always means "No." C.Electrical outlets are dangerous. D.Spanking as a deterrent.

ANS: A 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 and is not likely to always associate her father with the word "No." 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.

The nurse determines an infant of 7 months is demonstrating appropriate fine motor development when performing which action? a.Transferring a rattler from one hand to the other. b.Using thumb and index finger to grasp a piece of food. c.Holding a crayon and make a mark on paper. d. Releasing cubes into a cup.

ANS: A 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.

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. CSara'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.

ANS: A 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.

What is the leading cause of death during the toddler period? Injuries Infectious diseases Congenital disorders Childhood diseases

ANS: A Injuries are the single most common cause of death in children ages 1 through 4 years. It is the period of highest death rate from injuries of any childhood age-group except adolescence. Infectious and childhood diseases are less common cause of deaths in this age-group. Congenital disorders are the second leading cause of death in this age-group.

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

ANS: A 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.

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.

ANS: A 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.

Which clinical manifestations should cause the nurse to suspect that a child, diagnosed with a digestive disorder, may be demonstrating signs of failure to thrive? A.Avoidance of eye contact. B.An associated malabsorption defect. C.Weight that falls below the 15th percentile. D.Normal achievement of developmental landmarks.

ANS: A 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 toy is the most developmentally appropriate for an 18- to 24-month-old child? A push-pull toy Nesting blocks A bicycle with training wheels A computer

ANS: A Push-pull toys encourage large muscle activity and are appropriate for toddlers. Nesting blocks are more appropriate for a 12- to 15-month-old child. A bicycle with training wheels is appropriate for a preschool or young school-age child. A computer can be appropriate as early as the preschool years.

In terms of gross motor development, what hallmark action should the nurse identify for the parents of a 5-month-old infant to anticipate? a.Roll from abdomen to back. b.Roll from back to abdomen. c.Sit erect without support. d.Move from prone to sitting position.

ANS: A 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.

A 9 year old often comes to the school nurse complaining of stomach pains. The teacher says that the child has lately been somewhat aggressive and stubborn in the classroom. What should the school nurse recognize as the possible trigger for these behaviors? Signs of stress Developmental delay A physical problem causing emotional stress Lack of adjustment to the school environment

ANS: A Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. This child is exhibiting signs of stress, not developmental delay, a physical problem, or lack of adjustment.

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.

ANS: A 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 parents of a 2 year old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend which intervention for the parents? A.Ignore the "baby talk." B.Explain to the toddler that "baby talk" is for babies. C.Tell the toddler frequently, "You are a big kid now." D.Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of saying that they are expressing stress. The parents should not introduce new expectations and should allow the child to master the developmental tasks without criticism.

By what age does the posterior fontanel usually close? A.6 to 8 weeks B.10 to 12 weeks C.4 to 6 months D.8 to 10 months

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

What is the first sign of pubertal change seen with boys? Testicular enlargement Facial hair Scrotal enlargement Voice deepens

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

Which consideration should be considered when planning care for an infant diagnosed with failure to thrive? A.Establishing a structured routine and follow it consistently. B.Maintaining a nondistracting environment by not speaking to the infant during feeding. C.Placing the infant in an infant seat during feedings to prevent overstimulation. D.Limiting sensory stimulation and play activities to alleviate fatigue.

ANS: A 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.

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. How should the nurse interpret this behavior? A.Normal development B.Significant developmental lag C.Slightly delayed development caused by prematurity D.Suggestive of a neurologic disorder such as cerebral palsy

ANS: A 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 by this behavior.

What skill that the nurse should expect a 5-year-old child to be able to master? Tie shoelaces. Use a knife to cut meat. Hammer a nail. Make change from a quarter.

ANS: A Tying shoelaces is a fine motor task typical of 5 year olds. Using a knife to cut meat is a fine motor task of a 7 year old. Hammering a nail and making change from a quarter are fine motor tasks of an 8 to 9 year old.

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.

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

In terms of gross motor development, what would the nurse educate the parents to expect a 5-month-old infant to do? (Select all that apply.) A.Roll from abdomen to back. B.Put feet in mouth when supine. C.Roll from back to abdomen. D.Sit erect without support. E.Move from prone to sitting position.

ANS: A, BRolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. Rolling from back to abdomen is developmentally appropriate for a 6-month-old infant. An 8-month-old infant should be able to sit erect without support. A 10-month-old infant can usually move from a prone to a sitting position.

Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include: (Select all that apply.) A.The child spends an inordinate amount of time in the nurse's office. B.Belongings frequently go missing or are damaged. C.The child wants to be driven to school. D.School performance improves. E.The child freely talks about his or her day.

ANS: A, B, C Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children expressed fear of going to school or riding the school bus, and their belongings often are damaged or missing. Very often, children will not talk about what is happening to them.

Which demonstrates the school-age child's developing logic in the stage of concrete operations? (Select all that apply.) a. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time. b.The school-age child understands the principles of adding, subtracting, and reversibility. c.The school-age child understands the principles of adding, subtracting, and reversibility. d.The school-age child has thinking that is characterized by egocentrism and animism.

ANS: A, B, C The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding, subtracting, and the process of reversibility, which occurs in the stage of concrete operations. Thinking that is characterized by egocentrism and animism occurs in the intuitive thought stage, not the concrete operations stage of development.

Which play patterns does a 3-year-old child typically display? (Select all that apply.) Imaginary play Parallel play Cooperative play Structured play Associative play

ANS: A, B, C, E Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years. Structured play is typical of school-age children.

The nurse is assessing parental knowledge of temper tantrums. Which are true statements regarding temper tantrums? (Select all that apply.) Temper tantrums are a common response to anger and frustration in toddlers. Temper tantrums often include screaming, kicking, throwing things, and head banging. Parents can effectively manage temper tantrums by giving in to the child's demands. Children having temper tantrums should be safely isolated and ignored. Parents can learn to anticipate times when tantrums are more likely to occur.

ANS: A, B, D, E Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap prior to fatigue or a snack if mealtime is delayed will be helpful in alleviated the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. The child should learn that nothing is gained by having a temper tantrum. Giving into the child's demands only increases the behavior.

1. Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves the following function: (Select all that apply.) intellectual development. physical development. self-awareness. creativity. temperament development.

ANS: A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Self-awareness is the process of developing a self-identity. This process is facilitated through play. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors but not the child's temperament attributes may be modified through play.

Which gross motor milestones should the nurse assess in an 18-month-old child? (Select all that apply.) Jumps in place with both feet Takes a few steps on tiptoe Throws ball overhand without falling Pulls and pushes toys Stands on one foot momentarily

ANS: A, C, DAn 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily are not acquired until 30 months of age.

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.) A.Allow parents to say goodbye to their infant. B.Once parents leave the hospital, no further follow-up is required. C.Arrange for someone to take the parents home from the hospital. D.Avoid requesting an autopsy of the deceased infant. E.Conduct a debriefing session with the parents before they leave the hospital.

ANS: A, C, E An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents' last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach? (Select all that apply.) Secure in a rear-facing, upright, car safety seat. Place the car safety seat in the rear seat, behind the driver's seat. Harness safety straps should be fit snugly. Place the car safety seat in the front passenger seat equipped with an air bag. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

ANS: A, C, E Toddlers younger than 2 years should be secured in a rear-facing, upright, approved car safety seat. After the age of 2 years, a forward-facing car seat can be used. Harness straps should be adjusted to provide a snug fit. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an air bag.

The nurse is caring for a hospitalized 4 year old. The parents tell the nurse that they will be back to visit at 6 PM. When the child asks the nurse, "when my parents are coming", what is the nurse's best response? "They will be here soon." "They will come after dinner." "Let me show you on the clock when 6 PM is." "I will tell you every time I see you how much longer it will be."

ANS: B A 4 year old understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. This answer assumes that the child understands the concept of hours and minutes, which is not developed until age 5 or 6 years.

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

ANS: B 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.

Which statement describes a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden. B.Realizes that "out of sight" is not out of reach. C.Puts objects into a container but cannot take them out. D.Understands the passage of time such as "just a minute" and "in an hour."

ANS: B At this age the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. Putting an object in a container but being unable to take it out indicates tertiary circular reactions. An embryonic sense of time exists; although toddlers may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

The nurse assessing a 6-month-old healthy infant who weighed 7 lbs at birth, shares with the parents that the infant should weigh approximately how many pounds? A.10 lbs. B.15 lbs. c. 20 lbs. d. 25 lbs.

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, an infant who weighed 7 lbs at birth would weigh approximately 15 lbs. 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 mont

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

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

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

ANS: B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs 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 are 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.

Parents have been using a rearward-facing, convertible car seat since their baby was born. The parents should be taught that most car seats can be safely switched to the forward-facing position when the child reaches which age? 1 year 2 years 3 years 4 years

ANS: B It is now recommended that all infants and toddlers ride in rear-facing car safety seats until they reach the age of 2 years or the height or weight recommended by the car seat manufacturer. Children 2 years old and older who have outgrown the rear-facing height or weight limit for their car safety seat should use a forward-facing car safety seat with a harness up to the maximum height or weight recommended by the manufacturer. One year is too young to switch to a forward-facing position.

Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. What is the best interpretation of this behavior? This is typical behavior because toddlers are aggressive. This is typical behavior because toddlers are egocentric. Toddlers should know that sharing toys is expected of them. Toddlers should have the cognitive ability to know right from wrong.

ANS: B Play develops from the solitary play of infancy to the parallel play of toddlers. The toddler plays alongside other children, not with them. This typical behavior of the toddler is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because the toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore, no right or wrong is associated with taking a toy.

A 4 year old is hospitalized with a serious bacterial infection. The child tells the nurse that, "I am sick because I was bad." What is the nurse's best interpretation of this comment? A.It is a sign of stress. B.It is common at this age. C.It is suggestive of maladaptation. D.It is suggestive of excessive discipline at home.

ANS: B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

An appropriate recommendation in preventing tooth decay in young children would include which intervention? A.Substitute raisins for candy. B.Serve sweets after a meal. C.Use honey or molasses instead of refined sugar. D.Serve sweets between meals.

ANS: B Sweets should be consumed with meals so the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth. Raisins, honey, and molasses are highly cariogenic and should be avoided.

A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development? A.The child's addition and subtraction ability B.The child's ability to classify C.The child's vocabulary D.The child's play activity

ANS: B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes. Subtraction and addition are appropriate cognitive activities for the young school-age child. Vocabulary is not as valid an assessment of cognitive ability as is the child's ability to classify. Play activity is not as valid an assessment of cognitive function as is the ability to classify.

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

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

The clinic is lending a federally approved car seat to an infant's family. Where in the car should the nurse explain is the safest place to put the car seat? 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.

ANS: B 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 lbs 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.

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 B.Difficult child C.Slow-to-warm-up child D.Fast-to-warm-up child

ANS: B 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 are 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.

ANS: B 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.

The mother of an 18-month-old child is concerned because the child's appetite has decreased. Which is the best response for the nurse to make to the mother? "It is important for your toddler to eat three meals a day and nothing in between." "It is not unusual for toddlers to eat less during this developmental stage." "Be sure to increase your child's milk consumption, which will improve nutrition." "Giving your child a multivitamin supplement daily will increase your toddler's appetite."

ANS: B Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. Physiologically, growth slows and appetite decreases during the toddler period. Milk consumption should not exceed 16 to 24 ounces daily. Juice should be limited to 4 to 6 ounces per day. Increasing the amount of milk will only further decrease solid food intake. Supplemental vitamins are important for all children, but they do not increase appetite.

According to Erikson, what is the psychosocial task of adolescence? a. Intimacy b. Identity c. Initiative d. Independence

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

Which statement about toilet training is correct? A.Bladder training is usually accomplished before bowel training. B.Wanting to please the parent helps motivate the child to use the toilet. C.Watching older siblings use the toilet confuses the child. D.Children must be forced to sit on the toilet when first learning.

ANS: B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

Which are characteristics of the physical development of a 30-month-old child? (Select all that apply.) Birth weight has doubled. Primary dentition is complete. Sphincter control is achieved. Anterior fontanel is open. Length from birth is doubled.

ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. A doubling of birth weight, opening of the anterior fontanel, and doubling of length are not characteristic of the physical development of a 30-month-old child.

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a SIDS incident? (Select all that apply.) A.Breastfeeding B.Low Apgar scores C.Male sex D.Birth weight in the 50th or higher percentile E.Recent viral illness

ANS: B, C, E Certain groups of infants are at increased risk for SIDS: those with low birth weight, low Apgar scores, or recent viral illness, and those of male sex. Breastfed infants and infants of average or above-average weight are not at higher risk for SIDS.

In terms of language and cognitive development, a 4-year-old child would be expected to have which traits? (Select all that apply.) Think in abstract terms Sexual curiosity Understand conservation of matter Use sentences of eight words Tell exaggerated stories

ANS: B, E Children 4 years of age demonstrate sexual curiosity and tell exaggerated stories. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. Five-year-old children use sentences with eight words with all parts of speech.

Because school-age children have developed increased muscular coordination and can apply cognitive ability to their behavior, the number of injuries in middle childhood is diminished compared to early childhood. Even so, injuries still occur near home and school. The most effective means of prevention is education for both the child and family regarding the hazards of risk-taking and the improper use of equipment. Please match the developmental ability of the school-age child with the injury for which he or she is at risk. Motor vehicle accidents Drowning Burns Poisoning Bodily damage Is apt to overdo Confidence exceeds physical capacity Is excited by speed and motion Enjoys trying new things May be easily influenced by peers

ANS: BEACD Physically active school-age children are highly susceptible to all of these injuries. Drowning is a high risk when the child over extends him/herself while in the water. As the child is increasingly involved in activities away from home, influenced by peers, and excited to try new things, risk for injury will be present. It is important that the nurse emphasize injury prevention for all school-age children.

Which type of play is most typical of the preschool period? a. A.Solitary b. Parallel c. Associative d. Team

ANS: C Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams.

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 what age? A.2 months B.4 months C.6 months D.12 months

ANS: C 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.

Developmentally, most children at age 12 months demonstrate what behavior? A.Use a spoon adeptly. B.Relinquish the bottle voluntarily. C.Eat the same food as the rest of the family. D.Reject all solid foods in preference to the bottle.

ANS: C By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and weaned totally by 14 months. The child should be weaned from a milk/formula-based diet to a balanced diet that includes iron-rich sources of food.

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.

ANS: C 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, appNlyUiRngSIgNeGnTtlBe.CpOreMssure. 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.

Which comment indicates that the mother of a toddler needs further teaching about dental care? "We use well water so I give my toddler fluoride supplements." "My toddler brushes his teeth with my help." "My child will not need a dental checkup until his permanent teeth come in." "I use a small nylon bristle brush for my toddler's teeth."

ANS: C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. Toddlers need fluoride supplements when they use a water supply that is not fluorinated. Toddlers also require supervision with dental care. The parent should finish brushing areas not reached by the child. A small nylon bristle brush works best for cleaning toddlers' teeth.

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

ANS: C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier 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.

What is the primary purpose of a transitional object? It helps the parents deal with the guilt when leaving the child. It keeps the child quiet at bedtime. It is effective in decreasing anxiety in the toddler. It decreases negativism and tantrums in the toddler.

ANS: C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. A decrease in parental guilt (distress) is an indirect benefit of a transitional object. A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

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

ANS: C 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.

Although a 14 month old received a shock from an electrical outlet recently, the parents find the child about to place a paper clip in another outlet. What is the best interpretation of this behavior? Her cognitive development is delayed. This is typical behavior because toddlers are not very developed. This is typical behavior because of inability to transfer knowledge to new situations. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age and represents typical behavior for a toddler. Only some awareness exists of a causal relation between events.

The parent of a 2 week old asks the nurse if the infant needs fluoride supplements because they plan to exclusively breastfed. What is the nurse's best response? "Your infant needs to begin taking them now." "They are not needed if you drink fluoridated water." "Your infant may need to begin taking them at age 6 months." "Your infant can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C 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 mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What should the nurse recommend to be used as substitute for the breastmilk? A.Skim milk B.Whole cow's milk C.Commercial iron-fortified formula D.Commercial formula without iron

ANS: C 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.

In what type of play are children engaged in similar or identical activity without organization, division of labor, or mutual goal?a. Solitary b. Parallel c. Associative d. Cooperative

ANS: C 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 who weighs 7 lbs at birth would be expected to weigh how many pounds at age 1 year? A.14 lbs B.16 lbs C.18 lbs D.21 lbs

ANS: D In general birth, weight triples by the end of the first year of life. For an infant who was 7 lbs at birth, 21 lbs would be the anticipated weight at the first birthday. Weights of 14, 16, and 18 lbs are less what would be expected for an infant with a birth weight of 7 lbs.

By what age does birth length usually double? A.1 year B.2 years C.4 years D.6 years

ANS: C 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.

By what age should the nurse expect that an infant will be able to pull to a standing position? a.6 months b.8 months c.9 months d.11 to 12 month

ANS: C 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 hips (DDH). 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.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. How should this behavior be interpreted? Behavior that encourages bullying and sexism. Behavior that reinforces poor peer relationships. Characteristic of social development of this age. Characteristic of children who later are at risk for membership in gangs.

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.

Why are imaginary playmates beneficial to the preschool child? A.Take the place of social interactions. B.Take the place of pets and other toys. C.Become friends in times of loneliness. d. Accomplish what the child has already successfully accomplished.

ANS: C One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interactions but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. What intervention is the most appropriate recommendation? A.Punish the child with an age appropriate punishment. B.Leave the child alone until the tantrum is over. C.Ignore the behavior, provided that it is not injurious. d. Explain to child that this is wrong.

ANS: C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age-group as the child becomes more independent and increasingly complex tasks overwhelm him or her. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial.

The parents of a 14 year old express concerns about the number of hours their child spends with friends. The nurse explains that peer relationships become more important during adolescence because: A.adolescents dislike their parents. B.adolescents no longer need parental control. C.they provide adolescents with a feeling of belonging. D.they promote a sense of individuality in adolescents.

ANS: C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and strength and power. During adolescence, the parent-child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.

In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. In this situation the nurse should recognize that fact about this task. A.Blocks at this age are used primarily for throwing. B.Toddlers are too young to imitate the behavior of others. C.Toddlers are capable of building a tower of blocks. D.Toddlers are too young to build a tower of blocks.

ANS: C This is a good parent-child interaction. The 18 month old is capable of building a tower of 3 or 4 blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. At this age, children imitate others around them and no longer throw blocks.

Which statement accurately describes an event associated with an infant's physical development? Anterior fontanel closes by age 6 to 10 months. Binocularity is well established by age 8 months. Birth weight doubles by age 5 months and triples by age 1 year. Maternal iron stores persist during the first 12 months of life.

ANS: CGrowth 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.

At which age can most infants sit steadily unsupported?a.4 months b.6 months c.8 months d.10 months

ANS: CSitting 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

The mother of a breastfed infant being seen in the clinic for the sixth month checkup is concerned that the infant has begun thumb sucking. How should the nurse respond to the mother's concern? A.Recommend that the mother substitute a pacifier for the infant's thumb. B.Assess the infant for other signs of sensory deprivation. c. Reassure the mother that this behavior is very normal at this age .d. Suggest that the mother breastfeed more often to satisfy sucking needs.

ANS: CSucking 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 versus thumb. This is a normal behavior to meet nonnutritive sucking needs. No data support that Latasha has sensory deprivation.

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? 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.

ANS: D 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.

By what age would the nurse expect that most children could understand prepositional phrases such as "under," "on top of," "beside," and "in back of"? A.18 months B.24 months C.3 years D.4 years

ANS: D At 4 years, children can understand directional phrases. Children 18 to 24 months and 3 years of age are too young.

Which characteristics best describes the language of a 3-year-old child? A.Asks meanings of words B.Follows directional commands C.Can describe an object according to its composition D.Talks incessantly, regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3 year olds are known to talk incessantly, regardless of whether anyone is listening. A 4 to 5 year old asks lots of questions and can follow simple directional commands. A 6 year old can describe an object according to its composition.

In girls, what is the initial indication of puberty? Menarche Growth spurt Growth of pubic hair Breast development

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

According to Kohlberg, children develop moral reasoning as they mature. What is the most characteristic of a preschooler's stage of moral development? Obeying the rules of correct behavior is important. Showing respect for authority is important behavior. Behavior that pleases others is considered good. Actions are determined as good or bad in terms of their consequences.

ANS: D 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 nurse is planning care for a 17-month-old child. According to Piaget, in what stage would the nurse expect the child to be? A.Trust B.Preoperations C.Secondary circular reaction D.Tertiary circular reaction

ANS: D The 17 month old is in the fifth stage of the sensorimotor phase: tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperation is the stage of cognitive development, usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

Which characteristic best describes the gross motor skills of a 24-month-old child? Skips Rides tricycle Broad jumps Walks up and down stairs

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and the ability to broad jump are skills acquired at age 3. Tricycle riding is achieved at age 4.

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.

ANS: D 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.

A 14 years old, mentions that he now has to use deodorant but never had to before. The nurse's response should be based on what knowledge? A.Eccrine sweat glands in the axillae become fully functional during puberty. B.Sebaceous glands become extremely active during puberty. c. New deposits of fatty tissue insulate the body and cause increased sweat production. d. Apocrine sweat glands reach secretory capacity during puberty.

ANS: D The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles in the axillae, genital and anal areas, and other areas. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitals and the "flush" areas of the body, such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue insulate the body and cause increased sweat production, but this is not the etiology of apocrine sweat gland activity.

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 what knowledge? 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.

ANS: D 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.

The parents of a newborn say that their toddler "hates the baby and suggested that we put the baby in the trash can so the trash truck could take him away." What is the nurse's best response to the parent's concern? A."Let's see if we can figure out why your toddler hates the new baby." B."That's a strong statement to come from such a small child." C."Let's refer your child to counseling to work this hatred out. It's not a normal response." D."That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

ANS: D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and help focus attention on the toddler. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. This is a normal response. The toddler can be provided with a doll to tend to its needs when the parent is performing similar care for the newborn.

A father tells the nurse that his toddler wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is a result of what factor? A.A sign that the child is spoiled. B.A way to exert unhealthy control. C.Regression, common at this age. D.Ritualism, common at this age.

ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate a child who has unreasonable expectations or a need to exert control, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What recommendation should the nurse make to the parents? A.Use fluoridated mouth rinses in children older than 1 year. B.Have children brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate. C.Give fluoride supplements to breastfed infants beginning at age 1 month. D.Determine whether water supply is fluoridated.

ANS: D The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach this age-group to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoridated toothpaste is still indicated, but very small amounts are used. Fluoride supplementation is not recommended until after age 6 months.

What is the most common cause of death in the adolescent age-group? Drownings Firearms Drug overdoses Motor vehicles

ANS: D The leading cause of all adolescent deaths in the United States is motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause the majority of deaths.

A parent asks the nurse about how to respond to negativism in toddlers. What is the most appropriate recommendation? A.Punish the child. B.Provide more attention. C.Ask child not always to say "no." D.Reduce the opportunities for a "no" answer.

ANS: D The nurse should suggest to the parent that questions should be phrased with realistic choices rather than "yes" or "no" answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say "no."

The father of 12 year old tells the nurse that he is concerned about his child getting "fat." The child's body mass index for age is at the 60th percentile. What is the most appropriate nursing action to address the father's concern? A.Reassure the father that his child is not "fat." B.Reassure the father that the weight is just a growing child. C.Suggest a low-calorie, low-fat diet, and provide food suggestions. D.Explain that this is typical of the growth pattern of children at this age.

ANS: D This is a characteristic pattern of growth in preadolescent boys, in which the growth in height has slowed in preparation for the pubertal growth spurt but weight is still gained. This should be reviewed with both the father and child, and a plan should be developed to maintain physical exercise and a balanced diet. Saying that the child is not "fat" is false reassurance. The child's weight is high for his/her height. The child needs to maintain his/her physical activity. The father is concerned; an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.

How should the nurse describe the fact that a 6 month old has 6 teeth? A.Normal tooth eruption. B.Delayed tooth eruption. C.Unusual and dangerous. D.Earlier-than-normal tooth eruption.

ANS: D This is earlier than expected. Most infants at age 6 months have two teeth, the lower central incisors. Six teeth at 6 months is not delayed; it is early tooth eruption. Although unusual, it is not dangerous.

Which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections? A. Respirations are abdominal. B. Pulse and respiratory rates are slower than those in infancy. C. Defense mechanisms are less efficient than those during infancy. D. The presence of short, straight internal ear/throat structures and large E. tonsil/adenoid lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

Three children playing a board game would be an example of: A. solitary play. B.parallel play. C. associative play. D. cooperative play.

ANS: D 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.

Place in order the expected sequence of fine motor developmental milestones for an infant, beginning with the first milestone achieved and ending with the last milestone achieved. A.Voluntary palmar grasp B.Reflex palmar grasp c. Puts objects into a container D. Neat pincer grasp E. Builds a tower of two blocks

BACDE Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 5 months, infants are able to voluntarily grasp objects. Gradually, the palmar grasp (using the whole hand) is replaced by a pincer grasp (using the thumb and index finger). By 8 to 10 months of age, infants use a crude pincer grasp, and by 11 months, they have progressed to a neat pincer grasp. By 11 months, they put objects into containers and like to remove them. By age 1 year, infants try to build towers of two blocks.