Peds 1

32. The parent of a 10-month-old male brings the child to the pediatrician's office with URI symptoms and a fever. The parent asks the nurse what can be done at home to improve the child's current condition. Which is the nurse's best response? 1. "Give your child small amounts of fluid every hour to prevent dehydration." 2. "Give your child Robitussin at night to reduce his cough and help him sleep." 3. "Give your child a baby aspirin every 4 to 6 hours to help reduce the fever." 4. "Give your child an over-the-counter cold medicine at night."

*32. 1. It is essential that parents ensure that their children remain hydrated during a URI. The best way to accomplish thi is by giving small amounts of fluid frequently.* 2. Over-the-counter cough and cold medi cine is not recommended for any child younger than 6 years. 3. Baby aspirin is never given to children because of the risk of developing Reye syndrome. 4. Over-the-counter cough and cold medi cine is not recommended for any child younger than 6 years.

Which symptoms does the nurse expect to find in the teething infant? Select all that apply. 1 Irritability 2 Drooling 3 Vomiting 4 Skin rashes 5 Facial edema

1, 2 Teething can cause irritability due to pain caused by the tooth erupting through the gum. The infant may also drool because of excess saliva production. If the infant is vomiting, then medical attention is needed because this is more than likely the result of another disease process. The teething process does not have any impact on skin integrity, so the infant is unlikely to have skin rashes or edema on the face.

Which example appropriately describes kinship care? 1 A 3-year-old girl staying in a group home 2 A 4-year-old girl living with grandparents 3 A 6-year-old girl living with a single mother 4 A 2-year-old boy living with a stepparent

2 Kinship care is the arrangement in which a child is taken care of by a relative. The most appropriate example here is the child staying with the grandparents. Staying in a group home or with a single mother are not examples of kinship care. A child living with a stepparent is an example of a reconstituted family

The nurse is giving anticipatory guidance to the parent of a 5-year-old. In this guidance, it is most important to: 1 prepare the parent for increased aggression. 2 encourage the parent to offer the child choices. 3 inform the parent to expect a more tranquil period at this age. 4 advise parents that this is the age when stuttering may develop.

3 The end of preschool/beginning of school age is a more tranquil period. Increased aggression indicates age 4 anticipatory guidance. Offering the child choices is indicative of age 3 anticipatory guidance. Developing stuttering is indicative of age 3 anticipatory guidance.

A child is hospitalized for a chronic illness. Initially, the child showed symptoms of depression but later started interacting with others. What does the nurse infer from the patient's behavior? The child is: 1 Content with the care provided. 2 Showing improved social skills. 3 Getting used to the surroundings. 4 Detached from both parents.

4 Hospitalized children undergo depression when they are separated from their parents. As they go through the stages of separation anxiety, children eventually detach from their parents and develop new and shallow relationships. Children interact with others and develop new relationships as a result of resignation, not contentment. Children who are detached begin to show increased interest in their surroundings. They are also not developing their social interaction skills. Children try not to think about the separation; hence, they start developing new interactions

2. Which of the following statements about the inheritance of CF is most accurate? 1. CF is an autosomal-dominant trait that is passed on from the child's mother. 2. CF is an autosomal-dominant trait that is passed on from the child's father. 3. The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF. 4. The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF.

4. If the child is born to a mother with CF and a father who is a carrier, the child has a 50% chance of acquiring the dis ease and a 50% chance of being a carrier of the disease.

In 2010, there were 2000 live births in an area with a population of 20 million. There were 10 deaths among infants younger than 27 days old, 20 deaths among children ages 0 to 6 months, and 40 deaths among children younger than 1 year of age (includes all subcategories of deaths under 1 year). What is the infant mortality rate (IMR)? Record your answer using a whole number. _____________ per 1000 live births

The infant mortality rate is the number of deaths during the first year of life per 1000 live births. The number of deaths of infants younger than 1 year of age was 40. Thus, IMR = number of deaths under 1 year / number of live births or 40 / 2000 = 20 / 1000

Which activity does the nurse expect to observe in a 4-month-old infant? The infant: 1 Grasps an object by using both hands. 2 Grabs an object by pulling on a string. 3 Transfers objects between both hands. 4 Matches two cubes and brings them together.

1 A 4-month-old infant has the ability to grasp objects with both hands. A 4-month-old infant is unable to secure an object by pulling on a string due to lack of fine motor skills. The infant is unable to transfer objects from one hand to the other or compare two cubes by bringing them together due to lack of developmental skills. At this age, the infant's muscle coordination is not well developed for performing these activities. An 8-month-old infant is able to secure an object by pulling on a string. A 7-month-old infant is able to transfer objects from one hand to the other. A 9-month-old infant is able to compare two cubes by bringing them together.

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: 1 concrete operations. 2 preoperational. 3 school-age rhetoric. 4 formal operations

1 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.

The nurse is caring for a child with measles and conjunctivitis. The nurse finds that the child has photophobia. What measures should the nurse follow while caring for the child? Select all that apply. 1 Clean the eyelids with warm saline. 2 Cover the eyes with a damp cloth. 3 Provide dim light in the room. 4 Avoid rubbing the infected eyes. 5 Clean the eyelids with warm water.

1, 3, 4 The nurse should clean the eyelids with warm saline to remove secretions or crusts. The room should be dimly lit if the child has photophobia, as sensitivity to light may develop in the child. Rubbing the eyes increases infection and therefore needs to be avoided. Covering the eye may cause irritation, itching, and burning, so it should be avoided. The eyes must be cleaned with warm saline instead of warm water, as it is more effective.

During the assessment of a 12-month-old infant, the nurse finds that the infant's head and chest circumference are equal, the length of the infant has increased by 50% since birth, and the weight is triple that of the birth weight. What does the nurse interpret from these findings? 1 The infant has slow development. 2 The infant has normal development. 3 The infant has inadequate weight gain. 4 The infant has insufficient dietary protein.

2 A 12-month-old infant has equal head and chest circumference. In a 12-month-infant, there is an increase in birth length by 50% and increase in weight three times that of birth weight. So, the nurse should interpret from these findings that the infant has normal development. Inability to gain weight indicates slow development. Development of the infant is normal according to standard parameters. Thus, it does not indicate that the infant lacks dietary protein.

The nurse working at a day care center finds that a child is obedient at home but bullies peers at the day care center. What does the nurse infer from the child's behavior? The child: 1 Is aggressive. 2 Is scared of the parents. 3 Respects elders. 4 Likes to play alone.

2 A child who is obedient at home and not at school is usually scared of his or her parents and takes out the aggression on peers or outsiders. Aggression is commonly seen in children; it is not an illness but indicates that the child needs attention. The nurse cannot interpret whether the child respects elders or not based on his or her behavior with peers and parents. A child who likes to play alone may not bully others and usually spends time alone.

A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child's development is on target? 1 The child has not gained weight for 3 months. 2 The child can throw a large ball but not a small ball. 3 The child's arms are the most rapidly growing part of the child's body. 4 The child can pull herself or himself to her or his feet before the child is able to sit steadily

2 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 indicates 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 to her or his feet.

Often parents are 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: 1 a child grows taller all through early childhood. 2 a child learns to throw a ball overhand. 3 a child's weight triples during the first year. 4 a child's brain increases in size until school age.

2 Development is the mental and cognitive attainment of skills. Growth is the increase in physical size—both height and weight.

A patient who is undergoing stem cell therapy asks the nurse about undifferentiated cells. Which response given by the nurse is most appropriate? "These cells:" 1 are able to divide at a very rapid rate." 2 multiply to form any part of the body." 3 can perform specialized functions." 4 are similar to all other cells in the body."

2 Differentiation is the process by which immature cells transform into mature cells to form tissues. Thus undifferentiated cells are immature and not developed. These cells would be able to reproduce to form any part of the body. These cells are not similar to cancer cells and do not multiply rapidly. These cells are immature and are not able to perform specialized functions. These cells are not well developed and thus do not resemble other mature cells of the body

The nurse is caring for a child who has developed dyslalia. The primary health care provider (PHP) recommends that the child take the Denver Articulate Screening Exam. What should the nurse suspect the child has? 1 Decreased sight 2 Impaired speech 3 Reduced motor skills 4 Hearing impairment

2 Dyslalia is a condition seen in children who revert to using infantile speech or have articulation problems. The Denver Articulate Screening Exam is used to assess the articulation skills in the child. The Denver Articulate Screening Exam does not analyze sight, motor skills, or hearing impairment. In addition, dyslalia does not result in any of these impairments.

The nurse instructs a child's parent to be cautious because the child is hyperactive and difficult. What assessment would the nurse have performed to confirm the child's behavior? 1 Restlessness 2 Temperament 3 Hypothermic conditions 4 Neurological maturation

2 Temperament is a person's manner of thinking, behaving, or reacting. It is a useful tool for identifying the difficult child. Restlessness or sleeplessness has more impact on tissue activity. Hypothermic conditions, where thermal adaptability is not seen, cause hypoglycemia in infancy. Skin-to-skin care is given to a child in order to maintain body temperature. Neurological maturation occurs primarily before birth and in the neonatal stage, where rapid neuron formation is seen

To establish evidence-based practice, the nurse has to collect high-quality evidence from various sources. Where does the nurse find the best quality of evidence? 1 Observational studies 2 Hospital patient records 3 Randomized clinical trials 4 Direct interview with patients

3 The nurse knows the best source for consistence and unbiased evidence is from well-performed randomized clinical trials (RCT). Observational studies have biased information, so are not reliable, unless the study is done meticulously. RCTs are preferred to hospital records or patient interviews. As biases can affect the establishment of evidence-based practice, the nurse should take precautions to avoid biased or low-quality evidence.

The nurse should expect to possibly incorporate which religious and cultural practices into the plan of care when caring for a 35-year-old Jewish mother who just gave birth to a healthy baby boy? Select all that apply. 1 Circumcision in hospital 2 Ordering house diet lunch tray of roasted pork with mashed potatoes 3 Allowing family, friends, and rabbi to visit patient often 4 Ask males to remove shawl and yarmulke while visiting 5 Ordering house diet with the exception of shellfish

3, 5 Family, friends, and rabbi should be allowed to visit. Individuals of the Jewish faith generally are prohibited from eating pork or shellfish. Ritual circumcision of male infants is custom on the eighth day and performed by a mohel. Asking males to remove shawls or yarmulkes is inconsistent with acceptance of religious values.

7. A female child with CF is hospitalized with constipation. The parent asks the nurse what will need to be done to relieve the child's constipation. Which is the nurse's best response? 1. "Your child likely has an obstruction and will require surgery." 2. "Your child will likely be given IV fluids to relieve her constipation." 3. "Your child will likely be given GoLYTELY to relieve her constipation." 4. "Your child will be placed on a clear liquid diet to relieve her constipation."

3. CF patients with constipation commonly receive a stool softener or an osmotic so lution orally to relieve their constipation.

The nurse is teaching a pregnant woman to eat a nutritious diet and to attend regular antenatal health check-ups for the assessment of fetal well-being. The primary purpose of this nursing intervention is to reduce the neonatal mortality rate due to: 1 birth weight less than 2.5g. 2 gestational diabetes in mother. 3 birth weight of more than 3.5 g. 4 febrile convulsions in neonates.

1 Birth weight of less than 2,500 grams or 5.5 pounds in considered low birth weight (LBW). LBW is associated with higher neonatal mortality rate in the United States when compared with other countries. The lower the birth weight, the higher the mortality rate. Birth weight of the neonates born to uncontrolled diabetic mother can be high. The mortality rate of neonates born with a birth weight of more than 3.5 g is lower than that of neonates born with LBW. Febrile convulsions seldom cause death in neonates.

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? 1 Cardiopulmonary resuscitation (CPR) 2 Administration of intravenous (IV) fluids 3 Reassurance that the infant cannot be electrocuted during monitoring 4 Advice that the infant not be left with other caretakers such as baby-sitters

1 CPR is essential for parents 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. Everyone needs to be taught how to use the monitoring equipment and how to perform CPR.

When providing nursing interventions, the nurses are expected to establish a positive relationship with patients and their families. Which action by the nurse will help establish such a relationship? 1 Teach the families rather than doing everything for them. 2 Call the parents to know the child's condition after going home. 3 Buy one or two colorful toys but not chocolates for the children. 4 Work a few extra hours to care for the family only in the hospital

1 The best action that the nurse can adopt for having a positive relationship with patients and their families is teaching the families rather than doing everything for them. The negative actions are making phone calls to families in off-duty hours, buying toys and chocolates for the children, working extra hours to take care of the family in the hospital, or spend time outside the hospital doing things for the family.

The nurse is assessing a 9-month-old infant. Which type of play should the nurse suggest to the infant's parents? Select all that apply. 1 Pat-a-cake 2 Peekaboo 3 Push-pull toy 4 Soft stuffed toy 5 Large plastic ball

1, 2 Pat-a-cake and peekaboo are the suitable ways to play with an infant. At this age, the sensorimotor skills of the infant are well developed and the infant is able to play these games. The child responds well to these games. The infant's skills are not adequately developed to play with push-pull toys as the 9-month-old cannot walk to push or pull a toy. An 18-month-old infant is able to play with push-pull toy because at this age the infant's skills are well developed to play this game. Soft stuffed toys should be given to a 3-month-old infant because the infant shows interest in stimuli and begins to play alone with the soft stuffed toy. An 18-month-old infant is able to play with a large plastic ball.

What are the most important public health interventions that the nurse should be aware of to achieve the greatest impact on the community health? 1 Supplying safe drinking water 2 Conducting childhood vaccination 3 Regularly supplying iron-fortified food 4 Prevention of deaths due to accidents 5 Screening for cervical and colon cancer

1, 2, 3 Clean drinking water and childhood vaccination are proven to have had the greatest impact on world health. Hence, the community nurse has to take measures to work on these two important public health concerns. Supply of iron-fortified food to the pregnant women decreases the congenital abnormalities and birth defects. Prevention of deaths due to falls and screening for cervical and colon cancer are also very much required, but these are not as important as clean drinking water and childhood vaccination programs.

The nurse finds that a 4-year-old child stutters. What instructions should the nurse give to the child's parents? Select all that apply. 1 "Speak to the child slowly and calmly." 2 "Listen to the child very attentively." 3 "Do not criticize the child's speech." 4 "Never speak to the child slowly at home." 5 "Take the child to a speech therapist now."

1, 2, 3 Speech development is most vital between the ages of 2 to 4 years. During this time, the children try to produce words faster than they can, and this failure of sensorimotor integration can lead to stuttering. It usually resolves in childhood. The parents should be encouraged to speak to the children slowly and listen to them attentively. Criticizing the child's speech can lead to worsening of stuttering. It is not required to take the child for speech therapy immediately at this stage

Which activities are indicative of the teething process in an infant? Select all that apply. 1 Infant rubbing on the gums 2 Infant biting on hard objects 3 Increased sucking on fingers 4 Increased need for sleep 5 Eating a lot more solid foods

1, 2, 3 Teething is a physiologic process. The infant may have discomfort as the crown of the tooth breaks through the periodontal membrane. Rubbing on the gums, biting on hard objects, and increased finger sucking are signs of teething. The pain from teething disturbs the infant's sleep cycle to where they may get less sleep, not more. The infant may also refuse to eat solid foods because of the pain from teething.

49. A pediatric client is diagnosed with epiglottitis. The parents ask the nurse what treatment their child will receive. Which is the nurse's best response? 1. "Your child will need to complete a course of intravenous antibiotics." 2. "Your child will need to have surgery to remove her tonsils." 3. "Your child will need 10 days of aerosolized ribavirin." 4. "Your child will recover without any intervention in about 5 days."

*49. 1. Epiglottitis is bacterial in nature and requires intravenous antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the intra venous course of antibiotics.* 2. Surgery is not the course of treatment for epiglottitis. Epiglottal swelling usually diminishes after 24 hours of intravenous antibiotics. 3. Ribavirin is an antiviral medication that is used to treat RSV. 4. Epiglottitis is bacterial in nature and re quires intervention. A course of intravenous antibiotics is indicated for this patient.

What information does the nurse include when teaching pool safety to a group of parents who havet oddlers? Children: 1 Like to explore areas 2 Tend to open doors. 3 Climb to reach heights 4 Prefer to stand on toes.

1 As toddlers begin to develop their gross motor and fine motor skills, they are more prone to injuries. The ability to explore if left unsupervised places the child at risk for drowning if left near a pool. Parents should always use fences, lock the door or gate to the pool, and supervise children closely while near the pool. The ability to open doors, reach heights, and stand on their toes are the developmental abilities of a child related to risks of accidental falls, vehicle injuries, and burns.

Which fine motor activity can be observed in a 4-month-old infant? 1 Playing with a rattle 2 Holding a bottle 3 Grasping objects 4 Taking objects directly to mouth

1 At the age of 4 months , the infant's fine motor skills are not fully developed, but the child is able to play and shake a rattle. Holding a bottle, grasping objects such as picking up a rattle when dropped, and taking objects directly to mouth are fine motor activities and require muscle coordination that is not developed at the age of 4 months. A 6-month-old child can hold a bottle. A 5-month-old child is able to grasp objects and take objects directly to mouth.

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for mommy. The nurse's best reply is: 1 "Mommy will be here after lunch." 2 "Mommy always comes back to see you." 3 "Your mommy told me yesterday that she would be here today about noon." 4 "Mommy had to go home for a while, but she will be here today."

1 Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time. Saying that the child's mother will always return does not give the child any information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Saying generally that the child's mother will visit does not give the child specific information about when his mother will visit

. The Kohlberg moral development theory states that children are concerned with conformity and loyalty at a stage of their growth. When this stage is correlated with the cognitive development of children, what would the age group be? 1. 0-2 years 2. 2-7 years 3. 7-11 years 4. 11-15 years

3 According to Kohlberg's moral development theory, when children are concerned with conformity and loyalty, they are at the conventional level. Children at this level are considered to be working on concrete operations of cognitive development, where children 7-11 years old are included. Infants between 0 and 2 years of age are included in the sensory motor level of cognitive development. Children between 2 and 7 years old are in the preoperational stage of cognitive development. Children between 11 and 15 years are considered to be in the formal operation stage of cognitive development.

The nurse observes a child having difficulty getting a mobile phone to work and looking puzzled. What type of play is the child demonstrating? 1 Skill play 2 Dramatic or pretend play 3 Social-effective play 4 Sense-pleasure play

2 Children's play activities are categorized during each stage of development. Pretend play, which is also called dramatic play, is seen in 11- to 13-month-old children when they perform activities that might be puzzling or frustrating to them. Skill play is seen after infants have developed the ability to grasp objects with their hands and manipulate them. This is when they use their skills to do things they observe such as putting paper in and out of a toy. Social-effective play is seen in infancy, when infants take pleasure in relationships with people. Sense-pleasure play happens when infants become attracted to natural colors or things and focus intently on them. An example is playing with sand.

How can the nurse learn to provide culturally competent care? The nurse should: 1 take a class to learn about various cultures. 2 be sensitive to the cultural values of the patient and show respect. 3 find information about the types of cultures present in the country. 4 attend various workshops emphasizing different cultural aspects.

2 Cultural competence has five components. In health care, cultural awareness consists of being sensitive to the cultural values of the patient and respecting them. Learning about various cultures may not be sufficient for providing culturally competent nursing care. Attending workshops may not necessarily help in providing culturally competent care

The nurse is caring for a Vietnamese patient who says she uses an ancient healing process in which jars containing steam are held against the skin. Which procedure is the patient describing? 1 Burning 2 Cupping 3 Coining 4 Steaming

2 Cupping is an ancient practice in an attempt to cure the sick and drive evil forces out of the body. In this process jars containing steam are held against the skin, and the heat forms blemish-like lesions on the skin. Burning involves burning small areas of the skin to treat enuresis and temper tantrums. Coining involves repeatedly rubbing the edge of a coin lengthwise on the oiled skin to rid the body of disease. There is no Vietnamese ritual called steaming

The nurse is assessing a child and asks the child to climb the chairs to check for motor development. What is the age group of the child that the nurse is assessing? 1 Infancy 2 Early childhood 3 Middle childhood 4 Later childhood

2 During early childhood, development in motor activities is assessed by watching the child walk and climb. Infancy (0-12 months) is when rapid motor, cognitive, and social development is seen. In middle childhood (6-12 years), children develop skill competence. Steady increases in physical, mental, and social development are also seen. Later childhood is the adolescent age, when activity is advanced and children redefine themselves through various adaptations.

What play activities should the nurse suggest to the parents to help improve gross motor skills for their children? 1 Enclosed play yard 2 Easy passive exercise 3 Mobile walker 4 Commercial swings

2 Easy passive exercises are useful for developing an infant's gross motor skills because exercise increases muscle movement. Play yards, mobile walkers, and commercial swings are not helpful for developing the infant's gross motor skills because they restrict the infant's movement by confining the infant to one area. This prevents the infant from exploring and developing gross motor skills.

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 breastfeeds her back to sleep. What should the nurse suggest to help them deal with this problem? 1 Putting her in parents' bed to cuddle. 2 Beginning to put her to bed while still awake. 3 Letting her cry herself back to sleep. 4 Giving her a bottle of formula instead of breastfeeding her so often at night.

2 Parents need to develop bedtime rituals that involve putting the child in bed when 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. 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 is caring for a patient who follows Orthodox Judaism. The patient is scheduled for surgery on Saturday morning, but the patient refuses to get the surgery done. What is the most probable cause for this reluctance? The patient: 1 is scared of the surgery and outcomes. 2 is observing the Sabbath. 3 does not want to be there on a weekend. 4 is not comfortable with the surgeon.

2 People following Orthodox Judaism observe a weekly Sabbath day, which lasts from Friday sundown to Saturday sundown. It is against their beliefs to do any work during this time. It is unlikely that the patient is scared or does not want to have surgery on a weekend. The patient's reluctance is unlikely to be caused by concerns about the surgeon performing the surgery.

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? 1 The blanket encourages immature behavior. 2 The blanket is an important transitional object. 3 She has not mastered the developmental task of individuation-separation. 4 She has not bonded adequately with her mother.

2 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.

The primary health care provider (PHP) prescribed HepB (Recombivax HB) vaccine for a child. Which question should the nurse ask the child's parents to ensure it is safe to administer the vaccine? "Does your child have a history of: 1 Skin infections such as impetigo?" 2 Being hypersensitive to yeast?" 3 Any urinary tract infections?" 4 Respiratory tract infection?"

2 The nurse should assess for a history of yeast hypersensitivity in the child before administering the HepB (Recombivax HB) vaccine. HepB (Recombivax HB) vaccine is prepared from yeast cultures, so this vaccine should not be administered to the child who has yeast hypersensitivity. It may produce a severe anaphylactic reaction in the child. History of skin infections, urinary tract infections, and respiratory tract infections is not necessary because it does not have any impact on the vaccination

A child is 50 cm (20 inches) long in the second month of infancy. The nurse checks the baby 2 months later and finds healthy growth in the child. Approximately how long would the baby be at 4 months? 1. 52 cm 2. 55 cm 3. 57 cm 4. 60 cm

2 Until 6 months after birth, infants should grow 2.5 cm every month, so this 50-cm baby would to grow by 5 cm in 2 months. Therefore, the baby should be 55 cm in length by 4 months of age. If the child is only 52 cm, then the nurse should assess the child's nutritional status to determine whether caloric needs are being met. If the child is 57 cm or 60 cm, the nurse should assess the parents' height first. The baby may be longer because of greater than average parental height. If this is not the case, then the nurse should assess the child's endocrine system for growth problems.

The nurse at an educational camp is explaining to parents about the growth and developmental changes in a preschooler. Which changes should the nurse mention? The preschool age child is: 1 Incapable of differentiating gender. 2 Uninterested in playing indoor games. 3 Curious about sexual reproduction. 4 Uninterested in mingling with peers.

3 A preschooler usually has increased curiosity about everything, including sexuality. As a result, the preschooler may ask questions about sexual reproduction. A preschooler has already developed the cognitive ability to differentiate gender. Interest in play is usually very high in preschoolers, as they are very active. They enjoy engaging in both indoor as well as outdoor games. Preschoolers usually prefer to play with peers, because they enjoy the company of children of the same age.

Which person is most likely to be included in a 3-year-old child's secondary social group? 1 The child's father 2 A friend 3 A priest 4 The child's mother

3 A secondary social group consists of people who have limited and intermittent contact with the child. A priest is the most appropriate example of a secondary social group member. The child's father, friend, and mother meet the child regularly and have intimate contact and are part of the child's primary social group

The nurse is caring for a toddler who is hospitalized. The nurse finds that the toddler is afraid of the new environment and gets cranky. What does the nurse tell the parents to do to make the toddler comfortable? 1 Explain the reason for being in the hospital to the child. 2 Leave the child alone for a few hours. 3 Give appropriate play objects to the child for comfort. 4 Instruct the child to calm down in a firm tone.

3 A toddler gains security and comfort in familiar objects; therefore the nurse should advise the parents to give the child an appropriate plaything such as a doll or a puppet. As the toddler is already cranky, reasoning or sweet talking may make the child crankier. The child may feel rejected and may cause harm to self if left alone. Instructing toddlers firmly may make them even more scared and increase their distress

The nurse observes that a child is fidgety, restless, and easily distracted. What does the nurse interpret from these symptoms? The child: 1 Has many of the signs and symptoms of dysgraphia. 2 Demonstrates characteristics of conversion reaction. 3 Exhibits signs of posttraumatic stress disorder (PTSD). 4 May have attention deficit hyperactivity disorder (ADHD).

4 If a child displays fidgetiness and restlessness and is easily distracted, the child may have ADHD. Dysgraphia is the difficulty of the child with writing. Abdominal pain, fainting, pseudoseizures, paralysis, headaches, and visual field restriction are the symptoms of conversion reaction. The symptoms of PTSD include persistent re-experiencing of the traumatic event and avoidance of stimuli associated with the event or trauma.

6. A 2-year-old has just been diagnosed with CF. The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response? 1. "You can expect your child to develop a barrel-shaped chest." 2. "You can expect your child to develop a chronic productive cough." 3. "You can expect your child to develop bronchiectasis." 4. "You can expect your child to develop wheezing respirations." 50

4. Wheezing respirations and a dry non productive cough are common early symptoms in CF.

40. Which of the following patients is at highest risk for requiring hospitalization as a result of RSV? 1. A 3-year-old with a congenital heart defect. 2. A 2-month-old who is a former 32-week preemie. 3. A 4-year-old who is a former 30-week preemie. 4. A sixteen-month-old with a tracheostomy.

40. 1. Most children with RSV can be managed at home. Children 2 years and younger are at highest risk for developing complica tions related to RSV. Children who were premature, have cardiac conditions, or have chronic lung disease are also at a higher risk for needing hospitalization. The 3-year-old with a congenital heart disease is not the highest risk among this group of patients. *2. The younger the child, the greater the risk for developing complications re lated to RSV. The age and the prema ture status of this child make the the patient the highest risk.* 3. Children who were premature, have cardiac conditions, or have chronic lung disease are also at a higher risk for needing hospitaliza tion. This child was a former premature in fant but is now 4 years of age. 4. This child has a tracheostomy, but this is not an indication that the child cannot be managed at home.

The nurse is caring for a patient who is on long-term catheterization. According to the National Quality Forum, what should the nurse assess in this patient? 1 Oxygen saturation using arterial or venous blood 2 Monitoring of respiratory rate while in a sitting position 3 Signs and symptoms of a urinary tract infection 4 Abnormal changes in the electrocardiogram (ECG).

3 According to National Quality Forum, the nurse has to measure the patient-centered outcome. The nurse has to assess the patients in the intensive care unit (ICU) regularly to identify the urinary tract infections associated with the urinary catheter. Signs and symptoms of a urinary tract infection are fever, burning urination, and yellow urine. The urinalysis is done to confirm the presence of urinary tract infection (UTI). Urinary catheterization has no direct association with changes in arterial or venous oxygen saturation, respiratory, or cardiac complication

The nurse teaches progressive relaxation of muscle groups to a 12-year-old child. Which sign of stress is the nurse likely to find in the child? 1 Calmness 2 Enthusiasm 3 Facial redness 4 Bradycardia

3 Redness in the face is a physiologic sign of stress seen in children 7 to 12 years of age. Relaxation techniques such as progressive relaxation of muscle groups, deep breathing exercises, and positive imagery help to reduce stress. Calmness and enthusiasm are behavioral patterns of school-age children. These behavioral patterns help the child to develop good peer relations. If a child is experiencing stress, the heart rate would be increased (tachycardia), instead of a decreased heart rate (bradycardia).

The nurse is assessing a child with a communicable disease who reports itching due to rashes. Which measure should the nurse suggest to the parents to make the child comfortable? 1 Promote intake of fluids. 2 Ensure that the child is on bed rest. 3 Give the child a cool bath. 4 Ensure that the child has reduced activity.

3 The nurse suggests the parents give the child a cool bath because it relieves itching by decreasing the heat. In a communicable disease, fluid intake is necessary, but it does not give relief from itching. Providing bed rest helps make the child well rested but is not the primary treatment for rashes. Reduced physical activity helps prevent the child from being exhausted, but it does not make the child comfortable

Which person is the most likely to be included in a 5-year-old child's primary social group? 1 A priest 2 A doctor 3 The child's mother 4 A third cousin

3 The primary social group of a child consists of people with whom the child has intimate and regular contact. The mother is the most appropriate example of primary social group member. The priest, doctor, and third cousin are members of a secondary social group.

53. A 3-year-old is seen in the physician's office for a dry, hacking cough that is preventing the child from sleeping. The child is diagnosed with a URI. Which of the following interventions is most appropriate for this patient? 1. The child should be given cough suppressants at night. 2. The child should be given a cough expectorant every 4 hours. 3. The child should be given cold and flu medication every 8 hours. 4. The child should be given 1/2 teaspoon honey four to five times per day.

53. 1. Cough suppressants are not recommended for children. Coughing is a protective mechanism, so do not try to stop it. 2. Cough expectorants are not recommended for children younger than 6 years of age. There is no research information that they are effective. 3. Cold and flu medications are not indi cated for children younger than 6 years of age as there is no indication they are effective.

54. Which of the following statements about pneumonia is accurate? 1. Pneumonia is most frequently caused by bacterial agents. 2. Children with bacterial pneumonia are usually sicker than children with viral pneumonia. 3. Children with viral pneumonia are usually sicker than those with bacterial pneumonia. 4. Children with viral pneumonia must be treated with a complete course of antibiotics.

54. 1. Pneumonia is most frequently caused by viruses but can also be caused by bacteria such as Streptococcus pneumoniae. 2. Children with bacterial pneumonia are usually sicker than children with viral pneumonia. Children with bacterial pneumonia can be treated effectively, but they require a course of antibiotics. 3. Children with viral pneumonia are not usually as ill as those with bacterial pneu monia. Treatment for viral pneumonia in cludes maintaining adequate oxygenation and comfort measures. 4. Treatment for viral pneumonia includes maintaining adequate oxygenation and comfort measures.

The primary health care provider (PHP) prescribes a psychostimulant drug for a child. The nurse checks the medical history of the child and requests that the PHP change the drug. What would be the possible reason for the nurse to make such a request? The child: 1 Has had physical trauma. 2 Demonstrates dysgraphia. 3 Has malocclusion. 4 Has a history of facial tics.

4 Psychostimulant drugs are given to children for the treatment of attention deficit hyperactivity disorder (ADHD). These drugs should be avoided in children who have a history of ticlike behaviors because they can worsen the symptoms. Physical trauma refers to a serious injury resulting from an assault, a natural disaster, or a sports injury. Dysgraphia is a condition where a child has difficulty with writing. Psychostimulant drugs do not affect the oral health of the child. These drugs are not known to aggravate malocclusion problems. Orthodontic treatment is successful for malocclusion problems.

The nurse is assessing a newborn who weighs 3 kg (7 lb). At what growth stage would the child weigh 12 kg (26 lb)? 1 Infancy 2 Toddlerhood 3 Preschool age 4 School age

2 A child's weight should quadruple by the toddler stage. The child's weight would be 12 kg if it was 3 kg at birth. Birth weight triples by the end of infancy, so it would be 9 kg if it is 3 kg at birth. After the toddler weight is achieved, an annual weight increase of 2-3 kg is seen in both preschool- and school-age children

An adolescent with a past history of attempted suicide is admitted to the hospital for treatment. What is the best action of the nurse? 1 Call a chaplain for a prayer. 2 Do screening for suicidal ideation. 3 Conduct total body physical check-up. 4 Inform the parents about the incident.

2 The nurse has to assess whether the adolescent has any suicidal ideation. It helps to prevent further suicide attempts by the adolescent and also helps the nurse to plan effective care for the adolescent. Calling a chaplain for prayer, conducting total body physical check-up, and informing the parents about the incident are not recommended for this adolescent in the first place. Nurses should be alert to the symptoms of mental illness and potential suicidal ideation, and be aware of potential resources for high-quality integrated mental health services

In which age-group does a toddler exhibit rapid cognitive processes? 1. 6 to 12 months 2. 9 to 18 months 3. 12 to 24 months 4. 24 to 36 months

3 The toddler age-group is from 12 months to 36 months of age. The period from 12 to 24 months of age is a continuation of the final two stages of the sensorimotor phase. The toddler uses play and experiments to reach new developmental milestones, develop new physical skills, and begin the use of rational judgment and intellectual reasoning. A child aged 6 to 12 months is still considered an infant and not in the toddler stage. A child between 19 to 24 months is in the final stage of the sensorimotor phase. These two phases together show the rapid cognitive development in a child. The preoperational phase of cognitive development includes children between 24 to 36 months of age.

The parent of a newborn child asks the nurse the importance of breastfeeding. What should the nurse tell the parent? Select all that apply. 1 Breast milk is not rich in micronutrients. 2 Breast milk is not recommended for infants with fever. 3 Enzymes in breast milk are helpful in the digestion of milk. 4 Immunoglobulins in milk can prevent infections and diseases. 5 Breastfeeding can decrease infant mortality and morbidity

3, 4, 5. Breast milk contains enzymes that are helpful in the digestion of milk and improve the bioavailability of all nutrients in the milk. Immunoglobulins in milk give immunity against infections and allergies. Hence, breastfeeding can decrease infant mortality and morbidity. Breast milk is rich in micronutrients. Breast milk has immunologic properties, so it can be given to the infants with fever.

3. The parent of a 4-month-old with CF asks the nurse what time to begin the child's first CPT each day. Which is the nurse's best response? 1. "You should do the first CPT 30 minutes before feeding the child breakfast." 2. "You should do the first CPT after deep-suctioning the child each morning." 3. "You should do the first CPT 30 minutes after feeding the child breakfast." 4. "You should do the first CPT only when the child has congestion or coughing."

3. 1. CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting.

20. A 7-year-old female with asthma is playing a soccer game in gym class. During the game the child begins to cough, wheeze, and have difficulty catching her breath. The school nurse is called to the soccer field. Which of the following should the nurse administer to provide quick relief? 1. Prednisone. 2. Singulair. 3. Albuterol. 4. Flovent.

3. Albuterol is the quick-relief bron chodilator of choice for treating an asthma attack.

22. A 3-year-old female is admitted to the hospital with asthma. The nurse is trying to work with the child on breathing exercises to increase her expiratory phase. What should the nurse have the child do? 1. Use an incentive spirometer. 2. Breathe into a paper bag. 3. Blow a pinwheel. 4. Take several deep breaths.

3. Blowing a pinwheel is an excellent means of increasing a child's expira tory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child's expiratory phase.

9. A 7-month-old is taken to the pediatrician's office with a low-grade fever, nasal congestion, and a mild cough. Which should the nursing care management of this child include? 1. Maintaining strict bedrest. 2. Avoiding contact with family members. 3. Instilling saline nose drops and bulb suctioning. 4. Keeping the head of the bed flat.

3. Infants are nose breathers and often have increased difficulty when they are congested. Nasal saline drops and gen tle suctioning with a bulb syringe are often recommended.

4. The parent of a 10-month-old with CF asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion? 1. "You may need to increase the number of fresh fruits and vegetables you give your child each day." 2. "You may need to advance your child's diet to whole cow's milk because it is higher in fat than formula." 3. "You may need to change your child to a higher-calorie formula." 4. "You may need to increase your child's carbohydrate intake each day."

3. Often infants with CF need to have a higher-calorie formula to meet their nutritional needs. Infants may also be placed on hydrolysate formulas that contain added medium-chain triglycerides.

24. A pediatric client was seen at the pediatrician's office and was diagnosed with viral tonsillitis. The parent asks how to care for the child at home. Which is the nurse's best response? 1. "You will need to give your child a prescribed antibiotic for 10 days." 2. "You will need to schedule a follow-up appointment in 2 weeks." 3. "You can give your child Tylenol every 4 to 6 hours as needed for pain." 4. "You can place warm towels around your child's neck for comfort."

3. Tylenol is recommended prn for pain relief.

14. A school-age child is admitted to the hospital for a tonsillectomy. The nurse caring for this patient is assessing the child 8 hours after surgery. During the nurse's assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations should be of most concern to the nurse? 1. The child's heart rate and blood pressure are elevated. 2. The child complains of having a sore throat. 3. The child is refusing to eat solid foods. 4. The child is swallowing excessively.

4. Excessive swallowing is a sign that the child is swallowing blood. This should be considered a medical emer gency, and the physician should be contacted immediately. The child is likely bleeding and will need to return

23. The parents of a 6-year-old who has a new diagnosis of asthma asks the nurse what to do to make their home a more allergy-free environment for the child. Which is the nurse's best response? 1. "Use a humidifier in your child's room." 2. "Have your carpet cleaned chemically once a month." 3. "Wash household pets weekly." 4. "Avoid purchasing upholstered furniture."

4. Leather furniture is recommended rather than upholstered furniture. Upholstered furniture can harbor large amounts of dust, whereas leather furniture may be wiped off regularly with a damp cloth.

12. A 5-year-old female is diagnosed with pharyngitis. The child is complaining of throat pain. Which of the following statements by the mother indicates that she needs more education regarding the care and treatment of her daughter's throat pain? 1. "I will have my daughter gargle with warm saline three times a day." 2. "I will offer my daughter ice chips several times a day." 3. "I will give my daughter Tylenol every 4 to 6 hours as needed." 4. "I will give my daughter her amoxicillin until all doses of the antibiotic are gone."

4. Pharyngitis is a self-limiting viral ill ness that does not require antibiotic therapy. Pharyngitis should be treated with rest and comfort measures, in cluding Tylenol, throat sprays, cold liquids, and popsicles.

15. A pediatric client had a tonsillectomy 24 hours ago. The nurse is reviewing discharge instructions with the parents. The parents tell the nurse that the child is a big eater, and they want to know what foods to give the child for the next 24 hours. What is the nurse's best response? 1. "The child's diet should not be restricted at all." 2. "The child's diet should be restricted to clear liquids." 3. "The child's diet should be restricted to ice cream and cold liquids." 4. "The child's diet should be restricted to soft foods."

4. Soft foods are recommended to limit the child's pain and to decrease the risk for bleeding.

The role of the pediatric nurse is influenced by trends in health care. The greatest trend in health care is: primary focus on treatment of disease or disability. national health care planning on a distributive or episodic basis. accountability to professional codes and international standards. shift of focus to prevention of illness and maintenance of health

shift of focus to prevention of illness and maintenance of health Prevention is the current focus of health care, one in which nursing plays a major role. Traditionally, treating disease or disability is the role of the physician. National health care planning is not a major trend. Accountability to professional codes is an established responsibility, not a trend.\

The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: 1 trust. 2 industry. 3 initiative. 4 separation.

1 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.

What specific instruction should the nurse give the parents of 5-year-old children to prevent their children from succumbing to the most common cause of death at that age? 1 "Take precautions to prevent motor vehicle accidents." 2 "Feed your child a balanced diet and prevent malnutrition." 3 "Take your child for vaccinations regularly to prevent infections." 4 "Keep any medications away from your child to prevent poisoning."

1 "Take precautions to prevent motor vehicle accidents." According to the National Safety Council, common causes of death in 5-year-old children in the United States include motor vehicle accidents, drowning, fires and flames, mechanical suffocation, and poisoning. Among them, motor vehicle accidents are the leading cause. Malnourishment is not a common cause of deaths in 5-year-old children in the United States. In the United States, strict measures are taken to prevent infections. Therefore, infection is not a common cause of death in 5-year-old children in the United States. Poisoning is a common cause of death in 5-year-old children in the United States. However, deaths due to poisonings are not as common as deaths due to motor vehicle accidents.

The school nurse is teaching a class on safety. Which activities require protective athletic gear? Select all that apply. 1 Lacrosse 2 Football 3 Swimming 4 Gymnastics 5 Skateboarding

1, 2, 5 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.

The nurse is educating parents about ways to prevent and treat burns to a group of families. What first aid measures does the nurse teach the parents? Select all that apply. 1 Remove the person away from the source of the heat. 2 Cool the burned area instantly with ice water. 3 Apply an oil or ointment to the affected skin. 4 Put an adhesive dressing on the burned area. 5 Cover the burn area, ideally with a cling film. 6 Remove the burned clothes and jewelry.

1, 5, 6 Immediately after someone sustains a burn, the affected person should be removed from the source of heat to prevent further burns. The burned area should be covered to prevent contamination and infection. The burned clothes and jewelry should be removed as they can worsen the heat penetration. Tepid running tap water should be poured over the burned area instead of using ice water, as ice water damages the skin and the person may become hypothermic. Oil or ointment should never be applied as it can lead to an infection. Adhesive dressings should not be used over the burned area, as they may stick to the flesh and cause pain, as well as lead to infection and loss of healthy skin when removing the dressing.

The pediatric nurse is working on a project to contribute to research and evidence-based practice. What should the nurse do when caring for patients of different age groups? Arrange the following steps in the correct order: Evaluate the effectiveness of intervention Identify specific questions. Develop a care plan. Collect information.

1. Identify specific questions. 2. Collect information. 3. Develop a care plan. 4. Evaluate the effectiveness of intervention The responses of the nurse to health and illness have to be followed in an order. The nurse has to identify specific questions to collect appropriate information and develop a care plan to implement. Identification of specific questions to be asked to the patient would help to formulate a clear and precise assessment plan. Collection of subjective and objective information of the patient would be helpful in determining the needs of the patient. Developing a care plan of the patient would help in establish the desired outcomes and the interventions required to achieve those outcomes. Finally, the nurse should evaluate the effectiveness of the intervention to determine if the care plan designed for the patient was successful

In which age group is homicide the third major cause of death? 1 5-9 years of age 2 15-19 years of age 3 10-14 years of age 4 20-25 years of age

2 Homicide is the third most leading cause of death in the children who are 15-19 years of age. In children of 5 to 9 years of age, congenital anomalies are the major cause; in children 10-14 years of age, suicide is the major cause. In young adults 20 to 25 years of age, death is caused due to substance abuse and suicides.

The nurse is caring for a Hindu patient who wears a thread around his body. What should the nurse do while caring for this patient? 1 Remove the thread because it is not therapeutic. 2 Do not remove the thread because it is considered sacred. 3 Tell the patient that wearing the thread is unnecessary. 4 Remove and replace the thread with a new one every day.

2 The nurse should not remove the thread. Many Hindus wear thread, which they consider sacred, around the body. Unless it obstructs medical care, it should not be removed. The nurse should respect the patient's religion and beliefs and should not tell the patient that wearing the thread is unnecessary. It should not be removed and replaced because it is considered sacred.

The nurse is instructing a group of parents about the prevention of communicable diseases. What measures do the parents need to follow in order to prevent the spread of diseases? Select all that apply. 1 Finish the antibiotic course. 2 Follow the hygiene measures. 3 Vaccinate the child on time. 4 Finish the leftover antibiotics. 5 Wash hands frequently.

2, 3, 5 The nurse instructs the parents to follow hygiene measures, such as not sharing utensils to reduce the risk of contamination. Vaccination is also important, because it increases immunity. Washing hands helps prevent the spread of diseases. An antibiotic course needs to be finished when the child is infected, but it is not a prevention method. Leftover antibiotics should never be administered; this can cause severe adverse effects in the child.

1. The nurse caring for a female pediatric client with CF sends a stool for analysis. The results show an excessive amount of azotorrhea and steatorrhea. What does the nurse realize about the laboratory values? 1. They reflect that the patient is not compliant with taking her vitamins. 2. They reflect that the patient is not compliant with taking her enzymes. 3. They reflect that the patient is eating too many foods high in fat. 4. They reflect that the patient is eating too many foods high in fiber.

2. If the patient were not taking her en zymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool. CF patients must take digestive enzymes with all meals and snacks. Pancreatic ducts become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum. Therefore, patients must take digestive enzymes to aid in absorption of nutri ents. Often, teens are noncompliant with their medication regimen because they want to be like their peers.

10. A school-age child has been diagnosed with nasopharyngitis. The parent is concerned because the child has had little or no appetite for the last 24 hours. The parent asks the nurse if this is a concern. Which is the nurse's best response? 1. "Do not be concerned; it is common for children to have a decreased appetite for several days during a respiratory illness." 2. "Be sure your child is taking an adequate amount of fluid. The appetite should return soon." 3. "Try offering the child some favorite food. Maybe that will improve the appetite." 4. "You need to force your child to eat whatever you can; adequate nutrition is essential."

2. It is common for children to have a decreased appetite when they have a respiratory illness. The nurse is appro priately instructing the parent that the child will be fine by taking in an adequate amount of fluid.

25. A 2-month-old is seen in the pediatrician's office for his 2-month well-child checkup. The nurse is assessing the patient and reports to the physician that the child is exhibiting early signs of respiratory distress. Which of the following would indicate an early sign of distress? 1. The infant is breathing shallowly. 2. The infant has tachypnea. 3. The infant has tachycardia. 4. The infant has bradycardia.

2. Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants.

16. A pediatric client is admitted to the ER with an acute asthma exacerbation. The nurse tells the parents that blood will have to be drawn for some diagnostic laboratory studies. Which laboratory result will provide the health-care team with the most important information regarding the child's respiratory status? 1. A CBC. 2. An ABG. 3. A BUN. 4. A PTT.

2. The ABG gives the health-care team valuable information about the child's respiratory status: level of oxygenation, carbon dioxide, and blood pH.

The mother of a school-age child with a toothache seeks medical advice at a pediatric clinic. What measure should the nurse recommend to the mother to prevent dental caries in the child? 1 Use a commercial mouthwash. 2 Drink filtered water without fluoride. 3 Fluoridated water is good for drinking. 4 Use fluoride toothpaste for pain relief.

3 Fluoridated water is good for drinking. Dental caries can be prevented by oral hygiene, drinking fluoridated water, and brushing the teeth with toothpaste containing fluoride. Commercial mouthwash is not recommended as it can do harm to teeth. Drinking water that does not contain fluorides may cause fluoride deficiency in the children. This increases the risk of dental caries in the children. Filtered water without fluoride is not preferable to fluoridated water. Fluoridated toothpaste does not act as an analgesic that relieves pain.

Evidence-based practice, a current health care trend, is best described as: 1 gathering evidence of mortality and morbidity in children. 2 meeting physical and psychosocial needs of the child and family in all areas of practice. 3 using a professional code of ethics as a means for professional self-regulation. 4 questioning why something is effective and whether there is a better approach.

4 questioning why something is effective and whether there is a better approach Evidence-based practice helps to focus on measurable outcomes and the use of demonstrated, effective interventions and questions whether there is a better approach. Gathering evidence of mortality and morbidity in children will assist the nurse in determining areas of concern and potential involvement. It is not possible to meet all needs of the family and child in all areas of practice. The nurse is an advocate for the family. This is part of the professional role and licensure

62. A sweat chloride test is used to diagnose CF. A chloride level greater than _____________________ is a positive diagnostic indicator of CF.

62. 60 mEq/L. The definitive diagnosis of CF is made when a patient has a sweat chloride test with a chloride level >60 mEq/L. A normal chloride level is <40 mEq/L.

The nurse finds that a child spends several hours each day playing video games and lives in a home environment with limited access to safe playgrounds and parks. What health risks does the nurse expect based on these findings? Select all that apply. Correct Incorrect A Tooth decay Correct Incorrect B Hypertension Correct Incorrect C Diabetes Correct Incorrect D Growth delays Correct Incorrect E Hypercholesterolemia

B, C, E A child's home environment with limited access to safe outdoor play areas and abundant access to television and video games is a major contributing factor for childhood obesity. Childhood obesity increases the risk for hypertension, diabetes, and hypercholesterolemia, among other conditions. Tooth decay is associated with poor dental care, not lack of exercise contributing to childhood obesity. Growth delays are associated with malnutrition, not lack of exercise contributing to childhood obesity

Which may be true of a child raised in an isolated secondary group, such as a church group? Select all that apply. A The child will get high level of material support from the church group. B The child will remain in a community within comparatively defined limits. C The child will have more concern from the church group for his development. D The child will tend to respond to any given situation in only one acceptable way. E The child will not have many opportunities to observe and absorb external cultural practices.

D, E If a child is brought up in the comparative seclusion of one secondary group, such as a church group or professional association, he or she tends to learn that there is only one suitable way to respond to any given circumstance. The child may get inadequate personal concern for his or her behavior. Therefore, he will not get sufficient opportunity to observe and absorb cultural practices. In primary groups such as peer groups or in a family, he will have high level of material support, more concern for his behavior, and would remain in a community within comparatively well-defined limits.

A child is measured to be 50 cm (20 inches) long when born. The nurse assesses the child's height after 13 years and confirms that the child has been growing at a normal rate. What should be the child's approximate height in centimeters at the age of 13 years? Record your answer using a whole number. _____cm

On average, a child's height should triple from birth to 13 years of age. The child was 50 cm (20 inches) at birth, so at the age of 13 it would be 50 x 3 = 150 cm (59 inches).

In a calendar year, the total number of live births is 2,000, the number of still births is 25, the number of abortions within 3 months of gestational age is 20, total number of deaths under 6 months of age is 25, and total number of deaths under 1 year of age is 100. What is the infant mortality rate for that calendar year? Record your answer using a whole number. ______/1,000 live births

The infant mortality rate is the number of deaths during the first year of life per 1,000 live births. So, 100/2,000 = 50/1,000

The senior nurse instructed the student nurse to check the website, www.ndvh.org. Information about which topic will the student nurse find on this website? 1 Domestic violence 2 Malnourishment 3 Infant mortality rate 4 Hospital administration

1

What has had the greatest impact on reducing infant mortality in the United States? 1 Access to high-quality prenatal care 2 Decreased incidence of congenital abnormalities 3 Better maternal nutrition 4 Improved funding for health care

1

26. Nursing care management of the pediatric client with a diagnosis of mononucleosis should include which of the following? 1. Limit the child's visitors to family only. 2. Limit the child's activity to bedrest. 3. Limit the child's diet to clear liquids. 4. Limit the child's daily fluid intake.

*26. 1. Children with mononucleosis are more susceptible to secondary infections. Therefore, they should be limited to visitors within the family, especially during the acute phase of illness.* 2. Children with mononucleosis do not need to be forced to be on bedrest. Children usually self-limit their behavior. 3. Children with mononucleosis do not need a restricted diet. Often they are very tired and are not interested in eating. The nurse and family must ensure that the children are taking in adequate nutrition. 4. Children with mononucleosis usually have decreased appetite, but it is essential that they remain hydrated. There is no reason to restrict fluid.

29. The parent of a pediatric client with influenza is concerned about when the child will be able to return to school. The parent asks the nurse when the child is most infectious. Which is the nurse's best response? 1. "24 hours before and after the onset of symptoms." 2. "1 week after the onset of symptoms." 3. "1 week before the onset of symptoms." 4. "24 hours after the onset of symptoms."

*29. 1. Influenza is most contagious 24 hours before and 24 hours after onset of symptoms.* 2. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms. 3. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms. 4. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms.

39. An 8-month-old male twin is in the hospital with RSV. The nurse educated the parent on how to prevent the healthy twin at home from contracting RSV. Which statement indicates the parent needs further teaching? 1. "I should make sure that both my children receive Synagis injections for the remainder of this year." 2. "I should be sure to keep my infected son away from his brother until he has recovered." 3. "I should insist that all people who come in contact with my twins thoroughly wash their hands before playing with them." 4. "I should insist that anyone with a respiratory illness avoid contact with my children until the children are well."

*39. 1. Synagis will not help the child who has already contracted the illness. Synagis is an immunization and a method of primary prevention.* 2. RSV is spread through direct contact with respiratory secretions, so it is a good idea to keep the ill child away from the healthy one. 3. RSV is spread through direct contact with respiratory secretions, so it is a good idea to have all persons coming in contact with the child wash their hands. 4. RSV is spread through direct contact with respiratory secretions, so it is a good idea to have ill persons avoid any contact with the children until they are well.

44. Which of the following children is in the greatest need of emergency medical treatment? 1. A 6-year-old who has high fever, no spontaneous cough, and frog-like croaking. 2. A 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions. 3. A 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough. 4. A 13-year-old who has a high fever, stridor, and purulent secretions.

*44. 1. This child has signs and symptoms of epiglottitis and should receive immedi ate emergency medical treatment. The patient has no spontaneous cough and has a frog-like croaking because of a significant airway obstruction.* 2. This child has signs and symptoms of acute laryngitis and is not in a significant amount of distress. 3. This child has signs and symptoms of LTB and is not in significant respiratory distress. 4. This child has signs and symptoms of bac terial tracheitis and should be treated with antibiotics but is not the patient in the most significant amount of distress.

19. The parent of a pediatric client with asthma is talking to the nurse about administering the child's albuterol inhaler. Which statement by the parent leads the nurse to believe that the parent needs further education on how to administer the medication? 1. "I should administer two quick puffs of the albuterol inhaler using a spacer." 2. "I should always use a spacer when administering the albuterol inhaler." 3. "I should be sure that my child is in an upright position when administering the inhaler." 4. "I should always shake the inhaler before administering a dose."

19. 1. The parent should always give one puff at a time and should wait 1 minute be fore administering the second puff.

Which statement helps explain the growth and development of children? 1 Development proceeds at a predictable rate. 2 The sequence of developmental milestones is predictable. 3 Rates of growth are consistent among children. 4 At times of rapid growth, there is also acceleration of development

2 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.

13. A school-age child has been diagnosed with strep throat. The parent asks the nurse when the child can return to school. Which is the nurse's best response? 1. "48 hours after the first documented normal temperature." 2. "24 hours after the first dose of antibiotics." 3. "48 hours after the first dose of antibiotics." 4. "24 hours after the first documented normal temperature."

2. Children with strep throat are no longer contagious 24 hours after initia tion of antibiotic therapy.

A 3-month-old bottle-fed infant is allergic to cow's milk. The nurse's best option for a substitute is: 1 goat's milk. 2 soy-based formula. 3 skim milk diluted with water. 4 casein hydrolysate milk formula.

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

8. The parents of a 5-week-old have just been told that their child has CF. The mother had a sister who died of CF when she was 19 years of age. The parents are sad and ask the nurse several questions about CF and the current projected life expectancy. What is the nurse's best initial intervention? 1. The nurse should tell the parents that the life expectancy for CF patients has improved significantly in recent years. 2. The nurse should tell the parents that their child might not follow the same course that the mother's sister did. 3. The nurse should listen to the parents and tell them that the physician will come to speak to them about treatment options. 4. The nurse should listen to the parents and be available to them anytime during the day to answer their questions.

4. The nurse's best intervention is to let the parents express their concerns and fears. The nurse should be available if the parents have any other concerns or questions or if they just need someone with whom to talk.

41. A 6-month-old is admitted to the hospital with RAD. The nurse is assessing the child. Which of the following physical findings should be of most concern? 1. The baby has tachypnea. 2. The baby has mild retractions. 3. The baby is wheezing. 4. The baby is grunting.

41. 1. Tachypnea, an increase in respiratory rate, should be monitored but is a common symptom of RAD. 2. Retractions should be monitored, but they are a common symptom of respiratory distress and RAD. 3. Wheezing should be monitored but is a common symptom of RAD. *4. Grunting is a sign of impending respi ratory failure and is a very concerning physical finding.*

51. A 2-year-old is admitted to the hospital with croup. The parent tells the nurse that her 7-year-old just had croup and it cleared up in a couple of days without intervention. She asks the nurse why her 2-year-old is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response? 1. "Some children just react differently to viruses. It is best to treat each child as an individual." 2. "Younger children have wider airways that make it easier for bacteria to enter and colonize." 3. "Younger children have short and wide eustachian tubes, making them more susceptible to respiratory infections." 4. "Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed."

51. 1. All children should be treated as individuals when they are being treated for a particular illness. However, most children exhibit similar symptoms when they have the same diagnosis. Younger children have worse symptoms than older children because their immune systems are less developed. 2. Children have airways that are shorter and narrower than those of an adult. As chil dren age, their airways begin to grow in length and diameter. 3. Children are more prone to ear infections because they have eustachian tubes that are short and wide and lie in a horizontal plane. 4. Younger children have less developed immune systems and usually exhibit worse symptoms than older children.

What is the daily requirement of calcium for children 1 to 3 years of age? Record your answer using a whole number.

The recommended daily amount of calcium for children 1 to 3 years of age is 500 mg. This is essential for optimal growth and development of bones.

On assessing a large family, the nurse finds one of the adolescents is less peer-oriented, lacks autonomous inner controls, and does not tend to participate democratically in family interactions or depend on parents for advice. Which behavior of the adolescent will the nurse think to be uncharacteristic of an adolescent belonging to a large family? 1 Less peer orientation 2 Democratic participation 3 Autonomous inner controls 4 Depending on parents for advice

1 Peer orientation is typically seen in adolescents from large families. Democratic participation, developed autonomous inner controls, and depending on parents for advice are not normal behavioral patterns seen in adolescents from large families.

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: 1 completing the child's sentences. 2 listening attentively. 3 encouraging the child to speak slowly. 4 helping the child relax.

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

Which pattern of growth and development would be seen when a parent is working with a toddler to read the alphabet? 1 Sensitive 2 Sequential 3 Directional 4 Developmental

1 When the child is learning or training and going through psychologic changes, the child is going through the sensitive phase of development and growth pattern. Sequential growth patterns are definite growth patterns where the child crawls before standing and stands before walking. Directional development refers to early development and symmetrical growth along with central and peripheral nervous system development. Developmental pace focuses on growth patterns of the child as toddler, preschooler, and adolescent.

The nurse is caring for a child of Yemenite Jewish parents. The child is admitted to the hospital with a high fever. The parents tell the nurse that they followed their traditions and used garlic to try to cure the child. What would the nurse notice on assessment as a result of this treatment? 1 Blisters 2 Swelling 3 Abrasions 4 Lacerations

1 Application of garlic irritates the skin and may cause garlic burns. It may also cause blisters on the skin. Swelling may be indicative of an allergy. Abrasions may result from falling while playing. Lacerations may be caused by a motor vehicle collision

A mother observes that her 7-month-old infant bears full weight on the feet when held in a standing position. What is the reason for this? 1 It indicates that the child's growth and development is normal. 2 It indicates that the child will start walking within 2 months. 3 It indicates that infant physical development is occurring slowly. 4 It reflects that the infant's upper limbs are not developing properly

1 A 7-month-old infant bearing full weight on feet when held in a standing position is a normal developmental milestone. By 8 months the infant can readily bear weight on legs when supported and may stand holding onto furniture. It does not indicate that the infant may begin walking within 2 months. A 12-month-old infant can walk with one hand held. The observation does not indicate that the infant's physical development is slow. Nor do the assessment findings reflect that the infant's upper physical development has not occurred properly. The assessment findings are suggestive of age appropriate development in the child.

The nurse is caring for a child who is frequently hospitalized with either an injury or infection. On further assessment of the child's medical history, the nurse finds that the child had delayed immunization and malnutrition. What possible reason does the nurse consider for delayed immunization and malnutrition in the child? 1 Physical neglect by the parents 2 Severe illness of the child 3 Improper growth of the child 4 Physical abuse by the parents

1 A child who is physically neglected by parents may not get the attention to basic needs that he or she requires. Consequently, the child may have delayed immunization and malnutrition and frequently fall ill and develop infections. Delayed immunization and malnourishment are not caused by severe illness. Improper growth is a consequence of malnourishment, not the reason for malnourishment. Physical abuse involves causing injury to the child, not necessarily malnourishment or delayed immunization.

The nurse is caring for a child with a head injury. After a few days, the child is again hospitalized with a fractured leg. What could be the possible reason for the child's frequent injuries? 1 Physical neglect by the parents 2 Physical abuse by the parents 3 Aggressive behavior of the child 4 Low cognitive development

1 A child who is physically neglected by the parents is prone to frequent injury due to lack of supervision. A physically abused child typically has injuries such as burns or belt marks, not leg fractures and head injuries. An aggressive child usually harms his peers, not himself. Low cognitive development is indicated by reduced thought processes and reduced intelligence. Frequent injuries do not reflect low cognitive development.

The nurse finds that a newborn weighs 3 kg (7 lb). By the time the child reaches 2 years, she weighs 12 kg (26 lb). What would be the child's approximate weight by 6 years of age? 1. 20-22 kg (44-48 lb) 2. 27-29 kg (59-64 lb) 3. 30-32 kg (66-70 lb) 4. 36-38 kg (79-84 lb)

1 A newborn's weight quadruples by the age of 2-2.5 years, and thereafter it increases by 2-3 kg per year. Therefore, a child who weighs 12 kg at the age of 2 years will weigh approximately 20-22 kg at 6 years of age. Any weight more than 20-22 kg is more than the expected weight for children of 6 years of age. Therefore, body weight between 27-29 kg, or 30-32 kg, or 36-38 kg is overweight for the age group

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? 1 The amount of medicine is less. 2 The amount of medicine did not change, only its appearance. 3 Pouring medicine makes the medicine hot. 4 The glass changed shape to accommodate the medicine.

1 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 parents of a toddler state their child is having trouble sleeping. What is the nurse's best suggestion to improve sleep habits? 1 Using a transitional object. 2 Varying the bedtime ritual. 3 Restricting stimulating activities during the day. 4 Explaining away fears.

1 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 nurse has taught the parents of an 18-month-old child about the behavior of toddlers. Following the teaching session, the nurse asks the parents what they would do if their child accidentally falls down from a staircase and starts scolding the staircase. What response given by the parents indicates effective understanding? 1 "We would join the child in scolding the staircase." 2 "We would say to the child that it's bad to scold someone." 3 "We would advise the child to walk carefully on the stairs." 4 "We would make the child realize that it was the child's mistake."

1 According to Piaget, children have preoperational thoughts and feelings. The parents should be able to effectively respond to the toddler's thoughts and feelings. Animism is a preoperational thought in which the child scolds the inanimate objects such as a staircase for hurting the child. The parents can join the child in scolding the staircase. These painful events help the child to have significant memories for specific events and use them for problem solving. The child feels rejected when scolded. After scolding the stairs the parents can later advise the child to be careful while getting on the staircase. The child is too young to have logical thinking, so the child cannot realize the mistake.

The school nurse is called to attend to a 7-year-old child whose tooth is avulsed while playing. The nurse finds the avulsed tooth on the ground. What is the most appropriate step taken by the nurse? 1 Transport the child immediately to a dentist for further care. 2 Hold the tooth by its root and rinse it in running water to wash off dirt. 3 Insert the tooth back into the socket with the concave surface facing front towards the lip side. 4 Dispose of the tooth and apply a dressing on the wound to prevent infection.

1 An avulsed tooth should be replanted and stabilized as soon as possible to reestablish the blood supply. This increases the chances of the tooth being kept alive. Therefore, the child should be immediately transported to the dentist. The nurse should hold the tooth by its crown and rinse it under running water. Then the nurse should insert it back into the socket with the convex side facing front towards the lip side. Disposing of the tooth is not advisable as the tooth can be reimplanted.

The nurse is assessing a child who can count backward from 20 to 1. Based on the child's age, what concepts of conservation is the child able to determine? The child can: 1 Determine the permanence of an object's mass and volume. 2 Select the one face from a chart that is different from the rest. 3 Count marbles placed in different rows and decide whether they are equal. 4 Determine that the length is the same if objects placed differently

1 Children who are 8 to 9 years old will be able to count backward from 20 to 1. This age group understands conservation concepts and will be able to determine whether mass and volume are permanent. The 6-year-old child can identify a unique face in a chart. The conservation concepts of children who belong to the age group of 5 to 7 years are determined by asking them to count marbles by placing them in different rows. For children aged 6 to 7 years, conservation is determined by identifying the length of the object by placing it in different positions.

A community health nurse notices dental caries in a preschool child when conducting a routine dental check-up. The child's parent says "my son brushes his teeth regularly and drinks both bottled and filtered water." What should the nurse tell the parent to prevent dental caries? 1 "Always drink fluoridated water." 2 "Do not use fluoride toothpaste." 3 "Always use brush with hard bristles." 4 "Use hydrogen peroxide mouthwash."

1 Drinking fluoridated water is recommended for consumption to prevent tooth decay. Toothpaste with fluoride content can remove the plaque on teeth effectively and prevent infection to teeth and gums. Hard brushing and hydrogen peroxide are never suggested for cleaning the teeth as they do more harm than good

The nurse is assessing a child's functional self-care level and rates the child at a IV (four). What should the nurse document in the assessment? The child: 1 Is totally dependent in all aspects of self-care. 2 Needs assistance of someone for feeding. 3 Requires equipment or a device for self-care. 4 Is independent in all aspects of their self-care.

1 Grade IV (four) indicates that the child is totally dependent on others for all aspects of self-care. Grade II (two) indicates that the child requires assistance of others for some tasks. Grade I (one) indicates that the child requires equipment or a device for self-care. Grade 0 (zero) indicates that the child is able to take care of all their needs without assistance.

A community nurse is conducting an awareness program for parents of children older than 1 year of age. What should the nurse include in the teaching to prevent the most common cause of death in their children? 1 Teach measures to prevent injuries. 2 Encourage vaccination according to age. 3 Teach about prevention of dehydration. 4 Teach about early manage infections.

1 Injuries are the most common cause of death and disability to children in the United States. Parents and children should take measures to prevent injuries from motor vehicle accidents, falls, poisoning, choking, drowning, fires, and firearm accidents. Vaccination and health promotion measures are indirectly helpful in preventing injuries by keeping the children healthy. Diarrhea or infection is not the most common cause of death

The nurse preparing a nutritional teaching plan for the parents of a preschool child should include which information? 1 The quality of the food consumed is more important than the quantity. 2 Nutrition requirements for preschoolers are very different from requirements for toddlers. 3 Requirement for calories per unit of body weight increases slightly during the preschool period. 4 Average daily intake of preschoolers should be about 3000 calories.

1 It is essential that the child eat a balanced diet with essential nutrients. Requirements are similar for preschoolers and toddlers. Caloric requirement decreases slightly during the preschool period. Average intake for preschoolers is about 1800 calories each day

The nurse is preparing to administer an intramuscular immunization to a 5-year-old child. The child says to the approaching nurse, "Please don't do that. My blood can leak out from my body and I may die." Which is the best response of the nurse to the boy? 1 "I will apply a bandage; it will not allow blood to come out." 2 "Blood is in blood vessels and heart so it will not come out." 3 "Blood will not come out as clotting factors form a clot to stop it." 4 "Only a minimal amount of blood comes out in intramuscular injection."

1 It is important for the nurse to know that preschoolers have little knowledge about their internal anatomy and body boundaries. So, they believe that any intrusive procedures that break their skin integrity such as injections can lead to leaking out of their blood and they may die. Therefore, the nurse should talk about their fears and inform them that a bandage would be applied, which would stop the bleeding. The nurse should never use medical jargons like blood vessels, clotting factors, or intramuscular injection when speaking to a child. The child would not understand it and may become more confused.

When teaching an adolescent mother about risk factors for neonatal death, the most important factor is: 1 low birth weight (LBW). 2 injuries to the mother during pregnancy. 3 newborn obesity. 4 chronic illness of the mother.

1 LBW, which is closely related to early gestational age, is considered the leading cause of neonatal death in the United States. Injuries are the leading cause of death in children over age 1 year, with the majority being motor vehicle accident (MVA) injuries. Injuries to the mother and chronic illness are not the major causes of neonatal death.

Parents of a 12-year-old child inform the nurse that their child prefers spending more time with friends rather than with family members. What should the nurse inform the child's parents? "During this age, children: 1 Enjoy the company of their peers." 2 Do not like social gatherings." 3 Avoid interacting with others." 4 Are more focused on their studies."

1 Middle school-aged children tend to spend more time with their peers and enjoy their company rather than spending time with family members. Children 12 years of age and older want to be independent and tend to reject some of the parental values. The child is comfortable spending time with peers and interacting with them. Therefore the nurse cannot infer that children of age 12 years do not like social gatherings or interacting with others. Avoiding spending time with family members does not indicate that the children are more focused on their studies. However, peer influence may cause distraction from studies in some children during middle school age.

Infants most at risk for sudden infant death syndrome (SIDS) are those: Select all that apply. 1 who sleep supine. 2 who sleep prone. 3 who were premature. 4 with prenatal drug exposure. 5 with a cousin who died of SIDS.

2, 3, 4 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.

What should be the basis for ethical decision-making and professional self-regulation in clinical nursing practice? 1 Code of ethics 2 Personal values 3 Institutional rules 4 Cultural values

1 Nurses should use the professional code of ethics for professional self-regulation and guidance. The code is used as a guide for carrying out nursing responsibilities in a professional manner and for abiding by the ethical obligations of the profession. Nurses should not follow personal or emotional values for decision-making and providing care. Similarly, nurses should not rely solely on institutional rules for ethical decision-making purposes, though they should familiarize themselves with the policies of their institutions. Nurses should be aware of the values of different cultures to better connect with their clients and reduce cultural imposition. However, nurses must understand that values and beliefs vary with cultures, so this is not a reliable guide for professional decision making

A patient is put on a ventilator in the intensive care unit of a tertiary hospital for long-term care. While caring for the patient, the nurse continuously assesses the health status of the patient. How does this intervention affect the patient's outcome? It prevents: 1 pneumonia. 2 lung cancer. 3 cystic fibrosis. 4 pulmonary edema.

1 One of the major disadvantages of long-term ventilator care is ventilator-associated pneumonia. The nurse has to assess the patient for ventilator-associated pneumonia or for the early detection of respiratory complications due to ventilators. Lung cancer is not associated with ventilator support. Cystic fibrosis is due to defect in chromosome number 7. Pulmonary edema is not the main concern associated with ventilators in the ICU

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? 1 If an object is hidden, that does not mean that it is gone. 2 He or she cannot be fooled by changing shapes. 3 Parents are not perfect. 4 Most procedures can be reversed

1 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.

The nurse is caring for a child with a genetic disorder and is instructed to not give the child milk or milk products. What type of disorder does this child probably have? 1 Phenylketonuria 2 Sickle cell disorder 3 Down syndrome 4 Turner syndrome

1 Phenylketonuria is a disorder of impaired phenylalanine metabolism. Because milk acts as an environmental trigger for this condition, the nurse instructs the child to stay away from milk products. Sickle cell disorder is a genetic disorder in which abnormal red blood cells are seen in the child; milk has no effect on children with this type of disorder. Down syndrome is a genetic disorder caused by improper chromosomal growth in the prenatal stage, and milk has no effect on these children. Turner syndrome is a condition that affects a child's growth, so milk is not contraindicated in these children

Which best describes Piaget's cognitive stage of formal operations? 1 Deductive and abstract reasoning 2 Inductive reasoning and beginning logic 3 Transductive reasoning and egocentrism 4 Cause-and-effect reasoning and object permanence

1 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

The nurse is teaching a group of students about the midline-to-peripheral concept of growth. About which pattern of growth and development is the nurse teaching? 1 Proximodistal 2 Cephalocaudal 3 Differentiation 4 Sequential trend

1 Proximodistal is the development pattern in which the children master the ability to use their hands before they can use their fingers. Cephalocaudal development is the pattern in which development of the head comes before the tail portion is developed. Differentiation is the complex development of the body organs and organ systems. A sequential trend of development describes the development of a baby in a sequential order (e.g., a baby crawls before walking).

The nurse is teaching the parents of a 5-year-old child about the importance of providing sex education to children. What suggestion should the nurse include in the teaching? 1 Read age-appropriate sex education booklets along with the child. 2 Change the topic when the child asks questions about sex. 3 Use fanciful expressions to answer the child's questions. 4 Tell the child that they will learn the details as they get older.

1 Sex education makes the child more responsible. Age-appropriate sex education booklets are available in public libraries. These books help satisfy the curiosity of children. Parents should not change the topic when a child asks about sex, because doing that may cause the child to ask an inappropriate person those questions. Honesty should always be maintained while answering the child's questions; using fanciful expressions is not advised. Telling the child that she will learn about these issues as she gets older may just enhance her curiosity and prompt her to get the information from other sources

The nurse assesses a child born to a patient with epilepsy and notices teratogenic effects in the baby. Which factors should the nurse assess to determine the cause of the teratogenic effects? 1 The medication history of the patient 2 The presence of environmental triggers 3 Abnormal CCR5 gene found in the patient 4 A family history of genetic abnormalities

1 Teratogenic effects are caused by teratogens. They are agents that cause birth defects when exposed to embryos in the uterus. Teratogens include medications, illicit drugs, metabolic agents, physical agents, and infective agents. Antiepileptic drugs such as phenytoin are potent teratogens, and therefore the nurse should obtain the patient's medication history. Exposure to this medication in uterus would be the most probable cause for the child's birth defects. Environmental factors can trigger genetic disorders, but they do not cause teratogenic effects in the baby. CCR5 gene activity is related to the transmission of human immunodeficiency virus. Genetic abnormalities in the patient's family history may affect the growth of the baby, but they are not considered teratogenic activity in the prenatal environment.

What is the corresponding stage of spiritual development of a child who states, "All women with big stomachs have babies"? 1 Mythical-literal 2 Undifferentiated 3 Synthetic-convention 4 Individuating-reflexive

1 The child is exhibiting transductive reasoning by saying, "All women with big stomachs have babies." In transductive reasoning, the child transfers the knowledge of one characteristic to another situation. This type of reasoning is seen in the preoperational phase of development, which corresponds with the mythical-literal phase of Fowler's spiritual development theory. The sensorimotor stage, during which the child develops a sense of cause and effect, corresponds with the undifferentiated phase of Fowler's spiritual development theory. In the concrete operations stage when the child begins to develop logic, the child experiences synthetic-convention according to Fowler's spiritual development theory. The individuating-reflexive phase of Fowler's spiritual development theory corresponds with the formal operations stage in which the child develops deductive and abstract reasoning.

The nurse is preparing to administer a vaccine to a child. The child is refusing to take the vaccination because of fear of bleeding. What should the nurse do in this situation? 1 Tell the child he or she can pick the bandage color. 2 Tell the child bleeding will stop in a few seconds. 3 Request a staff member sit beside the child. 4 Give a favorite toy to the child for distraction

1 The child is refusing to take vaccination because of fear of bleeding and pain. The nurse should ask the child to select the color of the bandage to be used. This reassures the child and will make him or her feel better. Even if the nurse tells the child that the bleeding will stop when the needle is removed, it does little to help relieve the child's fear. The nurse should not scold the child in a firm tone because the child may get frightened. Giving a favorite toy to the child for playing is not helpful for relieving the fear. A favorite toy may help the child sleep at night. Requesting a staff member sit beside the child may not be helpful for relieving the child's fear. It may be needed to help hold the child still during a procedure.

A parent of a preschooler informs the nurse that the child spends most of the time watching television and playing computer games. On assessing, the nurse finds that the child has impaired motor skills. Which instruction should the nurse give to the parent to improve the child's motor skills? 1 Encourage the child to play in a water park. 2 Involve the child in dramatic games such as dressing up. 3 Encourage the child to make articles using clay. 4 Engage the child to indulge in memory games such as puzzles

1 The child should be encouraged to play in a water park because it helps in muscle development and increases motor skills. Games such as dressing up help in socializing the child, but they do not help in developing their motor skills. Making articles using clay is suggested to help in the development of motor skills in a toddler but not a preschooler. Memory games such as puzzles improve the cognitive thinking of a child.

The nurse is caring for a newborn who weighs 3 kg (7 lb). The nurse assesses the child 4 years later and notes that the child weighs 13 kg (30 lb). What should the nurse do with this information? 1 This finding is normal; continue to monitor. 2 Instruct the parents to provide supplements. 3 Assess the child for nutritional deficiencies. 4 Talk to the police about parental neglect.

1 The child should gain 2-3 kg per year between birth and 4 years of age. The newborn's weight was 3 kg (7 lb), so 4 years later it should be 11-15 kg (24.2-33.0 lb). Because the child falls within the expected range for weight, the nurse should continue to monitor at regular office visits. The parents do not need to provide nutritional supplements. This would be done if the child were underweight. The nurse does not need to assess the child for nutritional deficiencies because the child has a normal weight. The nurse does not need to contact the police about parental neglect because the child has had normal weight gain.

The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. The nurse should recommend that: 1 fluids in addition to breast milk are not needed. 2 water should be given if the infant seems to breastfeed longer than usual. 3 water once or twice a day will make up for losses caused by environmental temperature. 4 clear juices would be better than water to promote adequate fluid intake.

1 The child will breastfeed according to needs. Additional fluids are not necessary for the breastfed baby. Supplemental water should not be given. The American Academy of Pediatricians does not recommend water supplements for breastfed babies during the first six months of life regardless of environmental temperature. Supplements are only necessary if there is a medical condition. Clear juices do not provide sufficient caloric or nutrient intake and may interfere with breastfeeding

A parent expresses to the nurse that the parents delayed sending their child to school because the child did not want to leave home. What information should the nurse give to the parent to improve the child's adaptability to school? 1 "I know it is hard to see your child mature, but you need to let your child go to school." 2 "Enroll the child as well as the child's best friend in the school at the same time." 3 "Provide special care and a lot of attention to the child at home after school." 4 "Let the child be at home until the child feels comfortable attending the school."

1 The child's adaptation to school is a major milestone for the developmental stage. The child's adaptation to school depends on various factors. Clinging behavior by the parents is a major factor. This behavior prevents the child from becoming mature and adapting to the school. It is not necessary to enroll the child with a friend; the child may develop relations once adapted to the school. Special care and extra attention is not required for a child with normal growth and development. Delaying the schooling would hamper the cognitive development in the child. Therefore the parents should enroll the child in the school as per the age.

A child is hospitalized for treatment of the flu. Once the child's parents leave, the child starts crying, looks for parents, attempts to leave, refuses to take medicine, hits other children, and breaks toys. What should the nurse conclude from the child's behavior? The child is in the: 1 Protest stage. 2 Despair stage. 3 Denial stage. 4 Detachment stage.

1 The child's behavior indicates that the child is in the protest stage of separation anxiety. The child is less able to cope with separation because of stress from the illness and wants to stay with the parents. The child expresses anger indirectly by showing behavioral changes. These behavioral changes are observed in the protest stage of separation anxiety. In the despair stage, the child appears less active, depressed, and uninterested in play and refuses to eat food. The denial stage is also called the detachment stage. In this stage the child is interested in the surroundings, plays with others, and forms new but superficial relationships with others.

A couple who has two children and wishes to follow the teachings of the Roman Catholic Church seeks advice from the nurse regarding family planning. Which is an appropriate nursing action? 1 Advising them to avoid sexual intercourse in the fertile period of her menstrual cycle 2 Informing them that using both oral contraceptive pills and condoms is most effective 3 Advising them to take oral contraceptive pills and giving information regarding abortion 4 Recommending an intrauterine device (IUD), as it works for a long duration and has few adverse effects

1 The couple follows the teachings of the traditional Roman Catholic Church, which prohibits the use of contraceptives; therefore, the nurse should advise the couple to avoid sexual intercourse during the woman's fertile periods of her menstrual cycle to prevent pregnancy. Using contraceptives such as oral contraceptive pills, condoms, or IUDs or having an abortion are prohibited by the teachings of the Roman Catholic Church.

A 4-month-old infant is scheduled for heart surgery. Which nursing action is most appropriate to follow 2 hours before the surgery? 1 Place a pacifier in the infant's mouth to suck. 2 Give a toy cell phone to the infant to play with. 3 Place a bottle of milk in the infant's mouth to suck. 4 Give a doll to the infant to play with. 5 New Choice

1 The infant should not be given any foods or fluids by mouth before surgery. In this situation, the nurse should place a pacifier in the infant's mouth to suck because satisfying the sucking need is the priority at this age. Although giving a doll to play with or giving a mobile phone to watch is age appropriate, the sucking need is the priority. The nurse should not place a bottle of milk in the infant's mouth to suck because the infant should receive nothing by mouth before surgery.

The nurse is obtaining the admission history of a recently admitted adolescent. The nurse notes the patient requires help inserting contact lenses. Under which functional health pattern should the nurse record this observation? 1 Activity-exercise pattern 2 Cognitive-perceptual pattern 3 Nutrition-metabolic pattern 4 Health perception-health management pattern

1 The nurse records the admission history of the patient in terms of different functional health patterns. This helps in documenting all the required information about the patient. The patient requires help inserting his or her contact lenses. This implies that the patient needs support to perform an activity. The nurse should record this information under the activity-exercise pattern. The cognitive-perceptual pattern recognizes the cognitive development in the child and includes information such as defects in vision, hearing, or grading in the school. The nutrition-metabolic pattern is used in the assessment of nutrition in the patient, food allergies, and food intake habits. The health perception-health management pattern reports the medication and the health history of the child.

The nurse is completing the admission assessment of a patient. The nurse shows the patient the playroom but calls it the activity room. Which age-group does this patient belong to? 1 Adolescent 2 Preschool age 3 Early school age 4 Middle school age

1 The nurse should try to make the hospital environment comfortable for the patient. The adolescent may find it a bit difficult to perform activities in a playroom because these activities are primarily for kids. Therefore the nurse should replace the term playroom with activity room. This encourages adolescents to use the room for activities. For a preschooler, playroom would be the best place to perform their activities and be stress relieved. Similarly, early school-age and middle school-age children would find the playroom a comfortable place.

A couple who is going through a divorce asks the nurse how to disclose this news to their 4-year-old child. What would be the nurse's best response? 1 "You should sit down and calmly explain the situation to your child." 2 "You should not discuss it with the child until after the divorce is final." 3 'You should ask the grandparents or another relative to break the news." 4 "You should take your child to see a psychiatrist to break the news."

1 The parents should set aside time and explain the separation to their child. They should answer the child's questions and give the child time to absorb the information. The parents should not hide the information from the child because it can damage trust between the parents and the child. It is healthier when the child finds this out from parents rather than somebody else, whether it is the grandparents or a psychiatrist

What should the nurse recommend to help a toddler cope with the birth of a new sibling? 1 Give the toddler a doll on which he or she can imitate parenting. 2 Discourage the toddler from helping with care of new sibling. 3 Prepare the toddler for upcoming changes about 1 to 2 weeks before birth of the sibling. 4 Explain to the toddler that a new playmate will soon come home.

1 The toddler can participate in the activity of caring for a new family member or imitate parenting through caring for a doll. 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. Telling the toddler that he or she will have a new playmate establishes unrealistic expectations

Which statement is correct about young children who report sexual abuse? 1 They may exhibit various behavioral manifestations. 2 In most cases, the child has fabricated the story. 3 Their stories are not believed unless other evidence is apparent. 4 They should be able to retell the story the same way to another person.

1 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.

Which statement describes the growth and development in a 24-month-old child? The child can: 1 Go up and down stairs alone. 2 Run clumsily and frequently falls. 3 Jump in place using both feet. 4 Walk upstairs holding one hand to the side grill.

1 Toddlers are children between the ages of 12 to 36 months. During this period, rapid growth and development can be observed in the child. At the age of 24 months, the gross motor functions are developed and the child is able to go up and down stairs alone with two feet on each step. At the age of 15 months, the child is able to run but is clumsy and falls often. At the age of 18 months, the child can jump in place with both feet and walks upstairs with one hand held

When completing the health assessment for a 2-year-old child, the nurse should expect the child to: 1 engage in parallel play. 2 fully dress self with supervision. 3 have a vocabulary of at least 500 words. 4 be one third of the adult height.

1 Two-year-olds typically play alongside each other. 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 nurse is educating a group of mothers about injury prevention for infants. Which statements by the nurse indicate effective teaching? Select all that apply. 1 "A smoke detector should be installed in the home." 2 "The floor should be clean where the child crawls." 3 "Diaper pins should be kept away from the child." 4 "Pour hot liquids in a cup with the child sitting on your lap." 5 "Heat the Infant formula before giving it to the infant."

1, 2, 3 The nurse should teach the parents about the precautions that should be taken for preventing injury to the infant. A smoke detector should be installed in the home to help in identifying fire and hence prevent a burn injury to the infant. Infants of about eight months have the ability to use their fingers and thumbs in opposition and this enables them to pick up small objects. So, the infant may put objects into their mouth and aspirate the object. To prevent this problem, the floor should be clean where the child is crawling. Diaper pins may cause injury to the infant. Therefore, diaper pins should be in a closed case and kept away from the child. Hot liquids may cause burn injuries to the child. The mother should be advised to not pour hot liquids when the child is sitting on her lap. Infant formula should not be heated before giving to the infant, as it can cause burn injury in the oral cavity.

The nurse is assessing a toddler's psychosocial development using Erikson's theory. What should the nurse include in the evaluation? Select all that apply. 1 Gross and fine motor skills 2 Mental acuity and capability 3 Level of doubt and shame 4 Competition with others 5 Inadequacy or inferior feelings

1, 2, 3 The stage in Erikson theory of psychosocial development that is used for toddlers (1-3 years) is autonomy versus shame and doubt. In this stage the toddler's motor skills, such as walking and climbing, are evaluated. The toddler's mental acuity and thought processes are also evaluated. The toddler develops negative feelings of doubt and shame when feeling low at this stage of growth. In the middle childhood growth pattern, the child tends to compete with others, aiming to accomplish tasks. This stage is referred to as industry versus inferiority in child. Inadequacy or inferiority complexes arise in this stage when parents impose huge expectations on the child. They tend to feel inferior in this stage of development.

The pediatric nurse is providing first aid to a child. The child sustained minor injuries while playing on the ground, and has severe pain in the knee joint. Which of the nursing interventions in the care of the child come under atraumatic care? Select all that apply. 1 Controlling pain 2 Allowing the child's privacy 3 Respecting cultural differences 4 Fostering the parent-child relationship 5 Giving vaccination for preventing tetanus

1, 2, 3, 4 Atraumatic care refers to the provision of the therapeutic interventions that would minimize or eliminate a patient's physical and psychologic distress. Atraumatic care includes interventions to reduce physical distress such as pain control measures. Interventions such as allowing the child privacy, respecting cultural differences, and fostering the parent-child relationship are examples of interventions those are helpful in minimizing psychologic distress in the child. Preventive measures such as vaccination for preventing tetanus are not an intervention included in a traumatic care.

The nurse is instructing the parents of a 6-month-old child about the dietary requirements and factors that may influence the eating habits of the child. Which statement made by the nurse is appropriate? Select all that apply. 1 "Culture will have some influence on children's eating habits." 2 "Cholesterol is required for the synthesis of neurons in child's brain." 3 "During adolescence, children tend to make food choices for sociability." 4 "First 3 years of life are crucial in establishing eating habits of children." 5 "Cholesterol content is high in nuts and vegetable oils so use them sparingly."

1, 2, 3, 4 The nurse should inform the parents that culture has some influence on children's eating habits, and the child is likely to follow it. Cholesterol is required for the synthesis of neurons in the child's brain and should be included in the diet. During adolescence, children tend to make food choices for sociability and the first 3 years of life are crucial in establishing eating habits of children. Cholesterol is present only in animal products such as meat, milk, and eggs but not present in plant products.

The primary goals in the nutritional management of children with failure to thrive (FTT) are: Select all that apply. 1 allow for catch-up growth. 2 correct nutritional deficiencies. 3 achieve ideal weight for height. 4 restore optimum body composition. 5 educate the parents or primary caregivers on child's nutritional requirements. 6 educate the parents or primary caregivers that the child will need tube feedings first.

1, 2, 3, 4, 5 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 is 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 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. 1 Falls 2 Drowning 3 Poisoning 4 Sports injuries 5 Tricycle and bicycle accidents

1, 2, 3, 5 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.

The nurse is assessing a school-age child. The child stays with a parent who is recently divorced and has a meager income. The child does not like to mingle with other students at school. The child's performance is poor in studies and is cruel toward pets at home. Which factors in the child could most likely lead to pediatric social illness? Select all that apply. 1 Poverty 2 Pet cruelty 3 Single parent 4 Going to school 5 Behavior with others

1, 2, 3, 5 Pediatric social illness is a new morbidity in children. It refers to "the behavior, social, and educational problems that the children face". Poor socioeconomic status is a social problem. Animal cruelty is a behavioral problem. Problem within the family is a social problem Failure at school is an educational problem, and behavior with other children is also a behavioral problem. Any of these could cause pediatric social illness. Going to school does not cause social illness. It helps the child to gain knowledge, learn moral values, and to lead a successful life

What guidelines does the nurse follow while integrating spiritual care into pediatric nursing practice? Select all that apply. 1 Respect all religious beliefs and practices. 2 Discourage visits by the spiritual leaders. 3 Learn religious beliefs from children and families. 4 Develop awareness of nurse'sown spiritual perspective. 5 Understand the spiritual perspectives of the child.

1, 3, 4, 5 The guidelines a nurse has to follow in integrating spiritual care into pediatric nursing practice include respecting all religious beliefs and practice. It prevents bias in providing care to people across various religions. Learning religious beliefs from children and families helps the nurse to deliver culturally competent care. Developing awareness of the nurse's own spiritual perspective helps to prevent bias. Understanding about the spiritual perspective of the child's family is more important to understand the child. Visits of spiritual leaders should be encouraged to prevent hurting the sentiments of the patient.

Which instructions should the nurse give to the parents of a preschooler to promote optimal growth and development? Select all that apply. 1 Ignore focusing on the dysfluency of speech. 2 Anticipate a stable appetite. 3 Ignore the sexual curiosity of the child. 4 Provide up-to-date immunity. 5 Let the child deal with fears on his or her own.

1, 2, 4 Dysfluency in speech is normal in children during the preschool age. Therefore the nurse should suggest that parents avoid focusing on speech dysfluency. The digestive system is not well developed in the preschool child, so the child may have a more stable appetite. Therefore the nurse should prepare an appropriate diet plan. The immune system is not well developed in a preschooler. Therefore, to avoid the risk of communicable diseases, immunizations should be kept up to date. Preschoolers start identifying sexual differences between girls and boys and are curious about it. Therefore the parents should be advised to provide sex education to the child by using the sex education booklets. A preschooler cannot deal with fears on his or her own. Therefore children need emotional and moral support from an elder.

What appropriate growth and developmental changes can be observed in a toddler? Select all that apply. 1 The toddler is able to take a few steps on tiptoes by the age of 30 months. 2 The toddler can run fairly fast with a wide stance by the age of 24 months. 3 The birth weight doubles by 30 months of age. 4 The anterior fontanel closes at 18 months of age. 5 The toddler has daytime bowel and bladder control at 18 months.

1, 2, 4 Growth slows down considerably for the toddler age-group. The toddler may be able to jump with both feet, take a few steps on tiptoes at 30 months of age, and run fairly fast with a wide stance at 24 months of age. The anterior fontanel closes at 18 months of age. These changes indicate appropriate growth and development of child according to age. Birth weight quadruples at 30 months of age instead of doubling. Bowel and bladder control is attained at 30 months of age rather than 18 months.

What does the nurse instruct the parents to keep away from the child's diet when the child is receiving iron supplementation? Select all that apply. 1 Whole milk 2 Antacids 3 Fruit juice 4 Tea or coffee 5 Meat or fish

1, 2, 4 Iron-rich foods are recommended for all children older than 6 months of age. Sometimes iron supplementation may be necessary due to illness. Whole milk should be limited because it interferes with iron absorption. Antacids may increase the pH and interfere with iron absorption. Tannins present in coffee or tea decrease iron absorption. Vitamin C, present in fruit juice, increases the rate of iron absorption. Meat, fish, and poultry also increase the rate of absorption.

The nurse is preparing the playroom on a newly opened pediatric unit. Which items should the nurse include to foster the development of the preschool child? Select all that apply. 1 large blocks 2 alphabet flash cards 3 100-piece puzzles 4 dolls 5 hand puppets

1, 2, 4, 5 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.

The nurse is assessing a teenager who set a neighbor's house on fire, and is under the custody of the police. What is the nurse most likely to find while assessing the child's history? Select all that apply. 1 Mental depression and low mood 2 Association with violent groups 3 Difficulty in focusing on an activity 4 Harming animals when young 5 Trouble with the criminal justice system

1, 2, 4, 5 Nurses need to properly assess the adolescent who perform such activities that harm others. It is seen that such adolescents, are usually depressed or are associated with groups known to be violent. It is highly likely that these children had done harm to animals in the past. Such children tend to have inappropriate social behavior and are repeatedly in trouble with the criminal justice system. Difficulty in focusing on an activity is usually seen in children with attention-deficit hyperactivity disorder

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. 1 push-pull toys. 2 toys with black-white patterns. 3 pop-up toys, such as a Jack-in-the-box. 4 soft toys that can be put in the mouth. 5 toys that pop apart and go back together.

1, 3, 5 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 nurse is caring for a Vietnamese child and observes various marks on the child's body. When completing a thorough assessment, which applicable cultural practices should the nurse keep in mind? Select all that apply. 1 Coining 2 Cupping 3 Forced kneeling 4 Topical garlic application 5 Burning

1, 2, 5 Cultural practices possibly considered abusive by the dominant culture are: Coining—A Vietnamese practice that may produce weltlike lesions on the child's back when the edge of a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of disease; Cupping—An Old World practice (also practiced by the Vietnamese) of placing a container (e.g., tumbler, bottle, jar) containing steam against the skin surface to "draw out the poison" or other evil element. When the heated air within the container cools, a vacuum is created that produces a bruiselike blemish on the skin directly beneath the mouth of the container; Burning—A practice of some Southeast Asian groups whereby small areas of skin are burned to treat enuresis and temper tantrums; Forced kneeling—A child discipline measure of some Caribbean groups in which a child is forced to kneel for a long time; Topical garlic application—A practice of Yemenite Jews in which crushed garlic cloves or garlic-petroleum jelly plaster is applied to the wrists to treat infectious disease. The practice can result in blisters or garlic burns

The nurse is teaching a group of parents about therapeutic management for preventing plagiocephaly in the infant. What instructions should the nurse give to the parents? Select all that apply. 1 "Use a protective helmet for the infant." 2 "Alternate the infant's head position." 3 "Place the infant in side-lying position." 4 "Use soft bedding in the infant's crib." 5 "Place the infant prone when awake."

1, 2, 5 Plagiocephaly means an oblique or asymmetric head. Plagiocephaly is a condition acquired due to cranial molding during birth and infancy. Prolonged pressure on one side of the skull produces an asymmetrical distortion of the skull. The nurse should instruct the parents to use a helmet for the infant for decreasing the pressure on the skull. The infant's head position should be alternated to avoid pressure on the skull as well. The nurse should instruct the parents to place the infant in prone position when awake for preventing plagiocephaly and facilitating development of upper shoulder girdle strength. Placing the infant in the side-lying position may put pressure on one side of the head and lead to plagiocephaly. Using soft bedding may be more comfortable, but it can increase the risk of sudden infant death syndrome (SIDS).

What are the ways the nurse may help a family meet its needs based on family strength and functioning styles? Select all that apply. 1 Providing individualized support 2 Strengthening the family resources 3 Helping to delineate the individualized work 4 Training the family members to avoid stressful events 5 Building on qualities that make family function in a better manner

1, 2, 5 Providing individualized support, strengthening the family resources, and building on qualities that makes the family work better are the ways a nurse may help the family to meet its demands. Efforts should be made to share work in groups rather than delineating work. Families actually cope and respond to stressful events, which has to be identified and appreciated.

What does the nurse include in a program designed to teach parents and children about preventing childhood poisoning? Select all that apply. 1 Appropriate first aid care at home 2 Adequate supervision by parents 3 Self-administration of medicines 4 Reuse of empty medicine bottles 5 Safe storage of hazardous materials

1, 2, 5 The National Poison Control organizes the poison prevention programs used by health care workers. They recommend some guidelines for prevention and early treatment of poisoning cases. They educate parents about first aid care and how to call the poison control center. Adequate parental supervision is needed over children so that children are not left alone to get into poisonous substances. Safe storage of hazardous materials with warning labels helps to prevent accidental poisoning so that children can be taught to stay away from these items. The parents should not allow children to self-administer medicines. Medicine should always be given by a parent or caregiver. Empty medicine bottles should not be used even as part of play as this can lead to poisoning.

What social support and community resource needs of a single-parent family should the nurse be aware of? Select all that apply. 1 Need for parent enhancing centers 2 Need for evening and weekend health care services 3 Concern for sexual deprivation of the parent 4 Promoting translocation of a child to foster care 5 Need for respite child care centers

1, 2, 5 The social supports and community resources needs of a single-parent family include the need for parent enhancing centers to improve the parenting techniques. Evening and weekend health care services would help to meet the healthcare needs of the family. Respite child care should be used to relieve parental exhaustion. Sexual deprivation of the parent should not be a major concern, and can be managed with mutual discussion. Foster care is not a good practice over single parenting

During the home visit, the nurse finds that the parent of a 2-year-old child is serving food to the child immediately after coming in from play. The parent reports that the child avoids eating and has a reduced growth rate. What are appropriate responses given by the nurse? Select all that apply. 1 "Don't worry, children of this age have a reduced growth pattern." 2 "Children are too busy playing and exploring their world to eat." 3 "You should call the child in from play 15 minutes before meal time." 4 "Two-year-old children usually have a less developed taste sensation." 5 "Give some rewards to the child if the child finishes meals."

1, 3 Growth slows after the child is 2 years old. The child generally does not eat as much as during infancy; this is called physiologic anorexia, which is typical of this age group. The child has reduced appetite during this age. The child must be called in from play 15 minutes before mealtime. It helps the child to get ready for eating by relaxing an active mind and body. Although the toddler may be too busy to eat, this is not why the growth rate slows. Two-year-old children do not lose their taste but they become choosy. The parents must be advised not to give rewards to the child for finishing the food. The child may start overeating for the rewards and it can cause obesity in the child.

Which developmental changes are observed in a 5-month-old infant? Select all that apply. 1 Birth weight has doubled. 2 The rooting reflex is present. 3 There are signs of tooth eruption. 4 Length has increased by 50% from length at birth. 5 Head and chest circumference are equal.

1, 3 Rationale:In a 5-month-old infant,the birth weight is doubled and signs of tooth eruption are observed. Theseare normal findingsaccording to growth and development. The rooting reflex disappears at 4 months and may not be observed in a 5-month-old infant. In a 12-month-old infant, the birth length is increased by 50% and the infant hasequal head and chest circumference.

Which patients in the pediatric unit are more susceptible to the influenza infection? Select all that apply. A patient with: 1 Childhood asthma 2 A skin infection 3 Cardiac disease 4 Sickle cell disease 5 Joint inflammation

1, 3, 4 Patients with asthma, cardiac disease, and sickle cell disease are more susceptible to influenza virus infection. Patients with asthma may have swollen and sensitive airways, and influenza can cause further inflammation of the airways and lungs. Patients with cardiac disease are more susceptible to the influenza infection because of an increased risk for flu-related complications. Patients with sickle cell disease are more susceptible to the influenza virus infection because of a lack of immunity. Patients with skin infection and joint inflammation do not have respiratory complications or deficiency of immunity. Therefore these patients do not have an increased risk for acquiring the influenza virus infection.

Children are taught the values of their culture through observation and feedback on their own behavior. A nurse teaching a class on cultural awareness-competence should be aware of which factor(s) that may be culturally determined? Select all that apply. 1 Social roles 2 Racial variation 3 Degree of competition 4 Determination of status 5 Geographic

1, 3, 4 Social roles are influenced by culture . Cultures that value individual resourcefulness/competition of status is acceptable. Determination of status is culturally determined and varies according to each culture. Racial variation refers to transmissible traits. Culture is composed of beliefs, values, practices, and social relationships that are learned. Cultural development may be limited by geography. The geographic boundaries are not culturally determined.

The community health nurse is advising the parents of an overweight child about some dietary modifications and the need for regular physical activity. If the parents follow the health advice of the nurse, what health risks can be prevented in the child? Select all that apply. Correct Incorrect 1 Diabetes Correct Incorrect 2 Epilepsy Correct Incorrect 3 Heart disease Correct Incorrect 4 Insulin resistance Correct Incorrect 5 Down syndrome

1, 3, 4 The population studies have revealed that overweight children or adults are at an increased risk for diabetes, insulin resistance, heart disease, hypertension, and hypercholesterolemia. Therefore, a low-calorie high-protein diet will help and physical exercises are recommended for them. Epilepsy is caused due to changes in the levels of neurotransmitters and it cannot be prevented by changes in the diet. Down syndrome is a genetic disorder and cannot be prevented by changes in the diet

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. 1 "I only smoke in the kitchen." 2 "I put my baby to sleep on her back." 3 "I have my baby sleep with me instead of alone in the crib." 4 "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." 5 "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night."

1, 3, 4, 5 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. 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.

What guidelines does the nurse follow while integrating spiritual care into pediatric nursing practice? Select all that apply. 1 Respect all religious beliefs and practices. 2 Discourage visits by the spiritual leaders. 3 Learn religious beliefs from children and families. 4 Develop awareness of nurse'sown spiritual perspective. 5 Understand the spiritual perspectives of the child

1, 3, 4, 5 The guidelines a nurse has to follow in integrating spiritual care into pediatric nursing practice include respecting all religious beliefs and practice. It prevents bias in providing care to people across various religions. Learning religious beliefs from children and families helps the nurse to deliver culturally competent care. Developing awareness of the nurse's own spiritual perspective helps to prevent bias. Understanding about the spiritual perspective of the child's family is more important to understand the child. Visits of spiritual leaders should be encouraged to prevent hurting the sentiments of the patient

Following an assessment, the nurse suspects that a child is subjected to emotional abuse. What interventions does the nurse perform to provide care to the emotionally abused child? Select all that apply. 1 Identify the instance of abuse or neglect. 2 Keep the child alone in a separate room. 3 Report the findings to the local authorities. 4 Tell the child's teacher about her condition. 5 Take care of the child's physical and developmental needs.

1, 3, 5 A child suffering from emotional abuse and neglect may have poor nutrition, low self-esteem, and reduced immunization. The nurse should inform the local authorities about the situation so they can prevent further abuse. The nurse should provide a balanced diet by enrolling the child in support programs and should take care of the child's needs for proper growth and development. The emotionally abused child may feel lonely. To improve socialization, the nurse should encourage the child to mingle with peers, not keep her alone in a separate room. The child may feel rejected and inferior if her teacher is informed of the situation.

A recently divorced parent asks the nurse what behavior the infant might display when the parents are going through a divorce. What is an appropriate response by the nurse? Select all that apply. 1 Demonstrates irritability 2 Manufactures yellow urine 3 Changes in sleep patterns 4 Decreases use of pacifier 5 Changes in elimination

1, 3, 5 All the children in a family are affected when a family goes through a divorce. The infant may not be able to verbalize the feelings, but this distress is manifested by irritability, disturbed sleep, eating, and elimination patterns. Yellow urine is a normal finding. There is no evidence that if an infant uses a pacifier, the use decreases when parents go through a divorce.

The nursing student who is posted in the pediatric unit asks the nurse, "Which behaviors would be expected in 8-month-old infants?" Which appropriate answers does the nurse state to the nursing student? Select all that apply. The child: 1 "Can play peek-a-boo." 2 "Can drink from a cup." 3 "Exhibits stranger anxiety." 4 "Can remove some clothing." 5 "Can stand by holding furniture."

1, 3, 5 At this age the infant can play peek-a-boo. It is a typical behavior of an 8-month-old infant. The infant can easily understand that the person is still there even when the person is out of sight. An 8-month-old infant exhibits stranger anxiety. Stranger anxiety shows a good relationship between infant and parent. At this age the infant can stand by holding furniture. An 8-month-old infant is not able to drink from a cup or remove clothes. These activities require more muscle coordination, which will not be achieved by the infant at this age. A 12-month-old infant is able to drink from a cup. An 18-month-old infant is able to remove clothes.

A parent of a toddler reports to the nurse that the child always says no at mealtimes. Which corrective actions does the nurse suggest to the parent? Select all that apply. 1 Meals should be set at regularly scheduled times. 2 Show inconsistency in behavior with their children. 3 Decrease the opportunities for a negative answer. 4 Allow the child to eat whenever the child wants to. 5 Feed the child with the child's favorite plate and spoon.

1, 3, 5 During the early toddler age, the rate of growth slows down and decreases the amount of calories, proteins, and nutrients needed by the child. Toddlers also do better with a structured schedule. These two reasons may affect the feeding behaviors of the child. The nurse should instruct the parents that mealtimes should be established at the same times every day. The parents should give simple choices to their child to prevent the scope for negativism. Allowing the child to eat food with the child's favorite plate and spoon may provide structure to the child and increase their cooperation in eating. Parents should show consistency in parenting and have developmentally appropriate expectations form the child. Allowing the child to eat whenever the child wants to may cause the child to be full from snacks at mealtime.

The nurse is explaining play therapy to the parents of a child who has been admitted to the hospital. What information given by the nurse regarding play therapy is appropriate? Select all that apply. 1 Provides diversion from the disease condition. 2 Does not provide an opportunity to make choice. 3 Increases the feeling of security in a strange environment. 4 Does not help in accomplishing the therapeutic goals. 5 Encourages interaction and positive attitude towards others.

1, 3, 5 Engaging children in play within the hospital distracts them from the disease and makes them feel relaxed in a different environment. Another important purpose of play therapy is to make the children become comfortable and feel secure within the hospital. Play encourages interaction between children and fosters a positive attitude towards others. Play in the hospital provides an opportunity to make choices for themselves. Play in the hospital provides a means for accomplishing the therapeutic goals.

The nurse finds a child to be unmotivated and disheartened due to dysfluency in speech. What advice should the nurse give the parents to build the child's confidence in speaking? Select all that apply. 1 Speak to the child in a slow and relaxed way. 2 Persuade the child to speak at a faster pace. 3 Listen attentively to what the child says. 4 Keep talking to the child continuously. 5 Resist completing the child's sentences.

1, 3, 5 The child with dysfluency cannot talk rapidly and may feel inferior. To avoid these feelings, the parents should talk in a slow and relaxed tone. This improves the self-esteem of the child. The child must be encouraged and motivated to speak by carefully listening to what she has to say. Resisting the completion of sentences builds confidence in the child. Making the child speak faster would add pressure, further demotivating the child. Talking continuously and not letting the child speak would hurt the child's self-esteem and reduce her speaking confidence

Parents inform the nurse that they had noticed some needle injuries on their child's left elbow and some syringes and needles in the child's school bag. What should the nurse suggest to the child's parent? Select all that apply. 1 Encourage the child to participate in scouts. 2 Discourage the child from participating in sports due to injury. 3 Encourage the child to participate in church activities. 4 Provide first aid to the child and apply bandage to elbow. 5 Educate the parent and children about the ill effects of drugs.

1, 3, 5 The nurse should understand that the child is taking to illicit drugs. Preventive measures to reduce the youth's illicit drug use include encouraging participation in organized sports, scouts, and other church activities. The children and parents should be educated on the ill effects of drugs. Sports are not contraindicated and first aid is not a preventive measure.

The nurse is assessing a 5-year-old obese child and finds that the child has unusual eating habits. What advice should the nurse give to the parents to help improve the child's health? Select all that apply. 1 Play outdoor games with the child. 2 Exclude fiber from the child's diet. 3 Compare the child to peers. 4 Provide skim milk in the child's diet. 5 Supplement fruit juices in the child's diet.

1, 4 Obesity is usually caused by inadequate physical activity and unhealthy food habits. Therefore the child should be involved in playing outdoor games. Skim milk is low in fat content and should be included in the child's diet. Fiber helps keep the gastrointestinal system healthy. Fiber does not contribute calories to the diet and should be included in the child's diet. Comparing the child to peers at this age may emotionally hurt the child. Excessive consumption of fruit juices should be avoided as they are calorie-dense.

The nurse is counseling a married couple with a child. How should the nurse respond if the couple says that they are opting for divorce? Select all that apply. 1 Custody will be given to the parent best able to provide for the child's welfare. 2 The mother can provide the best care for the child and should take custody of the child. 3 Initial disclosure of the divorce should be done by the third party. 4 Initial disclosure of the divorce should include both parents and child. 5 The discussion should be healthy, and arguments are to be avoided during the discussion.

1, 4, 5 Custody should be given to the parent best able to provide for the child's welfare while permitting visitation of the other parent. Initial disclosure of the divorce should include both parents and child so that information is transparent to all family members. The discussion during the divorce should be healthy. Arguments between the spouses should be avoided during the discussion. It is not always true that the mother can provide the best care to the child. Careful assessment regarding which parent is best able to provide for the child's welfare should be done to decide about the custody of the child.Parents themselves rather than third party are preferred for initial disclosure of divorce as the information given by the third party cannot be relied upon

Which health promotion teaching points should a nurse include in a teaching plan to help prevent dental caries? Select all that apply. 1 Drink fluoridated water. 2 Begin dental hygiene after eruption of both front teeth. 3 Schedule regular dental appointments after age 2. 4 Give client dates and locations of free dental clinics. 5 Dental caries are preventable.

1, 4, 5 Dental caries is the single most common chronic disease of childhood. Nearly one in five children between the ages of 2 and 4 years has visible cavities. The most common form of early dental disease is early childhood caries, which may begin before the first birthday and progress to pain and infection within the first 2 years of life. Preschoolers of low-income families are twice as likely to develop tooth decay and only half as likely to visit the dentist as other children. Early childhood caries is a preventable disease, and nurses play an essential role in educating children and parents about practicing dental hygiene beginning with the first tooth eruption; drinking fluoridated water, including bottled water; and instituting early dental preventive care

The nurse is assessing a child with a mitochondrial disorder. What should the nurse communicate to the child's parents? Select all that apply: 1 Explain that it is a disorder that can happen in subsequent births. 2 Explain that all future generations of the family will be affected. 3 Explain that this disorder can be cured by medication. 4 Rule out any abnormal causes in the parents' minds. 5 Give the couple information about family planning.

1, 4, 5 Mitochondrial disorders are usually inherited, and they have a high chance of recurrence. When these disorders are seen, parents usually believe it is something they did wrong, such as drinking a glass of wine during pregnancy. The nurse should make the parents aware of techniques such as the use of donor eggs or sperm for future pregnancies. Mitochondrial disorders do not necessarily affect future generations. Mitochondrial disorders cannot be cured by medication but can be managed with medications.

What cultural competencies should the nurse possess for providing culturally competent care? Select all that apply. 1 Cultural desire 2 Cultural density 3 Cultural behavior 4 Cultural awareness 5 Cultural knowledge

1, 4, 5 The cultural competencies a nurse should possess are cultural desire, cultural awareness, and cultural knowledge. Cultural desires refer to the motivation of the nurse to work effectively with minority patients. Cultural awareness refers to the cognitive process due to which the nurse is sensitive to the familial and cultural norms. Cultural knowledge refers to the knowledge that the nurse acquires by formal and informal education regarding different cultures and their views. Culture density and behavior are not the components of culture.

A community nurse is educating parents regarding calcium and vitamin D requirements for children aged 1 to 8 years. What information should be included in the session? Select all that apply. 1 Daily calcium requirement for children aged 1 to 3 years is 500 mg. 2 Daily calcium requirement for children aged 1 to 3 years is 800 mg. 3 Daily calcium requirement for children aged 4 to 8 years is 500 mg. 4 Daily calcium requirement for children aged 4 to 8 years is 800 mg. 5 Milk and its products are excellent sources of vitamin D and calcium.

1, 4, 5 The daily calcium intake for a child aged 1 to 3 years should be 500 mg and a child aged 4 to 8 years should take in 800 mg of calcium daily. Milk and milk products are excellent sources of both calcium and vitamin D. Low-fat milk can be substituted as the child will get same amount of calcium with reduced fat content.

The nurse is counseling the parents of a child who has to be hospitalized for a surgery. The nurse teaches the parents about possible behavioral changes that may happen in the child after hospitalization. What should the nurse include in this discussion? Select all that apply. The child may: 1 Show jealousy toward siblings. 2 Need less attention when discharged. 3 Have the tendency to sleep all day long. 4 Report having nightmares at night. 5 Demonstrate aggressive behaviors.

1, 4, 5 The nurse should remind the parents that their child may feel jealous toward his or her siblings for being close with the parents when he or she is hospitalized. The nurse should also tell the parents that the child may have nightmares. Nightmares are a manifestation of fear of change that has developed. This separation anxiety may lead the child to behave in an aggressive manner with the parents. The nurse should instruct the parents to pay attention to the child when discharged from the hospital because the child may expect more attention from the parents. The nurse should also inform the parents that child may have difficulty sleeping when back at home.

A female patient tells the nurse, "I am well educated and would like to start working full-time like my husband." How should the nurse respond? Select all that apply. 1 "You might potentially get really stressed with work and house chores." 2 "You may at times direct your stress toward children." 3 "Dual income would help you to lead a joyous life." 4 "You may not have adequate time for social activities." 5 "You may have problems fulfilling time demands

1, 4, 5 Work overload is a common source of stress in a dual-earner family as both partners need to share the household chores. Social activities are significantly curtailed as most time is devoted in meeting the responsibilities of the household. Time demands and scheduling are major problems for all individuals who work. Dual income provides more economic stability rather than making them happy. It is usually an indirect stress to the child.

The nurse is caring for a 4-year-old child with severe injuries. The parents of the child inform the nurse that the child is afraid of the dark and does not like to go to bed alone. Which intervention should the nurse follow for encouraging the child to sleep alone and cope with fear? Select all that apply. 1 Leave a night lamp on in the child's room. 2 Tell bedtime stories to the child. 3 Teach deep breathing exercise to the child. 4 Seek professional help. 5 Assure the absence of monsters.

1, 5 Children who are 4 years old may fear the dark and believe that monsters will harm them in the dark, so they sometimes refuse to sleep alone in the night. In order to overcome the fear, a night lamp can be left on in the child's room, and the nurse should assure the absence of monsters in the room. Bedtime stories help hyperactive children fall asleep, but they are not an appropriate intervention for the child who is afraid of the dark. Teaching deep breathing techniques helps reduce stress and anxiety in the child, but it does not encourage the child to sleep alone. Fear of darkness and monsters is common at this age, so professional help is not required for the child.

The nurse is teaching a group of nursing students about growth and development in school-age children. Which activities give information about adaptive behavior in a 12-year-old child? Select all that apply. The child: 1 Is able to do easy repair work. 2 Spends a lot of time alone. 3 Helps with household tasks. 4 Counts backward from 20 to 1. 5 Looks after own needs and others.

1, 5 The growth and development of a 12-year-old child indicates an ability to perform easy repair work and look after own needs. These activities indicate the child has adaptive behavior. The child spending a lot of time alone depicts a personal-social development of a 7-year-old child. Readiness and ability to help with household tasks such as dusting is seen in children as young as 9 years. The 8- to 9-year-old child counts backward from 20 to 1, which shows the child's mental development.

The nurse includes mastery motivation in the plan of care to help an infant be more cooperative and less difficult. Which activities should the nurse do to achieve this goal? Select all that apply. 1 Provide early kinesthetic stimulation. 2 Give immediate assistance when asked. 3 Initiate an activity for the infant. 4 Provide controlling feedback during play. 5 Give praise when the infant accomplishes a task

1, 5 The nurse can include mastery motivation in order to make an infant more cooperative and less difficult. The nurse should provide kinesthetic stimulation such as picking up objects. Nurses should give praise when an infant accomplishes a task, especially the first few times. The nurse should allow the child to do the task rather than giving immediate assistance. The nurse should let the child initiate his or her own activity as part of mastery motivation techniques. Infants should be allowed to play on their own, and the nurse should give feedback after the game or task.

A 5-year-old child presents with a fever, cough, and flu-like symptoms. On examination, the nurse finds that the child's temperature is elevated and respiratory rate is increased. The nurse also notices wheezing on auscultation, a fracture in right forearm, and bruises near the elbows and knees. What should be the most appropriate response of the nurse? Select all that apply. 1 Confer with the health care provider and admit the child into the hospital immediately. 2 Advise the parent to take the child home and give an antihistamine to the child. 3 Instruct the mother to take the child home and continue to monitor the temperature. 4 Ask the mother to bring the child in the next day as assessment for asthma may be needed. 5 Report to the child welfare department as it can be a case of child abuse.

1, 5 The parent has brought the child to the hospital with flu-like symptoms and fever. However, the child has a fractured forearm and bruises on the body, which are not reported by the parent. Therefore, the nurse should suspect child abuse in this case as the history is not consistent with the presentation. The nurse should speak with the health care provider to immediately admit the child to the hospital to prevent any further injury. As the nurse is a mandatory reporter, the nurse should report this to the child welfare department. It would be inappropriate to send the child back home with the parent for any reason (i.e., to give an antihistamine, monitor the temperature, or wait to assess for asthma).

The nurse is assessing a 5-month-old infant. Which behavior does the nurse observe in the infant? 1 Grasping the feet and pulling them toward mouth 2 Picking up a toy and putting it into the mouth 3 Transferring toys from one hand to the other 4 Taking out objects hidden under a pillow

2 A 5-month-old infant is able to pick up a toy and put it into the mouth. At this age infants tend to explore objects by putting them into the mouth. This is called the palmar grasp, which develops before eye-hand-mouth coordination. A 5-month-old infant is unable to perform an activity such as grasping the feet and pulling them to the mouth or transferring objects from one hand to the other. The infant may not be able to pursue the object they observe being hidden under a pillow as the child lacks the motor abilities to grasp objects completely. A 6-month-old infant is able to grasp the feet and pull them to the mouth. In a 7-month-old infant, transferring the objects from one hand to the other is observed. A 10-month-old infant is able to pursue the object observed being hidden under a pillow. It is a concept of object permanence. It indicates that a locomotion skill of the infant has increased.

Which fine motor activity does the nurse observe in a 6-month-old infant? The infant: 1 Is able to hold two cubes. 2 Can hold a milk bottle. 3 Drops a cube in the cup. 4 Grabs a bell by the handle.

2 A 6-month-old infant is able to hold the milk bottle. Holding two cubes, dropping a cube in cup, and grabbing a bell by the handle requires more muscle coordination, which is not developed by the age of 6 months. A 7-month-old infant can hold the two cubes more than momentarily. A 12-month-old infant can release cubes in a cup. A 10-month-old infant can grasp a bell by the handle.

The nurse finds that a newborn infant weighs approximately 3 kg (7 lb). Approximately how much would the child weigh when he reaches 2.5 years of age? 1. 9 kg (20 lb) 2. 12 kg (27 lb) 3. 15 kg (33 lb) 4. 17 kg (38 lb)

2 A baby typically quadruples in weight by the time the child reaches 2 to 2.5 years of age. A child who weighed 3 kg (7 lb) at birth should weigh four times as much as that by 2.5 years, or 12 kg (27 lb). Birth weight triples by the age of 6 months, so the child's weight would be 9 kg (20 lb) at 6 months. The child would attain a body weight of 15 kg (33 lb) and 17 kg (38 lb) after 2.5 years of age

The nurse is caring for a child with nasal discharge, skin rashes, and a protruding neck. The health care provider has prescribed penicillin G (Pfizerpen) to the child. What medical condition does the nurse suspect that the child has? 1 Myositis 2 Diphtheria 3 Otitis media 4 Psoriasis

2 A child suffering from diphtheria has the symptoms of nasal discharge, skin rashes, and a protruding neck. Penicillin G (Pfizerpen) is prescribed as treatment for diphtheria. Myositis is an autoimmune disorder that is characterized by inflammation of the muscles, not by skin rash and nasal discharge. Otitis media is a disease that inflames the ear but does not cause skin rashes and running nose. Psoriasis is a skin disease that causes scaling and inflammation.

The school nurse is assessing a child who has already attended a day care center. What different feature does the nurse observe in this child from the child who does not attend day care? 1 Shows frustration easily 2 Adjusts to sociocultural differences 3 Avoids group cooperation 4 Displays evident dissatisfaction

2 A child who already attended daycare can easily mingle with a new environment and can adjust to sociocultural differences. The child does not show frustration as the child has developed a feeling of self-confidence and success. The child has already been exposed to the opportunity to learn in a group; therefore the child cooperates with the group. The child is already adjusted to the new environment and is in his or her comfort zone. Therefore the child does not show dissatisfaction.

The nurse advises a working single parent to enroll his or her child in an after-school program. What could be the reason behind the nurse's advice? The child: 1 Fails to have snacks available. 2 May be lonely and fearful. 3 Has a developmental disorder. 4 Prefers to spend time outdoors.

2 After-school programs are generally arranged for latchkey children. These children usually have working parents or may live with one parent who works. They have no proper supervision after coming home from school. These children may feel lonely and fearful, and parents are advised to enroll the children in an after-school program. An after-school program is not necessary just because the child does not have an after-school snack available. Children with developmental disorders need to attend special training programs rather than an after-school program. When the child plays outdoor games, it signifies that the child is developing good social interactions. These children do not have to attend an after-school program

A Mexican-American adolescent states to the nurse, "I have cancer because it is God's will. It will make me stronger." The most appropriate response by the nurse is: 1 "You're too young to think that way. You still have many years to live." 2 "Tell me how you feel about the treatment plan." 3 "I'll move your family into the waiting area to give you some quiet time." 4 "I'll contact the hospital chaplain for you."

2 Asking the patient an open-ended question to assess how the patient feels about the treatment plan will provide the nurse with more information about what the patient understands about the illness and exactly what treatment measures the patient desires. It is very common in the Mexican-American culture for patients to feel that health is controlled by environment, fate, and the will of God. The nurse should not provide false reassurance. Family and strong kinship is important in this culture. Separating a family member is not the most appropriate action. The nurse should ask about religious preferences first before assuming the patient would like to speak with a chaplain

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: 1 nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. 2 bowel control is accomplished before bladder control, so the parent should focus on bowel training first. 3 the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. 4 the universal age for toilet training to begin is 2 years; the universal age for completion is 4 years.

2 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.

In what age group should the nurse expect a child to develop gross motor skills? 1 Birth through infancy 2 Early childhood 3 Later childhood 4 Middle childhood

2 Children between 1 and 6 years of age are considered to be in early childhood. This is when motor skills such as walking, talking, and climbing develop. The nurse should assess the child to determine whether the child is progressing appropriately. The period from birth to 12 months is called infancy. This is when the relationship between parent and child develops. This increases trust in the baby, and gross motor activity is not prominent at this growth stage. Later childhood is from 11 to 19 years of age. It is a period of rapid maturation and a point of entry into adulthood. Middle childhood encompasses the age group from 6 to 10 years old. This is when steady physical, mental, and social development is seen in children.

The parent of a 26-month-old child reports to the nurse that the child spends most of the time talking to a doll and cares for it as if it is a small baby. The parent also reports that sometimes the child throws toys around with force. What does the nurse interpret about the child's behavior? The child has: 1 Impaired thoughts. 2 Normal behavior. 3 Impaired thinking. 4 Impulsive behavior.

2 Children of 13 to 30 months old imitate elders while playing. The toddler spends most of the time talking to a doll and caring for it. The toddler inspects the toys and tests the strength and durability of toys by throwing them with force. It indicates that the child has normal behavior. Caring for the doll and talking with it for a long time does not indicate impaired thoughts or impaired thinking. Throwing the toys with force does not indicate impulsive behavior.

The nurse is assessing a 14-month-old child. The child's mother is worried as the child is able to say only one word, "Maa." To reduce panic the nurse educates the mother about language development. Which statement made by the nurse is appropriate? 1 "A child's speech is not properly developed until 5 years of age." 2 "At the age of 1 children start using one-word sentences and gestures." 3 "Encourage the child to watch television, as it helps to improve language skills." 4 "Children start using simple sentences and avoid using gestures at the age of 2."

2 Children who are 1-year-old start use one-word sentences or holophrases and gestures to convey their message. That one word conveys the whole meaning for the children, but to others it may mean many things or nothing. Only 25% of a 1-year-old child's speech can be understood. Research demonstrates that television has a great impact on the toddler's language development. It impairs their language skills by reducing the adult-child conversation, so children must not be encouraged to watch television. They must be encouraged to listen to stories and interact with adults. Children start using multiword sentences and gestures at the age of 2 years. Children use gestures to convey their message until 30 months of age.

The nurse is assessing a child who is taking tricyclic antidepressants. The nurse advises the child to decrease the intake of refined carbohydrates in the diet. What side effect of the drug is the nurse trying to prevent? 1 Weight gain and obesity 2 Dental caries 3 Increased appetite 4 Impaired glucose levels

2 Children who are taking tricyclic antidepressants have a high incidence of developing dental caries. Therefore the nurse should recommend decreasing the intake of refined carbohydrates because they would worsen the effect. Children who are obese are asked to cut down sugar and carbohydrates in their dietary intake. These are not major side effects observed in children taking antidepressants. Children who are taking antidepressants do not experience an increase in their appetite levels but may sometimes have a decreased appetite. Impairment of the glucose levels of the child is not a side effect of antidepressants.

A parent of an 18-month-old child reports to the nurse that the child has become a "finicky eater" and is eating less. Knowing that 18-month-old children have physiologic anorexia, what suggestion does the nurse provide to improve the eating habits of the child? 1 "Give vitamin supplements to the child regularly to prevent malnourishment." 2 "Make sure that one variety of food does not touch another variety on the plate." 3 "The plate should look colorful, so completely fill it with salad and other dishes." 4 "To attract the child toward food, serve the food on different colored plates every time."

2 Eighteen-month-old children have physiologic anorexia. They become picky and fussy eaters. Such children do not like mixed foods and sometimes refuse their favorite food if it touches another variety of food on the plate. The parents should provide a balanced diet to children rather than giving vitamin supplements. Children tend to imitate adults, so the parents must eat along with their children and encourage them to finish the food. If the plate is too full children might refuse to eat the food and push the plate away. The nurse should suggest to the parent not to overfill the plate with salad and other dishes. Eighteen-month-old children have ritualistic behavior, so they like to have the same dish, cup, and spoon every time. If the food is served in different colored plates every time, they may refuse to eat the food as they are ritualistic and tend to prefer to eat from the same plate every day.

The nurse works in a pediatric unit. Which child would have an increased vulnerability to the stresses of hospitalization? 1 A female child 2 A child with a difficult temperament 3 A child with an average intelligence 4 A child older than 6 years of age

2 Hospitalization is a stressor in children and so they may react differently to it. Certain children are more susceptible to the stressful effects of hospitalization than others. Children who have difficult temperament may not readily adjust with the unfamiliar environment of the hospital. These children may experience adverse effects of hospitalization. Female children are able to withhold stress more when compared to male children and thus are less likely to experience stressors. Children with average intelligence may be able to understand their condition and the importance of hospitalization and thus may be more adaptable. Children with lower IQ would not understand the purpose of hospital admission and thus would be extremely stressed due to hospitalization. Children who are older than 6 years of age have developed the maturity to understand their condition and the purpose of hospitalization. Thus, they would be more adaptable to their condition, and experience less stress related to hospitalization.

The causative agent for erythema infectiosum (fifth disease) is: 1 paramyxovirus. 2 human parvovirus B19. 3 human herpes virus types 1 and 2. 4 group A β-hemolytic streptococci.

2 Human parvovirus B19 is the causative agent. Paramyxovirus causes mumps. Human herpes virus types 1 and 2 are the major causes of herpetic infections in humans. Group A β-hemolytic streptococci is the causative agent for scarlet fever

Which parameters should the nurse monitor in the infant with hypothermia to ensure effective care? 1 Hemoglobin levels 2 Blood glucose levels 3 White blood cell count 4 Serum potassium levels

2 Hypothermia causes hypoglycemia and metabolic acidosis. Blood glucose levels should be monitored to prevent hypoglycemia in the infant. Hypothermia does not affect hemoglobin levels, white blood cell counts, or serum potassium levels.

While teaching about parenting to a group of parents, the nurse explains to them about effective discipline techniques other than positive time-out for toddlers. Which additional discipline technique does the nurse teach the parents? 1 Separation 2 Extinction 3 Limitations 4 Punishment

2 If the child is not obeying the parents' instructions, the parents may give a time-out to the child. This means the child goes to a comfortable place to calm down. This place should be stocked with stuffed animals and books. Extinction conveys to the child the activity should not repeated again in interactions or during playtime. Separation, if temporary, may help the toddler to become independent, but it does not help in discipline. The parents cannot put limitations on toddlers; rather, they should communicate to the toddlers about the alternatives and give them options to choose from. Punishment is not a solution for bad behavior.

A woman wants to adopt a baby from a large family who wishes to give their baby up for adoption. The woman seeks counseling from the nurse and is anxious and worried about the adoptive process. Which is the most appropriate response of the nurse? 1 "Infants from large families have less attachment problems with the parents." 2 "The earlier the infant enters your home, the better the chances of attachment." 3 "I will refer you to an experienced psychiatrist in our hospital to help manage anxiety." 4 "The mother's breast milk is crucial for the growth of the baby, so you must wait 2 years."

2 If the infant is separated from its biological parents early, the chances of attachment between adopted parents and infant will be good. The woman does not need help from a psychiatrist in this situation. A nurse should be able to counsel. If the infant has more caregivers as is the case in large families, it is difficult to separate them. Therefore, the infant from a home with fewer care providers is preferable for adoption. Keeping the baby with the biological mother for 2 years will increase the affection between the child and the mother, and it will be difficult to break that bond.

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: 1 a nightmare. 2 sleep terror. 3 seizure activity. 4 sleep apnea.

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

The nurse assesses the growth rate of an infant and notices that the infant has decreased lower limb growth. What growth and development pattern should the nurse document in this child? 1 Maturation pattern 2 Cephalocaudal pattern 3 Differentiation pattern 4 Proximodistal pattern

2 In the cephalocaudal pattern of development, the upper body structures grow and mature faster than the lower body structures. Maturation is what occurs with age, and the child demonstrates increasing competency and adaptability. The differentiation pattern is complex, and it is where the formation of tissues and organs is observed. Proximodistal development pattern refers to the development from the midline to the periphery, relating to peripheral and central nervous system.

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should: 1 start the IV line because allowing the child to manipulate the nurse is bad. 2 start the IV line because unlimited procrastination results in heightened anxiety. 3 postpone starting the IV line until the child is ready so that the child experiences a sense of control. 4 postpone starting the IV line until the child is ready so that the child's anxiety is reduced.

2 Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. The nurse should start the IV line, recognizing that the child is attempting to gain control. If the timing of the IV line start was not essential for the start of IV antibiotics, postponing might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.

The nurse is caring for a dying boy whose religion is Islam (Muslim/Moslem). An important nursing consideration related to his impending death and religion is that: 1 there are no special rites. 2 there are specific practices to be followed. 3 the family is expected to "wait" away from the dying person. 4 baptism should be performed if it has not been done previously

2 Islam has specific rituals for bathing and wrapping the body in cloth before it is to be moved. The nurse should contact someone from the person's mosque to assist. Family may be present. No baptism is performed at this time

When preparing parents to teach their preschool child about human sexuality, the nurse should emphasize that: 1 a parent's words may have a greater influence on the child's understanding than the parent's actions. 2 parents should determine exactly what the child wants to know before answering a question about sex. 3 parents should avoid using correct anatomic terms because they are confusing to the preschooler. 4 parents should allow children to satisfy their sexual curiosity by playing "doctor."

2 It is important that the parent answer the question that the child is asking. The actions may have a greater influence because language is not fully developed. Using correct terminology lays the foundation for later discussion. Parents should encourage the asking of questions to resolve curiosity without undue investigation on the child's part.

The pediatric nurse has recorded the birth weight, head circumference, axillary temperature, and crown to rump length of a newborn baby. What does the nurse consider while assessing the risk for mortality in this infant? 1 Measure head circumference on alternate weeks. 2 Use the birth weight for the assessment of infant mortality rate. 3 Prefer rectal temperature to axillary temperature in the new born. 4 Crown to rump length is the best indicator of infant mortality rate.

2 Low birth weight is associated with high mortality rate so birth weight is considered in predicting the infant mortality rate. Head circumference, rectal temperature or axillary temperature, and crown to rump length are generally not preferred indicators as compared to birth weight. Large head may increase the susceptibility of the child to acquire a head injury. Body temperature fluctuates due to many physiologic and pathological reasons. Alterations in rectal or axillary temperature of a newborn do not indicate that the child has high infant mortality rate. The height (crown-rump length) of the newborn is not an indicator of infant mortality rate

The nurse is preparing a health teaching session for school-age children. What information should the nurse include about injury prevention in the plan? 1 Peer pressure is not strong enough to affect risk-taking behavior. 2 Most injuries occur in or near school or home. 3 Injuries from burns are the highest at this age because of fascination with fire. 4 Lack of muscular coordination and control results in an increased incidence of injuries.

2 Most injuries occur in or near school or home. Peer pressure is significant in this age group. 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 community nurse is asked by the hospital administration manager to report the incidence of obesity in children in the community area, according to the body mass index (BMI). Which children should the nurse classify as obese? 1 The 5-year-old boys with BMI greater than the 85th percentile for boys 5 years of age 2 The 5-year-old boys with BMI at or greater than the 95th percentile for boys 5 years of age 3 The 5-year-old boys with BMI at or greater than the 95th percentile for boys 10 years of age 4 The 5-year-old boys with BMI at or greater than the 95th percentile for girls 5 years of age

2 Obesity in children and adolescents is defined as a body mass index (BMI) at or greater than the 95th percentile for a child the same age and gender. Hence, the incidence is the number of 5-year-old boys with BMI at or greater than the 95th percentile for boys 5 years of age. The BMI of the 5 year olds greater than the 85th percentile for boys 5 years of age would indicate that these boys are either overweight or obese. The BMI is measured for the children in same age; children of 5 years of age cannot be compared with children of 10 years of age. In addition, the BMI is measured and compared with children of same gender. Therefore, BMI of boys cannot be compared with that of the girls

The community nurse is asked by the hospital administration manager to report the incidence of obesity in children in the community area, according to the body mass index (BMI). Which children should the nurse classify as obese? Correct Incorrect 1 The 5-year-old boys with BMI greater than the 85th percentile for boys 5 years of age 2 The 5-year-old boys with BMI at or greater than the 95th percentile for boys 5 years of age 3 The 5-year-old boys with BMI at or greater than the 95th percentile for boys 10 years of age 4 The 5-year-old boys with BMI at or greater than the 95th percentile for girls 5 years of age

2 Obesity in children and adolescents is defined as a body mass index (BMI) at or greater than the 95th percentile for a child the same age and gender. Hence, the incidence is the number of 5-year-old boys with BMI at or greater than the 95th percentile for boys 5 years of age. The BMI of the 5 year olds greater than the 85th percentile for boys 5 years of age would indicate that these boys are either overweight or obese. The BMI is measured for the children in same age; children of 5 years of age cannot be compared with children of 10 years of age. In addition, the BMI is measured and compared with children of same gender. Therefore, BMI of boys cannot be compared with that of the girls

The nurse is teaching the nursing students about functions of play in the hospital. Which statement made by the nursing student indicates the need for further teaching? "Play: 1 Can lessen the stress of separation from the family." 2 Makes the child nervous in a strange environment." 3 Helps the child develop a positive attitude for others." 4 Provides an expressive outlet for the child's creative ideas."

2 Play is one of the most important aspects of a child's life and one of the most effective tools for managing stress. It is helpful for the child to relieve stress. It is also essential for the child's mental, emotional, and social well-being. Play does not make the child anxious in an unfamiliar environment. It helps the child feel more secure in a strange environment. Play lessens the stress of separation from the family because the child is busy. During play, the child communicates with others, which helps develop a positive attitude toward others. It also stimulates thinking in the child by allowing the child to express creative ideas.

The nurse takes measures to reduce the mortality rate in infants (A), children between 5 to 14 years of age (B), children between 2 to 4 years of age (C). If the nurse is required to focus more on children with high mortality incidence and less time on children with low mortality incidence in that order. What is the appropriate order in which the nurse should work? 1 B, C, A 2 A, C, B 3 C, B, A 4 A, B, C

2 Research has proven that death rates for children decrease as they grow. The mortality rates of children between 2 to 4 years of age (older than 1 year) have always been lower than those for infants. Children between 5 to 14 years old have the lowest rate of death when compared to that of children between 2 to 4 years of age. Therefore, the nurse should work in the order of A, C, B. As the children between 5 to 14 years of age (B) have a lower mortality rate than infants(A), the nurse cannot follow the sequence of B, C, A. 2 to 4 year old children (C) have a lower mortality rate than the infants(A), therefore the nurse cannot follow the sequence of C, B, A. As children between 5 to 14 years (B) have low mortality rate when compared to that of children between 2 to 4 years of age(C), thus the nurse cannot follow the sequence of A, B, C.

The nurse should teach volunteers in the after school program that which characteristic is most descriptive of the social development of school-age children? 1 Identification with peers is minimal. 2 Children frequently have "best friends." 3 Boys and girls play equally well with children of either gender. 4 Peer approval is not yet an influence toward conformity.

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

A single working parent of a 2-year-old child comes to the clinic for a health checkup. The parent is worried about caring for the child while managing work. Which option can help the parent work outside the home and attend to the child? 1 Prenatal care 2 Day care service 3 Adoption service 4 Tertiary hospitals

2 Single parents who are working can use a day care facility for their children while they are at work. Prenatal care is needed for regular health checks of pregnant women. Adoption services are needed by people who want to adopt children. Tertiary hospitals are for those in need of medical intervention

The parents of a 5-year-old child are worried as the child stutters when speaking. On examination the nurse finds that the child has no problem with hearing. What should the nurse tell the parents? 1 "The vocal cords are inflamed and infected with bacteria, and need antibiotics." 2 "Stuttering is common at this age and usually resolves during late childhood." 3 "A deviated nasal septum may be one of the causes of stuttering in children." 4 "Stuttering typically happens due to poor vocabulary and hearing difficulties."

2 Stuttering is common during the age of 2 to 5 years. This is the period when children speak faster than they can produce the words. This failure of sensorimotor integration leads to stuttering. However, parents should be reassured that it usually resolves in childhood. Stuttering is more common in boys than girls. It is not caused due to bacterial infection or deviated nasal septum or hearing problems.

Which statement about early childhood caries (ECC) is correct? 1 The syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. 2 Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. 3 The syndrome can be prevented by breastfeeding. 4 Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

2 Sweet liquids pooling in the mouth during sleep cause dental caries. Protruding upper front teeth may result from pacifier use or thumb-sucking. Frequent breastfeeding before sleep can also cause bottle-mouth caries. Juice in bottles before sleep contributes to bottle-mouth caries.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is breastfeeding exclusively. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? 1 Vitamin B 2 Vitamin D 3 Vitamin C 4 Vitamin K

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

A parent brings a child to the clinic for a regular checkup. The health care provider begins to ask questions about the family's medical history. The parent privately explains that the child is adopted, and does not want the child to know. What is the most appropriate advice for the nurse to give this parent? The nurse should: 1 ask the parent to withhold the information until the child is an adult. 2 advise the parent to speak openly to the child and tell the truth. 3 divulge the information to the child in a very sensitive manner. 4 instruct the parent to never reveal the information to the child

2 The adopted child should be made aware of his or her adoption status. It helps the child develop a trustful relationship with the parents. The sooner the child knows the truth, the better. The parents should tell the children as soon as the children are old enough to understand rather than waiting until they are adults. This information should not come from a nurse or any other person. Getting this information from a third person may be detrimental to the relationship between the parents and the adopted child. The nurse should never instruct the parents to keep the secret forever

The nurse is preparing a child for "CAT" (computed tomography [CT]) scan. During preparations, the child asks the nurse if there will be any cats at the test. What should be the nurse's best intervention? 1 Instruct the parents to communicate this to the child. 2 Describe the procedure in simple words for the child. 3 Engage the child in another activity, such as playing a game. 4 Prepare the child for testing and ignore the question.

2 The child does not have knowledge about the medical terms and may be confused by hearing the word CAT. The nurse should describe the procedure in easy to understand words to the child and explain what the letters of the common name mean. It helps alleviate the child's fear about the diagnostic test. Sometimes it isn't the parents' responsibility to explain the procedure to the child. The parents may not have enough information about the CT scan to answer the child's question. Therefore asking the parents to communicate with the child may not be helpful. The nurse should not engage the child in other activity such as playing games. The nurse should explain to the child about CT scan and not ignore the child question. The nurse should explain about the CT scan process and relieve the child's fear.

The nurse is teaching the parents of a 24-month-old about motor skill development. Which statement should the nurse include in the teaching? 1 The toddler walks alone but falls easily. 2 The toddler's activities begin to produce purposeful results. 3 The toddler is able to grasp small objects but cannot release them at will. 4 The toddler's motor skills are fully developed but occur in isolation from the environment.

2 The child is able to walk up and down stairs at this age. Gross and fine motor mastery occur with other activities. Grasping small objects but not releasing them at will is a task of infancy. Interaction with the environment is essential at 24 months of age.

Parents bring their child in for a well-child visit before moving to a different city. The child tells the nurse that he doesn't want to move and is sad because he will miss his friends and family. What should the nurse suggest to the child's parents to relieve the stress in the child? 1 Tell the child that he will get new playmates in the new location. 2 Prepare the child to relocate to a different city. 3 Assure the child that the family will spend a few days in the previous city every month. 4 Tell the child he will get a new gift daily after relocating to the new city.

2 The child needs to be prepared for relocation to accept the necessary changes so that his stress level is not increased and he does not become depressed. The child may feel depressed about losing old friends and playmates, and telling him about new playmates can increase his stress. The parents should not give false assurance by saying that they will spend a few days in the previous city every month, because it may not be possible and may affect the child's education. Frequent gifts must not be given to the child, because they make the child demanding.

A 4-year-old boy has been having increasingly 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: 1 explain that this is normal in preschoolers, especially boys. 2 refer the child for professional help. 3 talk to the preschool teacher to obtain validation for the behavior the parent reports. 4 encourage the parent to try more consistent and firm discipline.

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

A child is being treated with methylphenidate hydrochloride (Ritalin). After assessing the child, the nurse decides to administer the medicine early in the day. What effect of the drug does the nurse note in the child? 1 Causes some seizure activity 2 Keeps the child awake 3 Results in decreased appetite 4 Caused the development of foot numbness

2 The child who is taking methylphenidate hydrochloride (Ritalin), a psychostimulant, may experience sleeplessness as a side effect. Therefore the nurse should administer the medication early in the day to counteract the effect. Seizures are not a side effect of Ritalin. Reduced appetite is a side effect of Ritalin, and therefore the nurse should administer the drug after the meals. The child doesn't develop numbness when administered Ritalin

The nurse working at a day care center observes that a child has a sore throat and skin rashes. What condition present in the child may indicate the risk of a communicable disease rather than just a bacterial infection? The child had: 1 Recently been treated for a head injury. 2 A recent exposure to a communicable disease. 3 Received all the immunizations as per schedule. 4 No history of having a communicable disease.

2 The child who was exposed to a communicable disease is at higher risk, because these diseases are spread through contact. A head injury does not indicate a risk for communicable diseases. Immunizations are the primary precautionary measures taken to prevent communicable diseases, so a child with proper immunization is usually safe. A child who already had a communicable disease is usually at higher risk.

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: 1 advise the mother to follow a milk-free diet for 3 to 5 days. 2 take a thorough, detailed history of usual daily events. 3 administer simethicone drops to provide relief from gas pains. 4 explain that the parents need to stay calm so the infant will remain calm.

2 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.

The nurse is caring for a 2-day-old neonate who is healthy but has a low body temperature. The nurse instructs the infant's mother to place the unclothed infant on her bare chest. Which finding in the infant indicates ineffective management of the infant's condition? 1 Hyperglycemia 2 Metabolic acidosis 3 Body weight of 21 lbs 4 Body weight of 7.5 lbs

2 The neonate has hypothermia, and therefore the nurse instructs the mother to perform kangaroo care, in which the unclothed infant is placed on the mother's bare chest. This ensures improved thermoregulation and improves the complications of hypothermia. The presence of metabolic acidosis is a symptom of hypothermia. Hypoglycemia is caused by hypothermia in the infant. The normal weight of a healthy neonate at birth is approximately 7.5 lbs. By one year of age, the infant's weight normally triples to 21 lbs.

The nurse who works in a pediatric ward wants to explore his/her own ability to develop a therapeutic relationship with children and their families. The nurse does a self-assessment to evaluate the caregiving style by using an assessment questionnaire. In the questionnaire the nurse answers "yes" to a question, which indicates a positive action. What was the question to which the nurse answered as "yes"? Correct Incorrect 1 "Do you control visitor access to children by using excuses?" Correct Incorrect 2 "Do you periodically interview children to determine their current issues?" Correct Incorrect 3 "Do you become critical when parents do not visit their children?" Correct Incorrect 4 "Does the senior nurse appreciate you for being close to the child?"

2 The nurse should maintain a therapeutic relationship with the children and their families to provide effective care. While performing the self assessment of the ability to develop therapeutic relationship with children, the nurse should evaluate her or his positive actions and negative actions. To evaluate the positive action the nurse should check whether she or he is taking periodical interviews of the children. It helps to evaluate their health, emotions, and feelings. The negative actions include restricting the parents not to see their children. Children feel comfortable with their parents, so the nurse should not restrict them. The nurse should not be critical and judgmental, as it is unprofessional. The nurse can suggest the parents spend time with children. The nurse should not be too close with any child

A child requires hospitalization for the treatment of cancer. What suggestion does the nurse give the parents for minimizing potential negative effects of hospitalization in the child? 1 Force the child into the hospital for the needed treatment. 2 Provide books to the child to read about being in hospitals. 3 Seclude the child in his or her room if the child refuses hospitalization. 4 Reprimand the child firmly if the child refuses hospitalization.

2 The nurse suggests the parents use books to prepare the child for hospitalization. This gives the child a better idea about things that happen in the hospital and what to expect. This helps minimize fear and negative feelings about hospitalization. The nurse instructs the parents to not force the child to be admitted for treatment because the child may be depressed and this may make it worse. If the child refuses hospitalization, the parents should not seclude the child in his or her room. It may make the child more vulnerable. The parents should avoid reprimanding the child in a firm tone in order to maintain a good and honest relationship with the child.

The nurse is assessing a child's level of self-care. The nurse documents a rating of II for dressing and grooming. What can be inferred from this rating? The child: 1 Is independent on all aspects of personal care. 2 Depends on the supervision of another person. 3 Needs to use equipment or another adaptive device. 4 Requires direction from a person and uses equipment.

2 The self-care scale can be used for rating the functional self-care abilities of the child. The score ranges from 0 to IV. If the child is scored a II, this implies that the child requires assistance or supervision from another person. A child who is independent with activities of daily living would receive a 0. A score of I implies that the child requires equipment or a device for self-care. A score of III implies that the child requires assistance or supervision from another person and equipment or a device. A score of IV implies that the child is totally dependent and does not participate.

Which statement made by a child's parent supports the nurse's conclusion that the child has a difficult temperament? 1 "My child has predictable habits." 2 "My child often cries and throws tantrums." 3 "My child responds with passive resistance to new routines." 4 "My child becomes inactive and moody with change in routine."

2 The temperament of a child is said to be difficult when the child exhibits frequent episodes of crying, frustration, and tantrums. Such children are irritable and show irregularity in habits. Almost 10 percent of children fall under the category of difficult temperament. A child with an easygoing temperament has predictable habits and a positive attitude towards new stimuli. A slow-to-warm-up child responds with passive resistance to new routines and becomes inactive and moody

A patient with multiple chronic health problems is admitted to the medical unit. What is required to keep the nursing practice dynamic rather than static throughout all phases of the nursing process? 1 Slow continuous flow of intravenous fluids 2 Continual assessment of the patient's status 3 Change the bed linen every day or when required 4 Nurses have to work in shifts to avoid caregiver stress

2 Throughout the five levels of the nursing process, continual assessment of the patient's status keeps the process dynamic rather than static. Slow continuous flow of intravenous fluids is not indicated for all patients. Changing the bed linen gives little opportunity to assess the status of the patient. Working in shifts can prevent caregiver stress but it does not mean that the patient is under continual assessment

A parent reports to the nurse that the child refuses to wear long zipped pants and prefers short button pants. Which characteristic of preoperational thought is exhibited by the child? 1 Animism 2 Centration 3 Egocentrism 4 Irreversibility

2 Toddlers exhibit many characteristics of preoperational thought including centration. This is where a child focuses on one thing and refuses to accept any alternatives. An example would be refusing to wear any pants that aren't long and zippered. Animism means the child attributes life-like qualities to inanimate objects. An example would be to blame the table for bumping the child's head. Egocentrism means that the toddler does not understand that each person sees things differently. The child believes that everyone sees things as they do. Irreversibility means that the child is unable to categorize the activity to be done or undone. For instance, if a parent deflates a ball, the child is not able to understand it can be reinflated. The child believes the ball is broken forever

The nurse is teaching a student nurse about a child who only has one X chromosome. What abnormality does the child have? 1 Down syndrome 2 Turner syndrome 3 Fragile X syndrome 4 Contiguous gene syndrome

2 Turner syndrome is the only viable condition that happens as a result of the child missing one X chromosome. Down syndrome occurs when the child has an extra autosome, chromosome 21. Fragile X syndrome is a condition in which the chromosomes are fragile or weak, and it is associated with other changes in the autosomes. Microdeletion or microduplication of chromosome segments is called contiguous gene syndrome.

An infant is hospitalized; however, none of the family members are able to stay with the infant. Which interventions does the nurse perform to provide psychological comfort for the infant? 1 Assign just one nurse to take care of the infant. 2 Follow a routine to which the infant is accustomed. 3 Ask a staff member to stay with the infant at all times. 4 Allow the infant to hear parents' voices over the phone.

2 Very young infants gain security from having their needs met consistently. Therefore, following a routine to which the infant is accustomed is helpful to provide psychological comfort for the infant. Assigning one nurse to care for the infant is ideal but it is not possible every time. The infant does not have any attachment with a staff member; therefore, asking a staff member to stay with the infant at all times may not help. The infant can identify the parents' voices, but hearing them over the phone does not help to provide psychological comfort to the child.

The nurse is reviewing Erikson's theory about the autonomy versus shame and doubt stage. The nurse is trying to correlate it to Freud's psychosexual theory. Which stage would the nurse review in Freud's theory? 1 Oral 2 Anal 3 Phallic 4 Latency

2 When the nurse is reviewing the autonomy versus shame and doubt stage in Erikson theory, it refers to a toddler. The corresponding level in Freud's theory for the toddler's psychosexual developmental stage is the anal stage, when the toddler is toilet trained. The oral stage in Freud's theory represents infancy, from birth to 1 year, and is the trust versus mistrust stage in Erikson's theory. The phallic stage in Freud's theory represents early childhood, 3-6 years of age, or initiative versus guilt in Erikson's theory. Latency in Freud's theory represents middle childhood, 6-12 years, or industry versus inferiority in Erikson's theory

As the nurse is assessing an infant, the nurse notices that the teeth are erupting and the infant's skin color is bluish. After assessing oxygenation, the nurse reviews the laboratory report and finds that the infant has methemoglobinemia. What would be the probable reason for this? 1 Excessive use of cold teething ring 2 Application of topical anesthetics 3 Administration of aspirin (Acuprine) 4 Excessive consumption of hard candy

2 uring teething, the infant may feel pain and discomfort as the crown of the tooth breaks through the periodontal membrane. Topical anesthetic ointments can be applied to relieve the pain. These ointments generally contain benzocaine as an active ingredient. Benzocaine causes methemoglobinemia, which is characterized by a bluish skin coloration. Excessive use of cold teething rings, administration of aspirin (Acuprine), and excessive consumption of hard candy do not cause methemoglobinemia. Hard candy may cause accidental choking or aspiration in the infant.

The nurse is assessing a traditional Hindu woman. What should the nurse ask in order to learn about the patient's health traditions? 1 "Do you have an advance directive for medical decisions?" 2 "What are your beliefs about health and illness?" 3 "How often do you pray or visit a place of worship?" 4 "Can you tell me when you developed the symptoms?"

2 Many cultures have health practices and traditions different from those of the Western world. The nurse can ask questions about their health and illness beliefs. These include all the health practices, medicines, and food of the patient's culture. This can help the nurse and patient develop mutually acceptable goals. Asking a patient whether he or she had an advance directive is important but will not provide information about cultural health practices. How often the patient prays is not related to cultural health practices. The nurse should ask questions about when the symptoms developed, but this does not relate to cultural health practices

The nursing instructor is teaching a group of nursing students about the occurrence and susceptibility of childhood infections in children. Which statement made by the nursing instructor is appropriate? 1 "Children may be less susceptible to upper respiratory tract infection during early childhood." 2 "Children who have been adopted from foreign countries may be highly susceptible to infections." 3 "Children whose parents were free from childhood infections may be susceptible to infections." 4 "Children of working parents who are sent to day care centers may be less susceptible to infections."

2 "Children who have been adopted from foreign countries may be highly susceptible to infections." Childhood infections are the major cause of childhood morbidity. The children who are adopted from the foreign countries cannot adapt to the change in the environment. Therefore, they are highly susceptible to infections. During early childhood, the immune system is not well developed and the children are highly susceptible to upper respiratory tract infections. However, the frequency of the respiratory infection decreases as the child grows older. There is no evidence that children whose parents were fee from infections are less susceptible to infections. The children who are sent to day care centers are highly susceptible to communicable diseases like infection. Infection may be caused due to exposure to external environment and due to contact with others who have an infection

What important information should the nurse include when teaching the parents of an adolescent about nutrition? 1 Adolescents are usually mature enough to make healthy food choices. 2 Resources are available to assist lower income families to obtain enough protein. 3 Behavior problems in this age group are not related to nutritional deficiencies. 4 Parental influence has the greatest impact on food choices at this age.

2 Resources are available to assist lower income families to obtain enough protein. Lower income families may need resources and information about how to obtain assistance in getting expensive foods such as meats to get enough protein intake. During adolescence, parental influence diminishes and the adolescent makes food choices related to peer acceptability and sociability. Occasionally these choices are detrimental to adolescents with chronic illnesses, such as diabetes, obesity, chronic lung disease, hypertension, cardiovascular risk factors, and renal disease. Families that struggle with lower incomes, homelessness, and migrant status generally lack the resources to provide their children with adequate food intake; nutritious foods, such as fresh fruits and vegetables; and appropriate protein intake. The result is nutritional deficiencies with subsequent growth and developmental delays, depression, and behavior problems. Behavior problems can indeed be related to nutritional deficiencies.

After conducting the fine motor skill assessment of a 2-year-old child, the nurse concludes that the child has the fine motor skill development of an 18-month-old child. Which fine motor activities can the child do? Select all that apply: 1 Build a tower using eight cubes. 2 Release a pellet in a narrow-necked bottle. 3 Use a cup for drinking water without spilling. 4 Draw on a paper by holding crayons with fingers. 5 Use spoon to eat food without spilling.

2, 3 The child has the fine motor development of an 18-month-old child. The abilities to release the pellet in a narrow-necked bottle and use a cup for drinking are attained by the age of 15 months. Thus, the child would be able to do these activities. The ability to use a spoon for eating food is developed by 18 months of age. The child would have been able to do this activity as well. Building a tower using 8 cubes and holding crayons with fingers require more manual dexterity. These activities could be performed by a child who is 30 months or older.

A child suffering from pertussis is hospitalized with symptoms of coughing, gagging, and high-grade fever. What supportive treatment does the primary health care provider (PHP) prescribe to this patient? Select all that apply. 1 Analgesic drug 2 Intensive care 3 Adequate fluid intake 4 Oxygen supplement 5 Vitamin supplement

2, 3, 4 A child hospitalized with pertussis needs intensive care because of difficulty breathing and the need for ventilation. Adequate fluid must be monitored because the child may have difficulty swallowing because of infection in the respiratory tract. Oxygen supplement is provided if the child develops shortness of breath as a result of continuous cough. Analgesic drugs are usually prescribed for pain but not for pertussis. Vitamin deficiency is not seen in pertussis; therefore vitamin supplements are not given.

A child is diagnosed with attention deficit hyperactivity disorder (ADHD). What symptoms in the child support the diagnosis? Select all that apply. The child: 1 Does not talk to others frequently. 2 Squirms when sitting in a seat. 3 Refuses to work on a jigsaw puzzle. 4 Cannot remember instructions given. 5 Is interested in quiet-time activities.

2, 3, 4 Children with attention deficit hyperactivity disorder (ADHD) have three major symptoms: inattentiveness, hyperactivity, and impulsiveness. The children squirm when seated, which signifies hyperactivity. Children with ADHD dislike engaging in activities that require concentration and a lot of mental effort. Therefore putting together a jigsaw puzzle would be difficult for a child with ADHD to perform. Children with ADHD tend to forget things very easily because they have difficulty paying attention to the directions given. Children tend to talk too much when they are hyperactive. This is a sign of ADHD. Children with ADHD show less interest in activities that keep them quiet or which are time consuming.

A community health nurse works closely with a foster care home. What are the concerns of the nurse in allocating a child to foster care? Select all that apply. 1 Child entering into foster care needs 12 hours of training 2 Potential foster parents needs 27 hours of training 3 Foster parents should meet all the standards of law 4 Foster parents should meet health standards as per the guidelines 5 Nurse should take measures to improve the health of parents

2, 3, 4 Parents need 27 hours of training before entering into the contract of fostering a child. Each state has standards that the foster parent has to meet for fostering a child. Each state also has health standards set, which the parents are supposed to maintain. The child entering into foster care does not require any training; instead parents require 12 hours of continuous education per year. Foster children are at risk of acute and chronic diseases; hence,the nurse should take measures to improve the health of foster children as opposed to the parents.

The nurse finds that a child has several dental caries. The nurse learns that the child refuses to go to sleep without a bottle full of juice. How does the nurse promote dental health in the child? Select all that apply. The nurse: 1 Explains to the child about the dental caries. 2 Instructs that dental caries can be prevented. 3 Uses the reward technique to change behavior. 4 Tells the child to drink juice in a cup. 5 Offers extra transitional objects to the child.

2, 3, 4 Regular dental examinations promote optimum dental health in children. The nurse should reassure the parents that the caries can be prevented by following dental hygiene measures. The parents can be taught to incorporate a rewards system if the child avoids sugar candies or juices. The nurse can also tell the child that to have juice in a cup rather than in bottle as it can increase the risk of caries. Explaining to the child about dental caries may not help as the child may not be able to understand it. If the nurse bribes the child with transitional objects, the child may continue the same type of behavior in the future.

A child was infected with poliovirus and showed symptoms after 14 days. The laboratory report shows that Enterovirus type II is the causative agent. Which instructions should the nurse provide to the parents for the child's care? Select all that apply. 1 Place a soft mattress on the child's bed. 2 Observe the child for respiratory paralysis. 3 Provide a high-protein diet to the child. 4 Get regular physiotherapy sessions for the child. 5 Ensure that the child is on complete bed rest.

2, 3, 4 The child should be observed for respiratory paralysis, because the child may have difficulty speaking. Symptoms such as the inability to hold her breath should be reported. A high-protein diet is necessary to build muscle strength. Physiotherapy is necessary for the child to increase movement in the limbs and to reduce paralytic effect. The child should be provided a pressure mattress, not a soft mattress. This helps prevent discomfort and fractures caused by excessive mobility. The child should be encouraged to perform some daily activities, such as self-feeding. This helps increase the self-esteem of the child. Asking the child to take complete bed rest may make the child depressed and cause bed sores.

The nurse assesses a toddler who is anxious because the parents are getting divorced. What behaviors does the nurse see when caring for this child? Select all that apply. 1 Severe panic reactions 2 Regressive behaviors 3 Separation anxiety 4 Fear and confusion 5 Increased aggression

2, 3, 4 Toddlers tend to explore how things work and how to control others. The parent's divorce has a great impact on the child's behaviors related to mental health. The stress can manifest itself in regressive behaviors (thumb sucking, loss of elimination control, temper tantrums) and separation anxiety. Separation anxiety happens because the child will only be living with one parent at a time. This may cause the child to feel frightened and confused. Panic reactions and increased aggression are usually exhibited by a school-age child when parents are divorcing.

After assessing a 24-month-old child, the nurse tells the child's parent that the child has age-appropriate growth and development. Which characteristics does the nurse observe in the child? Select all that apply. 1 The child's weight is 11 kg (24 lb) and height is 78.7 cm (31 inches). 2 The child is able to build a tower of seven cubes. 3 The child is able to turn the pages of a book one at a time. 4 The child is able to kick a ball forward without overbalancing. 5 The child is able to say six words including the parents' names

2, 3, 4 Twenty-four-month-old children have fine motor development. They are able to build a tower of seven cubes and turn pages of a book one at a time. The children will be able to kick a ball forward without overbalancing due to the development of motor skills. Twenty-four-month-old children have more than 11 kg (24 lb) of weight and 78.7 cm (31 inches) of height; 12.8-13.7 kg weight and 87.7 cm height. The child will be able to say approximately 300 words and two to three phrases. A 15-month-old child weighs 11 kg (24 lb) and has a height of 78.7 cm (31 inches). A 15-month-old child is able to say six words including the parents' names

The parents of a toddler ask the nurse how to handle their child's increasing number of temper tantrums. Which positive reinforcement methods of reducing the number of tantrums should the nurse include? Select all that apply. 1 Suggest that parents provide the child an "all or none" position. 2 Suggest that parents ignore the behavior as long as child is not harming himself. 3 Encourage the parents to provide comfort once the child has calmed down. 4 Ask parents to praise the child for positive behavior when not having a tantrum. 5 Tell parents not to give in to the original request that started the temper tantrum.

2, 3, 4, 5 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.

The nurse is developing a teaching plan about preventing fetal exposure to teratogens. Which teratogenic agents or conditions should the nurse include? Select all that apply. 1 acetaminophen (Tylenol) 2 isotretinoin (Accutane) 3 cocaine 4 hyperthermia 5 ethyl alcohol 6 phenytoin (Dilantin)

2, 3, 4, 5, 6 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).

Parents report that their child is often fussy during mealtimes. After assessment, the nurse finds that the child has very strong taste preferences. Which instructions should the nurse give the parent to encourage good eating habits in the child? Select all that apply. 1 Instruct the child to remain at the table until the plate is clean. 2 Encourage the habit of having the entire family at meals. 3 Offer the child a variety of healthy foods. 4 Serve the food to the child. 5 Be a proper role model to the child while teaching healthy eating habits

2, 3, 5 A child usually follows the eating habits of his parents. Therefore, while having a family meal, the child may imitate the family members and follow their eating habits. Children usually enjoy food when they are offered a variety. Children develop the same eating habits as their parents, so parents should work on being good role models. Remaining at the table until the plate is clean should be avoided as it may lead to overeating. The child should be allowed to serve himself, because this helps develop interest in eating

A 9-year-old child is put on tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD). How does the nurse advise the parents of this child? The child should: Select all that apply. 1 Be advised to limit physical exercise. 2 Be encouraged to have plenty of oral fluids. 3 Have a dental checkup done regularly. 4 Be referred to a cardiologist at the earliest date possible. 5 Have limited intake of refined carbohydrates.uraged to have plenty of oral fluids. 3 Have a dental checkup done regularly. 4 Be referred to a cardiologist at the earliest date possible. 5 Have limited intake of refined carbohydrates.

2, 3, 5 The anticholinergic action of tricyclic antidepressants leads to increased viscosity of saliva and dry mouth. These drugs lead to increased incidences of dental caries. Therefore, the nurse should advise the parents to encourage the child to take more oral fluids, take the child for regular dental visits, and limit the intake of refined carbohydrates. Tricyclic antidepressants do not affect the cardiac system, and so it is not required for the child to limit physical activity or to have regular visits to the cardiologist.

What should the nurse include when explaining the hospital's Bill of Rights for Children and Teens to a family during their child's admission? Select all that apply. The hospital will: 1 Need the child stay in bed to receive care. 2 Ensure that the child receives quality health care. 3 Provide supportive care to the child and family. 4 Be responsible to make decisions and choices. 5 Provide information that is easy to understand.

2, 3, 5 The child and the parents may sometimes experience feelings of powerlessness during a hospital stay. To empower the patients, hospitals have instated the Bill of Rights for Children and Teens. These rights mandate that the hospital provide adequate information to the patient and their family to demand quality health care from the hospital. This means that the staff are competent and qualified to care for the child. These rights also ensure that the child and the family will receive supportive care. This means that the hospital will support decisions made by the child and the family. According to the rights, the hospital staff must provide information that can be easily understood by the child and the family. The child should not have to stay in the hospital bed to receive care. The child should be allowed to have time for play activities. Hospital bill of rights would the child and parents the chance to make choices and decisions.

The nursing student is caring for a child admitted to the hospital. The nursing student asks the nurse instructor, "How can we keep the child's routine habits while he is in the hospital?" What would be the best response by the nurse instructor? Select all that apply. "Ask the parents: 1 "About the use of any herbal therapies." 2 "When the child goes to sleep at night." 3 "What foods the child prefers to eat." 4 "How the child's grades are in school." 5 "Which toy the child plays with at home."

2, 3, 5 The nurse should assess the child's usual health habits at home to promote a more normal environment in the hospital. This includes the child's sleep-rest, nutritional-metabolic, and activity-exercise patterns. The nurse would assess the sleep-rest pattern by asking when the child goes to sleep at night. Assessing the nutritional-metabolic pattern would include asking about food preferences. The nurse should also ask what toy the child plays with at home as part of the activity-exercise pattern. These will help the nurse plan individualized care for the child. History about herbal and complementary therapy helps in preventing drug-drug interaction and severe adverse effects.

The nurse is caring for a child suffering from chickenpox. The child has a fever and itching. What precautions does the nurse follow while caring for the child? Select all that apply. 1 Administer aspirin (Acuprin) for pain. 2 Bathe the child daily. 3 Keep the child away from susceptible individuals. 4 Provide a warm environment to the child. 5 Administer acetaminophen (Actamin) for the fever.

2, 3, 5 To prevent the spread of the infection, proper hygiene must be maintained. Therefore the nurse should bathe the child daily and change the clothes and linens daily. The child should be isolated from susceptible individuals, because this disease can easily spread. The child has a fever; therefore acetaminophen (Actamin) is advised. Analgesics such as aspirin (Acuprin) are avoided, because they may lead to Reye's syndrome. To prevent irritation and itching, the child needs a cold environment. Therefore the nurse should maintain a low room temperature rather than providing a warm environment to the child.

The nurse is caring for a child of African culture with epilepsy. What questions should the nurse ask the family to help explore their culture? Select all that apply. 1 "Which doctor have you been seeing?" 2 "What do you think caused this sickness?" 3 "Why do you think this illness happened?" 4 "What medications have you used?" 5 "What do you fear the most about your child's sickness?"

2, 3, 5 To understand the cultural sphere of the child's family, the nurse should analyze their thought processes. Questions such as what they think is the cause, what they feel about the sickness, or what they fear most about the sickness help the nurse understand their thought processes. Knowing which doctor or which medications were taken does not help the nurse understand the cultural process.

A 3-year-old-child is brought to the hospital by a parent and presents with a fever and rash. The father tells the nurse that his wife is pregnant and he is very worried about the health of his son. After examination, the child is diagnosed with rubella. What instructions should the nurse give to the father? Select all that apply. 1 Inform the parent that the child needs to begin receiving oral antibiotics. 2 Inform the parent that the child needs only antipyretics and analgesics. 3 Advise the parent to ask his wife to be with child for sometime during the day. 4 Advise the parent that the child should not be in contact with his pregnant wife. 5 Tell the parent that encephalitis is commonly seen in children with rubella.

2, 4 Rubella, or German measles, is one of the mild communicable diseases seen in children. The child with rubella requires only antipyretics and analgesics for fever and discomfort. However, the child should not be in contact with his pregnant mother because if the mother gets infected, it could be teratogenic and can also cause miscarriage or fetal death. Antibiotics are not required as rubella is a viral infection. Encephalitis is a rare complication seen in children with rubella.

After assessment, the nurse notices that a child is in the detachment stage of separation anxiety. Which behavioral changes would the nurse observe in the child? Select all that apply. 1 Refuses to eat, drink, or get out of the bed 2 Shows an increased interest in the surroundings 3 Tries to leave the hospital to find the parents 4 Begins to form new relationships with others 5 Interacts with strangers or familiar caregivers

2, 4, 5 Detachment is the third stage of separation anxiety. It is also referred to as the denial stage. In this stage the child begins to take an interest in the surroundings. The child also forms new but superficial relationships with others and becomes more interested in interacting with strangers or familiar caregivers. The child's behavior indicates that the child has finally adjusted to the loss of the parents. This is a serious stage because reversal of the potential adverse effects is less likely to occur after detachment. Refusing to eat, drink, and get out of bed are characteristics of the despair stage of separation anxiety. Attempting to leave the hospital to find the parents is observed in protest stage of separation anxiety.

The nurse is teaching a student nurse about the growth and development in school-age children. The nurse states that there are few prominent changes that can be found in the school-age child as compared to a preschooler. Which statement should the nurse include in the teaching? Select all that apply. 1 Excess fat deposition provides a bulky appearance. 2 Head circumference decreases in relation to height. 3 Calorie needs are smaller due to low physical activity. 4 Permanent teeth appear too large for the face. 5 Leg length increases in relation to the child's height.

2, 4, 5 During the school-age period, children's height rapidly increases to meet their physical needs. As a result, the head circumference of a school-age child is smaller when compared to overall height. Due to the loss of baby teeth, early deciduous teeth are lost and secondary teeth start to appear in the school-age child. These secondary permanent teeth may appear too large for the child's face. The child's leg increases when compared to increase in the height. Therefore the school-age child has long legs. The school-age child appears to be thinner when compared to the preschooler due to the excessive physical activity. The fat gets distributed evenly and the child does not have a bulky appearance. The caloric needs of the child gradually decrease in the school-age child as compared to the preschooler. However the parents must be informed to give a balanced diet to children for proper physical growth.

The parents report to the nurse that their infant has difficulty sleeping because of prolonged nighttime feedings. What instructions does the nurse give to the parents? Select all that apply. 1 Allow the child to go to sleep early. 2 The infant should go to bed awake. 3 Limit the total number of feedings. 4 Offer last feeding as late as possible. 5 Increase daytime feeding intervals.

2, 4, 5 If the infant has a continued need for middle-of-night bottle or breastfeeding, this condition can lead to sleep disturbances in both the infant and the parents. The infant should be put to bed awake so that the infant falls asleep immediately after the last feeding of the evening. Effective ways of managing this condition include increasing daytime feeding intervals to 4 hours or more. It slowly extends the amount of time in between feedings. The last feeding should be offered as late as possible, so that the infant sleeps with a full stomach. If the parent allows the infant to go to sleep early, the child may start crying in the middle of the night due to hunger. Limiting the number of feedings may cause nutritional deficiencies if the body's requirements are not met.

What factors increase the risk of infant mortality? Select all that apply. 1 Poverty 2 Male gender 3 Homicide 4 Lack of maternal education 5 Long periods of gestation

2, 4, 5 Male gender, lack of maternal education, and long periods of gestation are factors that increase the risk of infant mortality. Lack of maternal education may lead to poor perinatal care and perinatal complications. Long periods of gestation may be stressful for the fetus as the placental function eventually deteriorates and these infants are likely to experience complications. Poverty is not a major factor for infant mortality. Homicide is not a risk factor for infant mortality, but it is a significant factor of childhood mortality

What factors increase the risk of infant mortality? Select all that apply. Correct Incorrect 1 Poverty Correct Incorrect 2 Male gender 3 Homicide 4 Lack of maternal education 5 Long periods of gestation

2, 4, 5 Male gender, lack of maternal education, and long periods of gestation are factors that increase the risk of infant mortality. Lack of maternal education may lead to poor perinatal care and perinatal complications. Long periods of gestation may be stressful for the fetus as the placental function eventually deteriorates and these infants are likely to experience complications. Poverty is not a major factor for infant mortality. Homicide is not a risk factor for infant mortality, but it is a significant factor of childhood mortality

The community nurse is educating a group of parents about sleep and rest requirements of school-age children. What information does the nurse provide? Select all that apply. 1 School-aged children need to have 1- to 2- hour long good naps per day. 2 Children 5 years of age need approximately 11 hours of sleep a night. 3 Children 12 years of age need approximately 6 hours of sleep per night. 4 Children 6 years of age should be encouraged to read before bed time. 5 Children 7 years of age should be encouraged to read before bed time

2, 4, 5 Parents should be educated about good sleeping habits in school-aged children. A child who is 5 years of age needs about 11 hours sleep per night. Encouraging quiet activities like reading books or coloring before bedtime in children 6 or 7 years of age can help the children quiet down before going to bed., School-aged children usually do not need naps. Children 12 years of age need a minimum of 9 hours sleep per night

A teacher asks a school nurse what sports should be included in the curriculum for school-aged children. What is the nurse's response? Select all that apply. 1 Girls should only compete with girls when they are preadolescents. 2 Sports activities should include both practice sessions and unstructured play. 3 The actual sporting event should aim to stress the point of winning the game. 4 Common sports for school-aged children include baseball, soccer, and swimming. 5 All participants should be recognized in special ceremonies, not just the winners.

2, 4, 5 Teachers should include only age-appropriate sports activities in schools, which a school nurse can help in determining. It is appropriate to have activities that include practice sessions and unstructured play. Common sports for school-aged children include baseball, soccer, and swimming. It is important to recognize all the participants in special ceremonies and not just the ones who excel. In the preadolescence stage, there is no difference between strengths of boys and girls; therefore, girls can compete with boys at this age. It should be emphasized to the school management that actual sporting events should aim to stress the point of mastering a sport or enhancing self-image rather than winning.

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. 1 Administer iron with meals. 2 Place iron toward the back side of the mouth with a dropper. 3 Mix iron with milk for greater absorption. 4 Report black, tarry stools to health care provider. 5 Caution parents not to switch to a low-iron-containing formula or milk.

2, 5 Administration of iron supplements includes the following: (1) Ideally iron supplements should be administered between meals for greater absorption; (2) 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; (3) Avoid administration of liquid iron supplements with whole cow's milk or milk products, as these bind free iron and prevent absorption; (4) Educate parents that iron supplements will turn stools black or tarry green; (5) 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); (6) In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz); (7) Avoid administration of iron supplements with food or drinks that bind iron and prevent absorption

The nurse finds that a child is uncooperative, undisciplined, and ill-tempered. How does the nurse effectively interact with the child to assess the heart rate? Select all that apply. The nurse: 1 Tells the parent to force the child to stay in sitting position. 2 Informs the child that the heartbeat needs to be checked. 3 Allows the child to play with the stethoscope if the child is good. 4 Forces and frightens the child to keep the child in the sitting position. 5 Gives options to the child to sit quietly in a chair or a table.

2, 5 The nurse needs to communicate effectively with the child in order to gain cooperation. If it is explained to the child that the heartbeat needs to be assessed, this tells the child what needs to be done but does not give the child the chance to say no. If the nurse gives the child the option to sit in a chair or table, the child is allowed to actively participate in the assessment procedure and is allowed to make choices. The nurse should not ask parent to force the child into a sitting position, as the child may not cooperate and become irritable. The nurse should not bribe the child by allowing the child to play with the stethoscope. If the nurse forces or frightens the child, the child may not be willing to come to the clinic in the future.

27. The school nurse is planning to educate kindergarten children on how to stop the spread of influenza in the classroom. Which of the following should the nurse instruct the children? 1. Stay home if they have a runny nose and cough. 2. Wash their hands after using the restroom. 3. Wash their hands after sneezing. 4. Have a flu shot annually.

27. 1. Children do not need to stay home unless they have a fever. However, the children should be taught to cough or sneeze into their sleeve and to wash their hands after sneezing or coughing. 2. Children should always wash their hands after using the restroom. In order to de crease the spread of influenza, however, it is more important for the children to wash their hands after sneezing or coughing. *3. It is essential that children wash their hands after any contact with nasopharyngeal secretions.* 4. Children should have a flu shot annually, but that information is best included in an educational session for the parents. There is little that children can do directly to en sure they receive flu shots. Children of this age are often frightened of shots and would not likely pass that information on to their parents.

5. The parent of an 18-year-old with CF is excited about the possibility of the child receiving a double lung transplant. What should the parent understand? 1. The transplant will cure the child of CF and allow the child to lead a long and healthy life. 2. The transplant will not cure the child of CF but will allow the child to have a longer life. 3. The transplant will help to reverse the multisystem damage that has already been caused by CF. 4. The transplant will be the child's only chance at surviving long enough to graduate college.

2. A lung transplant does not cure CF, but it does offer the patient an opportunity to live a longer life. The concerns are that, after the lung transplant, the child is at risk for rejection of the new organ and for development of secondary infec tions because of the immunosuppressive therapy.

18. A 2-year-old is diagnosed with asthma. The parents are big sports fans and want their child to play sports. The parents ask the nurse what impact asthma will have on the child's future in sports. Which is the nurse's best response? 1. "As long as your child takes prescribed asthma medication, the child will be fine." 2. "The earlier a child is diagnosed with asthma, the more significant the symptoms." 3. "The earlier a child is diagnosed with asthma, the better the chance the child has of growing out of the disease." 4. "Your child should avoid playing contact sports and sports that require a lot of running."

2. When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging.

28. Which of the following is the highest priority for receiving the flu vaccine? 1. An 18-year-old who is living in a college dormitory. 2. A healthy 8-month-old who attends day care. 3. A 7-year-old who attends public school. 4. A 3-year-old who is undergoing chemotherapy.

28. 1. The flu vaccine is recommended for all ages, but the 18-year-old is not the highest priority. A person this age will likely recover without any complications. *2. Children between the ages of 6 and 23 months are at the highest risk for having complications as a result of the flu. Their immune systems are not so developed, so they are at a higher risk for influenza-related hospitalizations.* 3. The flu vaccine is recommended for all ages, but the 7-year-old is not the highest priority. A child this age will likely recover without any complications. 4. The flu vaccine should not be given to anyone who is immunocompromised.

The nurse is teaching a group of parents how to prevent death in infants due to accidents, injuries, poisoning, and other causes. Which preventive measure should the nurse emphasize during the teaching? 1 "Do not keep medicines within the reach of children." Incorrect 2 "Use a car seat when the baby is travelling with you in car." 3 "Don't give plastic bags to children to play with." 4 "Resuscitate immediately when your baby is unconscious."

3 Mechanical suffocation is the most common form of injury in infants. Parents or caregivers of the infants should take all measures to prevent death of infants due to accidents. Accidental consumption of medicines can be dangerous but they are not the most common cause of accidental death in infants. A car seat is recommended because motor vehicle accidents are the second most common cause of death in infants. The nurse is not teaching a management plan but teaching about taking preventive measures for accidents in this scenario.

The nurse is assessing a toddler and notices that the toddler kicks his/her feet and screams as loud as possible. What type of emotion does the nurse document? 1 Fear 2 Grief 3 Anger 4 Curiosity

3 Emotion is a subjective, conscious experience characterized by psychological and physiologic expressions. Anger is characterized by temper tantrums, which may include lying down on the floor, kicking of the feet, and screaming as loud as possible. Fear is characterized by many physiologic changes that include hyperventilation and an increased heart rate. Grief is a natural response to loss. It is an emotional suffering due to the loss of someone or something. Curiosity is seen when the child wants to explore new things and asks many questions

What information should the nurse include when giving parents guidelines about helping their children in school? 1 Help children as much as possible with their homework. 2 Punish children who fail to perform adequately. 3 Communicate with teachers if there appears to be a problem. 4 Accept responsibility for children's successes and failures.

3 Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. 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. School-age children need to develop responsibility. This helps with keeping promises and meeting deadlines, thereby laying successful foundations for adulthood.

The nurse is teaching nursing students about vaccine administration. Which statement made by the nursing student indicates effective learning? 1 "The influenza vaccine should not be administered to the patient with asthma." 2 "Vapocoolant spray should apply to the skin after administering the vaccine." 3 "A 16-mm (5/8-inch) length needle is used to administer the vaccine to newborns." 4 "All vaccines should be given to adults by using a 25-mm (1-in) length needle."

3 A 16-mm (5/8-inch) length needle is used for vaccine administration in newborn infants. Needle length is an important factor for administration of vaccine to ensure that the medication gets into the muscle. The proper needle length should be selected to get the medication in the infant's muscle. Influenza vaccines should be administered to patients with asthma because they are at higher risk of developing influenza. Vapocoolant spray should be applied to the skin 15 seconds before the vaccination for minimizing pain, not after. All vaccines should not be administered to adults by using 25-mm (1-inch) length needle. The needle length should be selected on the basis of muscle development, size, and age of the person.

A parent of a 5-year-old child reports that the child weighs 18 kg (41 lbs), is able to draw geometric shapes, and tries to tie his shoelaces. The parent also informs the nurse that the child tries to make sentences with two to three words, understands the concept of conservation, and can count objects irrespective of their arrangement. What does the nurse infer from this regarding the child's development? The child has: 1 Limited physical development. 2 Normal motor development. 3 Slow language development. 4 Increased cognitive development.

3 A 5-year-old child should be able to make complete sentences with six to eight words. The inability of the child to make complete sentences indicates that the child has slow language development. The weight of a 5-year-old child can be 18 kg (41 lbs). Five-year-olds should have well developed fine motor skills, so they can draw geometric shapes like triangles and try to tie their shoelaces. Children of this age understand the concept of conservation and can count objects that are placed randomly. Therefore the child has proper physical development, motor development, and cognitive development.

A 28-day-old infant of Roman Catholic parents is in critical condition with a very poor immediate prognosis. His father wants to perform a baptism for the boy in the health care unit immediately. Which is the most appropriate nursing action? 1 Contacting the nearest Roman Catholic Church 2 Informing the chaplaincy department in the hospital 3 Allowing the father of the baby to carry out the baptism 4 Asking the father to refrain from conducting baptism in the health care unit

3 According to the beliefs of the Roman Catholic religion, any baptized Catholic is permitted to carry out baptism when the infant's prognosis is very poor. The nurse should respect the sentiments of the family and allow the baby's father to perform the baptism in the health care unit. In this situation, as it is urgent, contacting Roman Catholic Church and informing the chaplaincy department in the hospital are not recommended. Baptism is allowed to be performed in the health care unit. Therefore, the nurse should not ask the father to refrain from performing baptism.

The most overwhelming adverse influence on health is: 1 race. 2 customs. 3 socioeconomic status. 4 genetic constitution

3 Although children of different racial groups have differing health issues, socioeconomic status is a key predictor. Customs do not usually have an adverse effect on health. A higher percentage of lower-class individuals have some health problem at any one time than other individuals in different classes. There is a high correlation between poverty and poor nutrition. On a population basis, genetic constitution is not an overwhelming adverse influence

At what age should the nurse advise parents to expect their infant to be able to say "mama" and "dada" with meaning? 1. 4 months 2. 6 months 3. 10 months 4. 14 months

3 At 10 months, infants say sounds with meaning. At 4 months, consonants are added to infant vocalizations. At 6 months, babbling resembles one-syllable sounds. Fourteen months is late for the development of sounds with meaning.

Nursing interventions to promote health during middle childhood include: 1 stressing the need for increased calorie intake to meet increased demands. 2 instructing parents to defer questions about sex until the child reaches adolescence. 3 educating the child and parents to the need for good dental hygiene because these are the years in which permanent teeth erupt. 4 advising parents that the child will need decreasing amounts of rest toward the end of this period.

3 Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. 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. School-age children often need to be reminded to go to sleep.

Parents reports to the nurse that their 12-year-old child resists going to bed at night. Which advice does the nurse give to the parents to help the child go to bed on time? 1 "Allow the child to go to bed at a later time." 2 "Promote daytime naps on a daily basis." 3 "Promote reading a book before bedtime." 4 "Urge video game playing before bedtime."

3 Bedtime resistance can be resolved by allowing the child to read before bedtime. Many 12-year-olds prefer to read before bed. The child's bedtime should not be changed because school-age children need adequate sleep. School-age children do not require naps, which can hamper sleeping at night. Children should not play video games before going to bed. This may stimulate and excite the child and make it harder to fall asleep.

Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake? 1 Using developmental stimulation by a specialist during feedings 2 Avoiding solids until after the bottle is well accepted 3 Being persistent through 10 to 15 minutes of food refusal 4 Varying schedule of routine activities on a daily basis

3 Calm perseverance is important. Parents often fail to persist through the child's refusals. Feeding times should have a nonstimulating environment so that the focus is on the meal. Solids should be introduced slowly to decrease dependence on the bottle. A daily schedule should be structured to provide consistency for the child.

The nurse assesses a child's cognitive development to determine whether the child has mastered the concept of conservation. In which age group is the concept of conservation usually attained? 1. 0-2 years 2. 2-7 years 3. 7-11 years 4. 11-15 years

3 Children 7-11 years old are categorized in the concrete operations stage of cognitive development. In this stage, thoughts become logical and coherent, and they develop a new concept called conservation, the ability to realize that physical factors remain the same even though they look different on the outside. Children who are 0-2 years old are categorized in the sensorimotor stage, when the development of reflex activity is attained. Children 2-7 years old are in the preoperational stage of cognitive development, when egocentrism is a prominent characteristic. At 11-15 years of age, children are in the formal operations stage. This stage of development is characterized by adaptability and flexibility.

An 8-year-old child loves swimming and riding a bicycle. The child's parent is a police officer and usually keeps his personal gun in a locker at home. What does the nurse advice the parent in order to prevent accidental death of the boy due to injuries considering his age first? Correct Incorrect 1 "Check your child's behavior for signs of illicit drug abuse." Correct Incorrect 2 "There should be a swimming trainer while your child is swimming." Correct Incorrect 3 "Your child should always wear a helmet while bicycling." Correct Incorrect 4 "Do not keep your personal gun at home."

3 Children between 5 to 9 years of age are at an increased risk for bicycling fatalities. Wearing a helmet is an important measure to prevent death and injuries caused by bicycle accidents. Drug abuse is not common at this age. The child requires a trainer when learning to swim. Deaths due to drowning are more likely in children between 1 to 4 years of age. A police officer is allowed to keep a personal licensed gun at home, but in a safe place.

The parent of an adolescent patient is concerned that the child does not confide in the parent anymore. The child writes notes in codes to his friends and keeps secrets. What should the nurse tell the parent? 1 "You should find someone to help you decipher the code on the notes." 2 "I will refer your child to a psychologist because it sounds like you need help." 3 "This is normal adolescent behavior. Just keep communication open." 4 "Your child should not be allowed to play with friends who keep secrets

3 During adolescence, children begin to detach from adults, and they tend to have secrets among themselves and confide in their peers rather than their parents. The parent should not try to find someone to decipher the code. This could break the trust between the parent and child. Because this is normal behavior, the child does not need to be referred to a psychologist, nor should the child be kept from his friends

A child is being treated in the emergency department because of a fracture in the lower extremity. After the cast is applied, the nurse asks the child, "How do you think you will look once the cast is removed? Could you please draw a picture for me?" What is the rationale for the nurse asking the child to draw the picture? To assess the child's: 1 Fine motor drawing skills 2 Cognitive development 3 Fear about bodily injury 4 Knowledge of anatomy

3 Children fear bodily injury and loss of body parts. To determine the child's perception of the injury, the nurse should ask the child to draw a picture of how he or she would look after the cast is removed. The child's drawing skills are not examined by the nurse because they have no relevance in this context. The child's cognitive development is assessed to determine whether the child has disabilities in hearing, vision, or talking. Older children try to understand the anatomy of the human body, but it is not related to the fractures and cast.

The parents of a 2-year-old child are worried and report to the nurse that their child always sleeps on the rocking chair and not the bed. They add that the child is afraid to sleep on the bed due to a fear of a monster under the bed. What does the nurse recommend to the parents? 1 "Arrange the sleeping area for the child alongside other family members." 2 "If the child starts crying, then allow the child to sleep on a rocking chair for 15 minutes." 3 "Encourage the child to sleep on the child's own bed by putting the child to bed when awake." 4 "Encourage the child to look under the bed and explain that monsters do not exist."

3 Children must be encouraged to sleep in their own bed. Children must be placed on their bed when they are awake, so that they can be accustomed to it. The child should not be transferred from the rocking chair to the bed while sleeping, as this would disturb the sleep and the child would be awakened. The child must be encouraged to sleep alone and a separate sleeping area must be arranged for the child. It helps to eliminate fears, and the child becomes independent. If the child starts crying, parents must not allow the child to sleep on the rocking chair. The parents should ensure that the child sleeps on the bed for a longer duration of time. The child may feel dejected if the parents tell the child that monsters do not exist.

The school nurse is discussing dental health with some children in first grade. What should the nurse include in the discussion? 1 Teach how to floss teeth properly. 2 Recommend a toothbrush with hard nylon bristles. 3 Emphasize the importance of brushing before bedtime. 4 Recommend nonfluoridated toothpaste approved by the American Dental Association

3 Children should be taught to brush their teeth after meals, after snacks, and 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. The American Dental Association recommends fluoridated toothpaste for this age group.

The school nurse is assessing a child who is taking psychostimulants. The child is instructed to approach the nurse for the medication soon after lunch. What is the most appropriate reason for giving this instruction to the child? 1 This type of medication helps prevent sleepiness. 2 It can cause slow human growth. 3 Psychostimulants reduce the appetite. 4 Food intake reduces psychostimulant drug efficacy.

3 Children who are taking psychostimulants commonly experience a decrease in appetite as a side effect. Therefore the nurse should administer medication with or after meals. Keeping the child awake is also a side effect of psychostimulant drugs. However this has nothing to do with why the medication would be administered after lunch. Reduced or suppressed growth is also observed as a side effect of psychostimulant drug and should be monitored regularly. Food intake does not affect the efficacy of psychostimulant drugs.

The nurse is assessing a 2-year-old child who was discharged from the hospital after a chronic illness. The child's parent tells the nurse that the child has forgotten all the rhymes that were learned before being hospitalized. Which response given by the nurse is appropriate? 1 "The memory in a 2-year-old child is not well developed." 2 "Give gingko and omega-3 fatty acids to improve the child's memory." 3 "You should ignore it and encourage the child by praising the existing behavior." 4 "The child might be having amnesia due to the administration of medications."

3 Children who have been hospitalized or have a chronic illness have regression due to stress. Stress causes the children to forget all newly learned tasks and newly acquired achievements. The nurse should advise the parents to not panic and to ignore the symptoms of forgetfulness. The parents should encourage the child by praising the existing behavior. The memory is well developed in a 2-year-old child. The nurse should not suggest that the parents give herbal supplements to the child as they may have toxic effects. The drugs affecting the brain may cause amnesia when used in large doses. Not all drugs indicate amnesia as a side effect.

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: 1 indicates giftedness. 2 indicates typical "twin" behavior. 3 is characteristic of cognitive development at this age. 4 is characteristic of psychosocial development at this age

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

The most appropriate recommendation for relief of teething pain is to instruct the parents to: 1 rub gums with aspirin to relieve inflammation. 2 apply hydrogen peroxide to gums to relieve irritation. 3 give child a cold teething ring to relieve inflammation. 4 have child chew on a warm teething ring to encourage tooth eruption.

3 Cold reduces inflammation and should be used for relief of teething irritation. Gums should not be rubbed with aspirin. It can be dangerous if the child aspirates aspirin. Hydrogen peroxide would not be effective. Cold, not warmth, reduces inflammation

The nurse is assessing a 4-month-old infant. Which reflex should the nurse expect to find in the infant? 1 Rooting 2 Crawling 3 Drooling 4 Tonic neck

3 Drooling begins around the age of 4 months. The nurse may observe drooling in a 4-month-old infant because they have a poorly coordinated swallowing reflex. In a 4-month-old infant, rooting, crawling, and tonic neck reflexes are not observed because these reflexes disappear at this age. The crawling reflex disappears by the age of 2 months

The nurse is speaking to a group in the community about psychosocial development according to Erikson's life-span approach. The nurse instructs the group not to impose too many expectations on a child because the child may develop an inferiority complex. What age group of children is nurse referring to here? 1. 1-3 years 2. 3-6 years 3. 6-12 years 4. 12-18 years

3 Erikson's life-span approach categorized childhood into five stages. Industry versus Inferiority is the fourth stage of development the crucial stage attained by children 6-12 years of age. Children at this stage are workers and producers, and they initiate and complete work aiming at real achievement. The child may feel inferior if parents impose many expectations on the child. The second stage is autonomy versus shame and doubt (1-3 years), when children increase their ability to control their bodies and their environment and use their mental powers in decision making. Negative feelings develop when children are made to feel low and when others shame them. Initiative versus guilt (3-6 years) is when children explore the physical world with all their senses and powers and may feel guilt when parents make their child feel their behaviors are bad. Identity versus role confusion (12-18 years) is the stage when rapid and marked physical changes occur. Adolescents struggle to fit the roles they have played and those they expect to play. When the ability to resolve these conflicts fails, it leads to role confusion.

During the assessment of a child, the nurse finds that the child is inactive, depressed, sad, and uncommunicative; refuses to eat; and generally lacks interest in everything around her. What should the nurse interpret from this assessment? The child is in the: 1 Denial stage. 2 Protest stage. 3 Despair stage. 4 Detachment stage.

3 From this assessment, the nurse interprets that the child is in the despair stage. This is the second stage of separation anxiety. In the despair stage, the child appears less active, depressed, and uninterested in play or food. In this stage the child's physical condition may deteriorate from refusing to eat, drink, or get out of bed. The denial stage is the third stage of separation anxiety. In the denial stage, the child is more interested in the surroundings, plays with others, and forms new but superficial relationships with others. In the protest stage, the child reacts aggressively, cries, screams, and searches for the parents with the eyes. Detachment is the third stage of separation anxiety. It is also called denial.

The nurse asks the parents to give food to a toddler on the same plate daily. Which characteristic of preoperational thought process is this instruction based on? 1 Egocentrism 2 Transductive reasoning 3 Global organization 4 Centration

3 Global organization is a thought process where the toddler feels that changing any one part of the whole changes the entire whole. The child may not be willing to eat food that is not served on the regular plate. Egocentrism is the inability of the child to view a situation from different perspectives. Transductive reasoning is a thought process where the child thinks that the characteristics of a particular thing remain the same forever, such as if the toddler is not willing to eat the food that tasted bad when prepared earlier. Centration is a thought process where a child focuses on one aspect of a thing rather than considering all aspects.

Nurses play an important role in current issues and trends in health care. What is a current trend in pediatric nursing and health care today? 1 The patient is the unit of care for the health care provider. 2 Discharge planning begins when the physician writes the order. 3 Health promotion resources enable children to achieve their full potential. 4 The focus of pediatric health care is trending toward acute hospital care.

3 Health promotion provides opportunities to reduce differences in current health status among members of different groups and provides a better chance to achieve the fullest health potential. The patient and family is the unit of care for the health care provider. Discharge planning begins when the patient is admitted. The focus of pediatric health care is trending away from acute hospital settings

What is appropriate advice for parents who are preparing to tell their children about their decision to divorce? 1 Avoid crying in front of children. 2 Avoid discussing the reason for the divorce. 3 Give reassurance that the divorce is not the children's fault. 4 Give reassurance that the divorce will not affect most aspects of the children's lives

3 If parents are able, they should hold and touch children and reassure them that they are not the cause of the divorce . Parents can cry in front of children; it may give the children permission to do the same. Parents should provide the reasons for the divorce in a manner the children will understand. Reassuring children that most aspects of their lives will not be affected is false reassurance because many aspects will change.

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 that: 1 a psychosocial evaluation is indicated. 2 an evaluation of possible parent-child conflict is indicated. 3 having imaginary playmates is normal and useful at this age. 4 having imaginary playmates is abnormal after about age 2 years.

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

A child is assessed and categorized in the industry versus inferiority stage according to Erikson's theory. The nurse compares the child with Freud's psychosexual development theory. At what stage would the child be categorized in Freud's theory? 1 Anal 2 Phallict 3 Latency 4 Genital

3 In Erikson's theory, the industry versus inferiority stage includes children 6-12 years old. The stage in Freud's theory that matches this age group is the latency stage. The anal stage of Freud's theory corresponds to the autonomy versus shame and doubt stage of Erikson's theory. The phallic stage of Freud's theory corresponds to initiative versus guilt, and the genital stage of Freud's theory corresponds to the identity versus role confusion stage of Erikson's theory.

After giving a bed bath and cleaning the feet of a 2-year-old boy, an intravenous line is inserted into a small area by shaving the scalp. His Jewish parents are upset with this procedure. What could be the most probable reason behind the parents' discontent? 1 Intravenous infusions are against Jewish culture. 2 Scalp vein insertions are against the Jewish culture. 3 Cutting the hair before 3 years of age is not permitted in Jewish culture. 4 Touching the head after touching the foot is disrespectful in Jewish culture

3 In Jewish culture, first haircut is done for boys at age 3 years. This is called the "upsherenish ceremony." Therefore, the nurse should have gotten consent from the parents before shaving the scalp of the boy. Intravenous infusions and scalp vein insertion are allowed in the Jewish culture. Touching the head after touching the foot is considered disrespectful in the Vietnamese culture

The nurse is assessing a 12-month-old child during a well-child visit. The nurse notices that the child's birth weight has tripled, birth length is increased by 50%, head and chest circumference are equal, and the child has six deciduous teeth. What does the nurse conclude from these findings? The child has: 1 Delayed development. 2 A calcium deficiency. 3 Normal development. 4 Excessive weight gain.

3 In a 12-month-old child, the birth weight is tripled, the birth length is increased by 50%, the head and chest circumference are equal, and the child has developed six deciduous teeth. These are normal findings. Therefore the nurse concludes that the child has normal development. The child has grown in height and is in the same height as compared with other children of the same age group. Therefore the nurse should not conclude that the child has slow development. Calcium deficiency is assessed using bone mineral density test. Decreased calcium levels in the body increase the risk of fractures in children. From this assessment, the nurse cannot conclude that the child has a calcium deficiency. Although the child's birth weight has tripled, this does not indicate that the child has excessive weight gain.

Which normal finding does the nurse expect to find when assessing an 8-month-old infant? 1 Doubled birth length 2 Eruption of the upper lateral incisors 3 Eruption of the lower central incisors 4 Equal head and chest circumference

3 In an 8-month-old infant, the nurse may find eruption of lower central incisors as a part of the normal growth and development. In a 12-month-old infant, the nurse may find an increase in the birth length by 50%. In an 11-month-old infant, the nurse may find eruption of the upper lateral incisors. A 12-month-old infant has equal head and chest circumference.

Which statement made by the nurse needs correction when teaching an infant's parent about expected growth changes in the infant? 1 "Infants gain head control before leg movements." 2 "Infants gain shoulder control before hand movements." 3 "Infants develop individual finger movements before whole hand movement." 4 "Infants develop the central nervous system before the peripheral nervous system."

3 In an infant, the whole hand movement is developed before individual finger movement. This is because of the proximodistal pattern of growth and development in which structures near the body's midline develop earlier that structures away from the midline. The infant gains head control before leg movements because of cephalocaudal development. In cephalocaudal growth, the structures nearer to the head show earlier development compared to structures present toward the feet. Shoulder control is achieved prior to hand movements due to the concept of proximodistal growth. The central nervous system develops faster than the peripheral nervous system due to the proximodistal pattern of development.

The psychosexual conflicts of preschool children make them extremely vulnerable to: 1 separation anxiety. 2 loss of control. 3 bodily injury and pain. 4 loss of identity.

3 Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschool child because of the poorly developed concept of body integrity. Separation anxiety is a characteristic of infancy. Loss of control is a characteristic fear of school-age children. Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.

The nurse is assessing a 4-year-old child who came for a regular checkup. The nurse learns that the child's parents are adopting a baby and that the child feels that the parents' love will be divided. What is the most appropriate action by the nurse? 1 Comfort the child and continue with the checkup. 2 Ignore this remark and continue with the checkup. 3 Have the parents speak to the child to alleviate fears. 4 Teach the child to speak to the parents and clarify things.

3 It is very common for children to worry when their parents decide to adopt another baby. The parents should make sure the child understands that there will be no change in their love. Merely comforting the child may not be enough because the child would still need reassurance from the parents. Ignoring the child may make the child feel more insecure. Asking the child to speak to parents may not be appropriate because the child may not readily express these feelings.

A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory? 1 Erikson 2 Fowler 3 Kohlberg 4 Freud

3 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 school nurse has asked a group of 8-year-old children to write a sentence about what they have learned from the class regarding bicycle safety. Which statement indicates the need for further teaching in the children? 1 "Stay in a single file when riding bikes with friends." 2 "Always keep as close to the curb as possible." 3 "Always ride with traffic and towards parked cars." 4 "Walk bikes across busy streets only at crosswalks."

3 Nurses play a vital role in educating children about bicycle safety. Children must be instructed to always ride with the traffic and away from parked cars to prevent accidental collisions. It is also important to stay in a single file when riding with friends, keeping as close to the curb as possible, and to walk bikes across busy streets only at crosswalks. All these measures help in reducing accidents and preventing serious injuries to children

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: 1 organized sports such as soccer are not appropriate at this age. 2 competition is detrimental to the establishment of a positive self-image. 3 sports participation is encouraged if the sport is appropriate to the child's abilities. 4 girls should compete only against girls because at this age boys are larger and have more muscle mass.

3 Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely. Organized sports can provide safe, appropriate activities with supportive parents and coaches. School-age children enjoy competition. 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.

When caring for a preschool age child, the nurse should incorporate knowledge that body image has developed to include: 1 a well-defined body boundary. 2 knowledge about his or her internal anatomy. 3 fear of intrusive procedures. 4 anxiety and fear of separation.

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

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? 1 "Never shake baby powder directly on your infant because it can be aspirated into his lungs." 2 "Do not permit your child to chew paint from window ledges because he might absorb too much lead." 3 "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall." 4 "Keep doors of appliances closed at all times."

3 Rolling over from abdomen to back occurs between 4 and 7 months. This is the appropriate anticipatory guidance for this age. Not shaking baby powder directly onto the infant is appropriate guidance for a first-month appointment. Not permitting the child to chew paint from window ledges should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand. Keeping doors of appliances closed at all times should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand.

A 10-year-old boy reports vomiting, diarrhea, and stomach pain for the past couple of days. The child does not go to school because of these symptoms However, the child is usually healthy on weekends and whenever allowed to stay at home. On examination the nurse finds that the child's temperature is mildly elevated. What does the nurse inform the parents? 1 The child needs to be put on antibiotic treatment for a high temperature. 2 The child should be allowed to stay at home for as long as the child wants. 3 The child has school phobia which is the likely reason for the child's presentation. 4 The child most likely has gastroenteritis and needs admission into a hospital.

3 School phobia can occur in children of all ages, but, it is more common in those 10 years of age and above. It can be manifested by the child reporting vomiting, diarrhea, stomach pain, mild fever, and headache during weekdays. A striking feature of this condition is that the child is healthy on weekends and whenever the child is allowed to stay at home. It is also important to find out the reason behind it and eliminate the cause. Though the symptoms of the child are similar to gastroenteritis, the absence of symptoms during weekends indicates school phobia as the most likely diagnosis. Therefore, antibiotics are not required in this case.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. What teaching should be included? 1 Flossing is not recommended at this age. 2 The child is old enough to brush teeth effectively. 3 Brush teeth with plain water if child does not like toothpaste. 4 Toothbrush should be small and have hard, rounded, nylon bristles.

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

The parent of an 8-year-old child is worried about their child's stealing behavior. The parent informs the nurse that they have punished the child several times for stealing, but the child still repeats the act. What is the most appropriate nursing action? 1 Advise the parent to ignore this behavior and to not discuss it with the child. 2 Advise the parent to tell the child that being jailed is possible if the child is caught stealing again. 3 Advise the parents to give a reasonable punishment including returning the stolen item. 4 Inform the parents that the child has antisocial behavior and needs psychiatric consultation

3 Stealing can be expected in children 5 to 8 years of age as their sense of property rights is limited. They may steal things simply because they are attracted to them. Parents should be advised to admonish such behavior and give a reasonable punishment like asking the children to return the stolen items. This would be enough for most children to learn from. Telling children that they could be jailed for the act of stealing may scare them. However, in some children this kind of behavior can indicate that there is something lacking in the child's life. For example, the child could be stealing to make up for a lack of love and affection. Therefore, it is not recommended to ignore such behavior. It is also not appropriate to inform the parent that the child needs a psychiatric referral.

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which suggestion should the nurse include? 1 Send the child to his or her room. 2 If the child cries, refuses, or is more disruptive, try another approach. 3 Select an area that is safe and nonstimulating, such as a hallway. 4 The general rule for length of time is one hour per year of age.

3 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 one minute per year of age. One hour per year is excessive.

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: 1 unusual and requires further evaluation of the son. 2 unusual because the onset of pubescence is usually the same in siblings. 3 normal because the onset of pubescence is usually earlier in girls than it is in boys. 4 abnormal because the onset of pubescence is usually earlier in boys than it is in girls.

3 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 school teacher speaks with the school nurse about a child who has improper conduct and tends to be aggressive with younger children. The school nurse observes that the child also influences the behavior of others in the group. What is the most appropriate nursing approach for the child's behavior? 1 Use corporal punishment to discipline the child. 2 Advise the child to participate in safety training. 3 Encourage the child to join an anti-bullying program. 4 Suggest the child undergo behavioral therapy

3 The child who is isolated from the family or under poor supervision tends to develop unacceptable behavior and acts against established rules. These children also try to influence other weaker groups such as small children. This behavior is considered bullying. The child should be encouraged to join an antibullying program to help set the behavior right. The nurse should not use corporal punishment on the child because it can worsen the child's behavior. Limits should be set and time-outs utilized for punishment. Safety training is given to the child for protection from injuries. Behavioral therapy is given to the child with attention deficit hyperactivity disorder.

The nurse is assessing the concept of conservation in a group of children 7 years of age. The nurse pours 200 mL water in a small glass, 200 mL water in a big glass, and 100 mL water in a tea cup. The capacities of the small glass (s), big glass (B), and tea cup (t) are 250 mL, 500 mL, and 100 mL respectively. A 7-year-old child is asked to choose the glass with more water. Which glass or glasses would the child choose if the child understands the concept of conservation? 1 Glass B 2 Glass s 3 Glass B and s 4 Glass t and s

3 The concept of conservation is one of the cognitive tasks mastered by children aged 5 to 7 years. They are able to understand that when the same amount of water is poured into glasses or containers of different sizes and shapes, the volume remains the same. Therefore, the child will choose glass B and s. Conservation of volume is usually the last concept mastered by school-aged children. Glass B has the same amount of water as glass s. Glass t has less water compared to glasses B and s.

A parent tells a 13-year-old child that he is adopted. What could happen as a result of telling the child at this age? 1 Sympathy 2 Happiness 3 Depression 4 Excitement

3 The earlier the child knows of his adoption status, the better. Generally, older children display anger and sadness. This can often be manifested as depression. The child may feel abandoned, but a feeling of sympathy is rare. Similarly, happiness and excitement are not what a child feels after learning about being adopted

An infant's parent reports to the nurse that the infant is very irritable, has difficulty sleeping, and refuses to eat solid foods due to teething. What nursing interventions should the nurse include in the plan of care to make the infant comfortable? 1 Provide hard candy for the infant. 2 Rub the infant's gums with salicylates. 3 Give ibuprofen (Advil) to the infant. 4 Use frozen liquid-filled teething rings.

3 The infant is very irritable, has difficulty sleeping, and refuses to eat solid foods. Therefore the nurse should administer Ibuprofen (Advil) to the infant. Ibuprofen (Advil) is a systemic analgesic that helps to relieve pain related to teething. It is not administered for more than 3 consecutive days to the infant. The nurse should not give hard candy to an infant because it may cause accidental choking or aspiration. The nurse should not rub the gums with salicylates because it can cause aspiration. The nurse should not give a frozen liquid-filled teething ring to the infant because it may rupture or crack. This can lead to a chemical leak that is harmful for the infant.

The nurse advises the parents of a 2-year-old child to vaccinate their child with the influenza vaccine (inactivated influenza vaccine [IIV]). The child's parents ask the nurse, "My child had the same vaccine last year. Why does my child need another one?" Which response should the nurse give to the child's parent? 1 "All children require influenza booster shots every year up to 12 years of age." 2 "The effectiveness of the influenza vaccine decreases 6 months after the dose." 3 "Different strains of influenza are used to manufacture the vaccine each year." 4 "The child needs to receive the influenza vaccine early due to lack of immunity."

3 The influenza vaccine (inactivated influenza vaccine [IIV*]) is administered yearly because different strains of influenza are used every year for manufacturing the vaccine. It is developed on the basis of flu strains that are likely to be in circulation, thus an influenza vaccine is administered yearly. The child does not require booster shots up to the age of 12 years. Effectiveness of influenza vaccine does not reduce after 6 months; it is effective even after 6 months. The vaccine is required for developing immunity against new strains of the flu virus and is administered yearly to develop immunity against new viral strains.

The nurse is educating a group of parents about safety promotion and injury prevention in the infant. Which statement made by a parent indicates effective teaching? 1 "The mattresses in the house should be covered with plastic." 2 "It is okay to give the child colored latex balloons at playtime." 3 "Diaper pins should be kept closed and away from the infant." 4 "Infant formula should be microwaved before feeding the child."

3 The nurse instructs the parents that diaper pins should be kept closed and away from the infant because it may cause injury to the baby. Mattresses in the house should not be covered with plastic as it increases the infant's chances of suffocation. Latex balloons should not be given to the child for playing because these increase the risk of suffocation in the infant. Infant formula should not be microwaved before giving to the infant as it can cause burns because of uneven warming.

The pediatric nurse works efficiently in providing nursing care to an acutely ill child. After discharge, parents of the child ask the nurse to visit their home for dinner. What should the nurse do? Correct Incorrect 1 Accept it; otherwise it may adversely affect the good relationship. Correct Incorrect 2 Tell them to schedule it later as it is a busy day in hospital. Correct Incorrect 3 Reject it courteously and thank them for the invitation. Correct Incorrect 4 Ask them to invite other staff who were involved in the care as well. The nurse is not supposed to develop personal relationships with the children and families during the care and after the discharge. Therefore, the nurse has to courteously reject such invitations that may lead to personnel relationships. Even if the nurse is busy, the nurse should not accept invitations for lunch, dinners, or other parties, or ask the families to invite other medical staff. This shows unprofessional behavior

3 The nurse is not supposed to develop personal relationships with the children and families during the care and after the discharge. Therefore, the nurse has to courteously reject such invitations that may lead to personnel relationships. Even if the nurse is busy, the nurse should not accept invitations for lunch, dinners, or other parties, or ask the families to invite other medical staff. This shows unprofessional behavior

A 6-month-old infant's parent asks the nurse, "What is the best alternative to breastfeeding?" What appropriate response should the nurse give to the infant's parents? 1 "Skim milk is an alternative to breastfeeding." 2 "Imitation milk is an alternative to breastfeeding." 3 "Commercial iron-fortified formula is an alternative." 4 "Pasteurized whole cow's milk is acceptable to give."

3 The nurse should advise the parents to give iron-fortified formula to the infant as it is the best alternative to breastfeeding. It is like human milk and contains all nutrients required by the infant for the first 6 months. Skim milk and imitation milk have limited digestibility, increased risk for contamination, and lack of nutrients needed for appropriate growth. Therefore they are not good alternatives to breastfeeding. Pasteurized whole cow's milk is deficient in iron, zinc, and vitamin C. It has a high renal solute load, which makes it undesirable for infants younger than 12 months and therefore is not a good alternative to breastfeeding.

The nurse is caring for a child with cancer. What should the nurse ask the child's parents about in order to obtain information about the child's coping-stress tolerance pattern? 1 "How do you both handle discipline problems at home?" 2 "Have you ever noticed if your child has many friends?" 3 "How does your child usually handle disappointment?" 4 "Who will be staying with your child at the hospital?"

3 The nurse should ask the child's parents about how the child usually handles disappointment. This can help the nurse understand the coping-stress tolerance pattern of the child. It is also helpful for identifying stressors in the child. It is important to know how discipline problems are managed in the child. This helps to know about the child and parent role-relationship pattern. When the nurse asks about the child's friends, it is to assess the child's role and relationship patterns outside the home. The nurse can understand the role and relationship pattern between the parents and child after knowing who will stay in the hospital with the child.

The nurse is caring for an infant who has an iron deficiency. The primary health care provider (PHP) has prescribed oral iron supplements to the infant. What instruction should the nurse give to the infant's parents for the safe administration of the supplement? Administer the medication: 1 With all the meals. 2 Mixed with fluids. 3 In between meals. 4 With milk products.

3 The nurse should instruct the parents to administer the supplement to the infant between meals for enhanced absorption. Iron supplements should not administered with food, drink, or milk products because these substances bind to free iron and prevent absorption. This results in an insufficient concentration of iron in the body.

A child has been admitted to the hospital to undergo cancer treatment. What does the nurse do during the admission process to make the child feel comfortable? 1 Places the child in a room with a child with a different illness 2 Does not tell the other child they are getting a new roommate 3 Places the child in a room with a child close to the same age 4 Instructs the new patient not to play with the new roommate

3 The nurse should place the child in a room with another child of the same age-group so that the child will feel comfortable. It is also psychologically and medically advantageous for the child. The nurse should not place the child in the room with a child who has a different illness because there are chances of passing infections between the children. The nurse should inform both children that they will be sharing a room so that the roommate can mentally prepare for arrival of the new child. The nurse should allow the child to play with the roommate so that the child can become comfortable.

The nurse is assessing the functional self-care level of a child and determines that the child requires the assistance of a caregiver for general hygiene and dressing. How would the nurse rate the child? 1. 0 2. I 3. II 4. IV

3 The nurse should rate the child as a II (two) because the child requires assistance of a caregiver for general hygiene and dressing. A grading of 0 (zero) is given to the child who is capable of taking full self-care. A grading of a I (one) is given to the child who requires the use of equipment or a device for self-care. A child who is totally dependent and does not participate in self-care would be rated a IV (four).

During assessment of a 7-month-old child, the nurse checks the child's height and weight and compares them with previous assessment records. The nurse finds that the child's height has increased by 1.25 cm, and the weight is 140 g more than in the previous month. What does the nurse infer from this observation? 1 The child is displaying symptoms of Down syndrome. 2 The child's weight is not ideal in relation to height. 3 The child's height and weight are ideal. 4 The child has a calcium deficiency due to malnutrition

3 The nurse should regularly check the height and weight of the child and compare them with previous assessment records. These comparisons help the nurse identify genetic defects that can affect the child's growth and development. A child gains 140 g in weight, and height increases by 1.25 cm every month from ages 6 to 12 months. Therefore, this child has an ideal height and weight. Down syndrome is characterized by a slower growth rate. The child is having age-appropriate increases in height and weight and thus does not have Down syndrome. Calcium deficiency decreases bone density and causes fractures in children. The nurse cannot determine whether the child has calcium deficiency by assessing height and weight.

The nurse is caring for a 7-year-old child. The child wears an amulet because the family believes that it will protect the child from the evil eye. For a diagnostic procedure, the nurse has to take this amulet off. What should the nurse do? 1 Allow the child to continue to wear the amulet for comfort during all aspects of the procedure. 2 Do not perform the prescribed procedure because removing the amulet will hurt the family's feelings. 3 Get permission from the family to remove it for the procedure and replace it afterwards. 4 Ask the family to remove the amulet and not to let the child wear it because it obstructs medical care.

3 The nurse should try to avoid hurting the family's feelings. If the amulet is an obstacle to medical care, the nurse should explain that to the family and obtain their permission to remove the amulet for the procedure. The nurse should replace it as soon as the procedure is over. Continuing the procedure without taking off the amulet may interfere with the procedure or hurt the child. The nurse should not cancel the procedure because it is essential for the child's care. The nurse should not ask the family to remove the amulet permanently because it does not impede all medical care; affects only this procedure

The nurse is caring for a child with an influenza viral infection. The child is anxious because the parents are unable to stay with the child. What should the nurse do to relieve the child's anxiety? The nurse should: 1 Not maintain any eye contact with the child. 2 Not speak with the child about missing the parents. 3 Use the phone to let the child talk with the parents. 4 Use a laptop to allow the child and parents to talk.

3 The nurse should use a telephone to maintain contact between the child and parents so that the child can feel comfortable. It helps relieve the child's anxiety. The nurse should maintain eye contact and gently touch the child to establish rapport. The nurse should talk with the child about the parents and family to prevent detachment of the child from the parents. The nurse should not use a laptop to contact the child and parents. The laptop may not be compatible with medical equipment, and use may be restricted in certain areas.

A child is admitted to the hospital unit for the management of diabetes mellitus. The parents ask the nurse, "Why does our child get insulin only once a day while the diabetic child in the other bed gets insulin twice a day?" How should the nurse respond to the parents' query? The nurse: 1 Changes the dosing times per the request of the parents. 2 Asks the primary health care provider to adjust the dosage. 3 Explains that the treatment may vary between children. 4 Explains the pharmacologic mechanisms of the drugs.

3 The requirement of medication in diabetes mellitus varies from child to child based on the insulin requirements. Therefore the nurse should answer the parents' question by explaining this to the parents. The dosing times are not adjusted because the parents request it. The dosing times are based on the patient's insulin needs. The nurse should follow the prescribed insulin dosage from the primary health care provider. The nurse should not need to ask the health care provider. The parents may not understand when pharmacologic aspects of the drugs are explained. Therefore the nurse should not explain it to the parents.

The nurse notices that a child's spleen is quite large. To which age group does the child belong? 1. 0-12 months 2. 1-6 years 3. 6-12 years 4. 12-18 years

3 The spleen is easily palpated between the ages of 6 and 12 years. If it is palpated at any other age, such as 0-12 months, 1-6 years, or 12-18 years, this finding must be reported to the primary health care provider.

A child has learned to put on his shoes by remembering that the buckle is to be placed outside the foot. Which possible developmental theory can be used to explain this behavior? 1 Psychological development 2 Moral development 3 Cognitive development 4 Social development

3 The theory of cognitive development explains the process of learning and the ability to perform tasks by using logical thinking. The ability to put on shoes properly and place the buckle in the right place requires logical thinking. Psychological development includes the development of ego from the conscience. Moral development involves characteristic obedience. Social development includes individuality and independence.

The nurse is caring for two children. The younger child creates complex imaginary stories using dolls and toys. The older child is engaged in building a model airplane. Which stages of development are the children likely in, according to Erikson? 1 The younger child is in the trust versus mistrust stage; the older child is in the initiative versus guilt stage. 2 The younger child is in the industry versus inferiority stage; the older child is in the identity versus role confusion stage. 3 The younger child is in the initiative versus guilt stage; the older child is in the industry versus inferiority stage. 4 The younger child is in the identity versus role confusion stage; the older child is in the trust versus mistrust stage.

3 The younger child exhibits a strong imagination and an urge to explore through her doll play, which indicates that she is in the initiative versus guilt stage of Erikson's psychosocial development theory. The older child is building a model, indicating a desire to produce something and complete a task, which is a primary characteristic of the industry versus inferiority stage according to Erikson. The trust versus mistrust stage of Erikson's theory consists of establishing trust and taking in the world using all the senses; neither child is exhibiting characteristics of the trust versus mistrust stage. The identity versus role confusion stage is characterized by rapid physical change in children and concern over how they are viewed by others; neither child is exhibiting behavior associated with this stage.

An infant's blood glucose levels are low, and the nurse instructs the mother to perform kangaroo care. Which condition would the nurse have assessed in the child? 1 Irregular sleep patterns 2 Reduced metabolism 3 Improper thermoregulation 4 Impaired maturation

3 Thermoregulation is one of the most important adaptations for an infant to develop. A hypothermic infant tends to develop conditions such as hypoglycemia and metabolic acidosis. Skin-to-skin contact, or kangaroo care, is beneficial in maintaining the infant's temperature. Sleep irregularities may develop when an infant is suffering from pain internally or externally, which would also affect the growth and development at early postnatal development. Metabolic rates are usually high in children. Neurological maturation, or a dramatic increase in the number of neurons, occurs when the infant is in the embryonic stage and the neonatal state.

What is the most appropriate teaching point to include in a health promotion teaching plan for parents of children age 5 to 14? 1 Causes of mechanical suffocation 2 Keeping all medications out of childrens' reach 3 Storing firearms in locked cabinets 4 Warning signs of violent crimes

3 Storing firearms in locked cabinets Improper use of firearms is the fourth leading cause of death from injury in children 5 to 14. Mechanical suffocation is the leading cause of death from injury in infants. Homicide is the second leading cause of death in 15 to 19 year olds. Poisoning causes a considerable number of injuries in children younger than 4 years of age

The signs and symptoms in a nursing diagnosis describe: 1 projected changes in an individual's health status, clinical conditions, or behavior. 2 an individual's response to health pattern deficits in the child, family, or community. 3 a cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems. 4 physiologic, situational, and maturational factors that cause the problem or influence its development.

3 a cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems Identifying characteristics derived from patient assessment is the third part of the nursing diagnosis , the signs and symptoms. Projected changes in health status are the outcomes or goals that are established. An individual's response to health pattern deficits is the definition of the problem statement, the first component of the nursing diagnosis. The factors that cause the problem or influence its development is the definition of etiology, the second component of the nursing diagnosis

The nurse is assessing a 5-year-old child and finds the child to be physically fit. After further discussion with the parent, the nurse finds that the child talks, plays, and interacts with an imaginary playmate more than with other children. What advice does the nurse give to the parent? Select all that apply. 1 Encourage the child to play with the imaginary playmate. 2 Call the child's imaginary playmate by its name. 3 Help the child to differentiate between make believe and reality. 4 Develop positive interactions with the child through mutual play. 5 Often give new toys to the child.

3, 4 A 5-year-old usually develops much higher cognitive thinking and is involved in different activities. The parents should help the child differentiate between realities and make-believe play. This helps the child acknowledge reality. Mutual play between the parent and the child helps strengthen their relationship. Encouraging the child to play with the imaginary playmate and referring to the imaginary playmate by its name will strengthen the child's fantasy. Therefore the nurse should advise the child's parents to avoid doing those things. Giving new toys will not prevent imaginative play.

Following an assessment, the nurse concludes that the child has a learning disability. Which activities of the child support the conclusion? Select all that apply. The child: 1 Runs useful errands. 2 Demonstrates stubborn behavior. 3 Shows trouble listening. 4 Has difficulty in speaking. 5 Takes part in group play.

3, 4 A learning disability is a group of disorders that is manifested by significant difficulties in the acquisition of and use of listening, speaking, reading, writing, reasoning, or mathematic skills. Difficulty in listening and speaking indicates the child's learning disability. If the child runs useful errands, then this shows the development of adaptive behavior. A stubborn nature in the child is normal in preschool-age children. Taking part in group play shows the development of social behavior of the child.

After speaking with a 12-year-old child, the nurse finds that the child is a victim of bullying. Which behavioral symptoms of the child might have led the nurse to conclude this? Select all that apply. 1 Poor academic performance 2 High levels of enthusiasm 3 Withdrawal from social activities 4 Low self-esteem 5 Readily joins in with peers

3, 4 Social isolation and low self-esteem are symptoms of psychological distress seen in victims of bullying. The child's poor academic performances are related to cognitive development. Therefore poor academic performance does not indicate that the child is a victim of bullying. The children are usually enthusiastic during their growth and development period, but if they are intolerably hyperactive, the child might be checked for attention deficit disorder. A bullied child is usually depressed and not enthusiastic. Bullied children tend to withdraw from social activities, and they do not readily involve in interacting with peers.

The nurse is teaching the importance of dental health to a group of parents in the community. Which points does the nurse emphasize in order to prevent dental caries in children? Select all that apply. 1 Decrease excessive fat intake in the diet. 2 Do not let the child have too much sleep. 3 Teach children how to correctly floss their teeth. 4 Demonstrate how to correctly brush their teeth. 5 Reduce the intake of fermentable carbohydrates.

3, 4, 5 Proper oral hygiene is the most effective means practiced to prevent dental caries. Not only is it important to teach children how to floss their teeth, but the nurse should also teach the parents to reinforce correct brushing techniques. This helps promote oral hygiene and prevent dental caries. Fermentable carbohydrates tend to increase the risk of dental caries and should be limited in the diet. Excess fat in the diet should not be included in the diets of children who are obese. Excess sleep in a child should not be encouraged as it makes the child more sedentary

The nurse is educating parents about sudden infant death syndrome (SIDS). What instructions should the nurse give to the parents for preventing SIDS? Select all that apply. 1 "Soft bedding should be used for the infant's bed." 2 "The side-lying position is the best for the infant." 3 "Adults should not share their bed with the infant." 4 "Smoking should be prohibited around the infant." 5 "Preterm infants can be placed in the supine position."

3, 4, 5 SIDS is defined as the sudden death of an infant younger than 1 year that remains unexplained after a complete postmortem examination. The nurse should educate the parents to avoid bed-sharing with infant because it increases the chances of overlaying and results in infant death. Smoking should never be allowed around infants. Smoking increases nicotine concentrations in lung tissue of the infant and may result in the sudden death of the infant. Preterm infants can be placed in the supine position to prevent suffocation. Soft bedding can cause suffocation because infants cannot yet move their heads to the side. A side-lying position is not suitable for the infant because it also increases the chances of suffocation.

Characteristics of physical development of a 30-month-old child include: Select all that apply. 1 anterior fontanel is open. 2 birth weight has doubled. 3 genital fondling is noted. 4 sphincter control is achieved. 5 primary dentition is complete.

3, 4, 5 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.

An 8-year-old child has been recently diagnosed with leukemia. What are the key assessments that a nurse should perform to determine the child's reaction to this crisis? Select all that apply. 1 Separation anxiety 2 Loss of self-control 3 Developmental age 4 Acquired coping skills 5 Past experience of illness

3, 4, 5 The child's reaction to the crisis is influenced by many factors. The developmental age of the child will influence the child's understanding of the disease condition and the reaction to it. The child's reaction to a crisis is also influenced by coping skills acquired through observation of family members and cultural practices. The child's previous experience of illness will also influence the child's reaction to illness. If the previous experience was positive, the reaction is likely to be positive. Separation and loss of self-control are types of crisis situation and not key assessments.

11. A physician diagnoses a school-age child with strep throat and pharyngitis. The child's parent asks the nurse what treatment the child will need. Which is the nurse's best response? 1. "Your child will be sent home on bedrest and should recover in a few days without any intervention." 2. "Your child will need to have the tonsils removed to prevent future strep infections." 3. "Your child will need oral penicillin for 10 days and should feel better in a few days." 4. "Your child will need to be admitted to the hospital for 5 days of intravenous antibiotics."

3. The child will need a 10-day course of penicillin to treat the strep infection. It is essential that the nurse always tell the family that, although the child will feel better in a few days, the entire course of antibiotics must be completed.

21. There are several children in the ER waiting area who all have asthma. The nurse has only one room left in the ER. Based on the following information, which child should be seen first? 1. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. 2. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. 3. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. 4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.

3. This child is exhibiting signs of severe asthma. This child should be seen first. The child no longer has wheezes and now has diminished breath signs.

30. A 6-week-old male is admitted to the hospital with influenza. The child is crying, and the father tells the nurse that his son is hungry. The nurse explains that the baby is taking nothing by mouth. The parent does not understand why the child cannot eat. Which is the nurse's best response to the parent? 1. "We are giving your child intravenous fluids, so there is no need for anything by mouth." 2. "The shorter and narrower airway of infants increases their chances of aspiration." 3. "When your child eats, he burns too many calories; we want to conserve the child's energy." 4. "Your child has too much nasal congestion; if we feed the child by mouth, the dis tress will likely increase."

30. 1. The child is receiving intravenous fluids, so he is being hydrated. However, this re sponse does not explain to the father why his son cannot eat. *2. Infants are at higher risk of aspiration because their airways are shorter and narrower than those of an adult.* 3. Eating burns calories, but if the baby is upset and crying he is also expending en ergy. Therefore, this is not the best choice of answers. 4. If the child has nasal congestion, that may make it difficult for him to feed. However, the recommendation to parents is to bulb suction an infant with nasal congestion before feeding.

17. A pediatric client is admitted in status asthmaticus. The parent reports that the child is currently taking Singulair, albuterol, and Flovent. What is the most important piece of information that the nurse must ask the parent in order to best treat the patient? 1. "What time did your child eat last?" 2. "Has your child been exposed to any of the usual asthma triggers?" 3. "When was your child last admitted to the hospital for asthma?" 4. "When was your child's last dose of medication?"

4. The nurse needs to know what med ication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.

31. The nurse is caring for a 22-month-old male who has had repeated bouts of otitis media. The nurse is educating the parents about otitis media. Which of the following statements from the parents indicates they need additional teaching? 1. "If I quit smoking, my child may have less chance of getting an ear infection." 2. "As my child gets older, he should have fewer ear infections, because his immune system will be more developed." 3. "My child will have fewer ear infections if he has his tonsils removed." 4. "My child may need a speech evaluation."

31. 1. Repeated exposure to smoke damages the cilia in the ear, making the child more prone to ear infections. 2. Children experience fewer ear infections as they age because their immune system is maturing. *3. Removing children's tonsils may not have any effect on their ear infection. Children who have repeated bouts of tonsillitis can have ear infections sec ondary to the tonsillitis, but there is no indication in this question that the child has a problem with tonsillitis.* 4. Children who have repeated ear infections are at a higher risk of having decreased hearing during and between infections. Hearing loss directly affects a child's speech development.

33. A physician prescribes 10 days of amoxicillin to treat a 6-year-old male with an ear infection. The nurse is reviewing discharge instructions with the parent. Which information should be included in the discharge instructions? 1. "Administer the amoxicillin until the child's symptoms subside." 2. "Administer an over-the-counter antihistamine with the antibiotic." 3. "Administer the amoxicillin until all the medication is gone." 4. "Allow your child to administer his own dose of amoxicillin."

33. 1. The parent should administer all of the medication. Stopping the medication when symptoms subside may not clear up the ear infection and may actually cause more severe symptoms. 2. Antihistamines have not been shown to decrease the number of ear infections a child gets. *3. It is essential that all the medication be given.* 4. The child is old enough to participate in the administration of medication but should only do so in the presence of the parents.

34. The parent of a pediatric client who has had frequent ear infections asks the nurse if there is anything that can be done to help the child avoid future ear infections. Which is the nurse's best response? 1. "Your child should be put on a daily dose of Singulair." 2. "Your child should be kept away from tobacco smoke." 3. "Your child should be kept away from other children with otitis." 4. "Your child should always wear a hat when outside."

34. 1. Singulair is an allergy medication, but it has not been proved to help reduce the number of ear infections a child gets. *2. Tobacco smoke has been proved to increase the incidence of ear infec tions. The tobacco smoke damages mucociliary function, prolonging the inflammatory process and impeding drainage through the eustachian tube.* 3. Otitis is not transmitted from one child to another. Otitis is often preceded by a URI, so children who are around other children with URIs may contract one, in creasing their chances of developing an ear infection. 4. Wearing a hat outside will have no impact on whether a child contracts an ear infection.

35. Which of the following children would benefit most from having ear tubes placed? 1. A 2-month-old who has had one ear infection. 2. A 2-year-old who has had five previous ear infections. 3. A 7-year-old who has had two ear infections this year. 4. A 3-year-old whose sibling has had four ear infections.

35. 1. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections. *2. A 2-year-old who has had multiple ear infections is a perfect candidate for ear tubes. The other issue is that a 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections.* 3. A 7-year-old who has had two ear infec tions is not the appropriate candidate. Surgical intervention is usually reserved for children who have suffered from recurrent ear infections. 4. Surgery is not a prophylactic treatment. Just because the sibling has had several ear infections does not suggest that the 3-year-old will also have frequent ear infections. The 3-year-old has not had an ear infection yet.

36. A 2-month-old is diagnosed with otitis. The parent asks the nurse if the otitis will have any long-term effects for the child. Understanding the complications that can occur with otitis, which is the nurse's best response? 1. "The child could suffer hearing loss." 2. "The child could suffer some speech delays." 3. "The child could suffer recurrent ear infections." 4. "The child could require ear tubes."

36. 1. Hearing loss is not an issue that would be discussed following one ear infection. Children with recurrent untreated ear infections are more likely to develop hearing loss. 2. Speech delays are not an issue that would be discussed following one ear infection. Children with recurrent untreated ear infections are more likely to develop some hearing loss, which often results in delayed language development. *3. When children acquire an ear infection at such a young age, there is an in creased risk of recurrent infections.* 4. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections.

37. A 6-month-old is diagnosed with an ear infection. The parents report that the child is not sleeping well and is crying frequently. The child also has a moderate amount of yellow drainage coming from the infected ear. This is the parents' first baby. Which of the following nursing objectives is the priority for this family at this time? 1. Educating the parents about signs and symptoms of an ear infection. 2. Providing emotional support for the parents. 3. Providing pain relief for the child. 4. Promoting the flow of drainage from the ear.

37. 1. It is important to educate the family about the signs and symptoms of an ear infection, but that is not the priority at this time. The infant has already been diagnosed with the infection. 2. The parents may need emotional support because they are likely suffering from a lack of sleep because their infant is ill. However, this will not solve their current problems with their infant. *3. Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better.* 4. Promoting drainage flow from the ear is important, but providing pain relief is the highest priority.

38. A 2-year-old is admitted to the hospital in respiratory distress. The physician tells the parents that the child probably has RSV. The parents ask the nurse how they will determine if their child has RSV. Which is the nurse's best response? 1. "We will need to do a simple blood test to determine whether your child has RSV." 2. "There is no specific test for RSV. The diagnosis is made based on the child's symptoms." 3. "We will swab your child's nose and send those secretions for testing." 4. "We will have to send a viral culture to an outside lab for testing."

38. 1. RSV is not diagnosed by a blood draw. 2. Nasal secretions are tested to determine if a child has RSV. *3. The child is swabbed for nasal secre tions. The secretions are tested to determine if a child has RSV.* 4. Viral cultures are not done very often because it takes several days to receive results. The culture does not have to be sent to an outside lab for evaluation.

A 14-year-old boy learns about his adoption from his relatives and wants to know his identity. He appears angry, embarrassed, and anxious. What should the nurse advise his parents to help resolve the conflict? 1 "Don't forget to obtain the boy's birth certificate." 2 "Don't reveal the information regarding the adoption." 3 "Don't encourage the boy to search for his identity in this situation." 4 "Don't forget to inform the child about the availability of a birth certificate."

4 Adoptive parents should inform the boy about the availability of a birth certificate. Open and honest communication between the boy and the parents is essential for the welfare of the adopted child. Legally, adoptive parents are not permitted to obtain the birth certificate. Parents should understand the need of the child to search for his identity and extend encouragement and support.

A person is eager to adopt a child. The person wants to know which age group of children adapt well to adoption. Which is the best response by the nurse? 1 1-year-olds 2 7-year-olds 3 15-year-olds 4 5-month-olds

4 A 5-month-old baby is much easier to adopt because the baby is not yet attached to anybody and tends to adapt well to a new environment. The earlier the child is adopted, the better he or she adapts to the new home. Children who are 1 year old, 7 years old, or 15 years old may not adapt well because they have not had consistency in their lives and may have developed other attachments

A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent indicates to the nurse that the parent needs more instruction regarding accident prevention? 1 "We locked all the medicines in the bathroom cabinet." 2 "We turned down the thermostat on our hot water heater." 3 "We placed gates at the top and bottom of the basement steps." 4 "We stopped using the car seat now that my child is older."

4 A car seat should be used until the child weighs 40 pounds, at approximately 4 years of age. Locking medicines in a cabinet is an appropriate action. Turning down the thermostat on the hot water heater is an appropriate action. Placing gates at the top and bottom of stairs is an appropriate action.

A medical team is delegated to rescue people from an area struck by a natural disaster. What should the senior nurse advise the junior nurse while rescuing the people? 1 First protect elderly people from the disaster. 2 Give immunization to injured soldier rescuers. 3 Give painkiller and antibiotics to injured women. 4 Protect the small children first in the disaster area.

4 According to the United Nations' Declaration of the Rights of the Child, children are the first to receive protection in disaster. Therefore, the nurse should protect children as a top priority. Then elderly people can be attended to as well as, injured soldiers, and injured women should also be protected and given appropriate treatment.

The nurse is teaching the parent of a 16-month-old child about safety measures that should be taken while storing medications at home. Which statement made by the nurse is most appropriate to prevent accidental poisoning of the child? 1 "You should keep the ointments and disinfectant in a table drawers." 2 "Medication having caps can be placed bedside as children cannot open the caps." 3 "If the child has a fever, administer aspirin to the child, as it is safe." 4 "Always keep lozenges and transdermal patches in a closed locked cabinet."

4 After 1 year children start exploring objects by tasting them due to curiosity. It can cause accidental poisoning. The nurse should teach safety measures to parents to prevent accidental poisoning. Children are attracted to lozenges because they look like candy. Transdermal patches are not packed with safety caps, so children can easily open them. The medications must be kept in a closed cabinet to prevent the child's access to these medicines. Unlike infants, young children 16 months of age can easily open the table drawers. If the medications are kept in table drawers, the child can take out the medication and put it in the mouth. Curious children tend to open the caps by trial and error and ingest the drugs accidently, so they should be kept in a closed cabinet. Aspirin must not be administered as it has potent side effects and it causes Reye's syndrome in children.

The nurse walks in the room of an infant and notices the baby is apneic; has pallor, cyanosis, and a change in muscle tone; and is gagging. Which condition is the infant exhibiting? 1 Symptoms of failure to thrive 2 Signs of hepatitis A infection 3 Varicella-zoster viral infection 4 Sudden infant death syndrome (SIDS)

4 Apnea, pallor, cyanosis, change in muscle tone, and gagging are apparent life-threatening events. Infants with an apparent life-threatening event are at higher risk for SIDS. Infants with failure to thrive are underweight and malnourished. Fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice are the symptoms of hepatitis A virus infection. Skin rashes, nausea, loss of appetite, aching muscles, and headache are the symptoms of varicella-zoster virus infection. Because the child does not have these symptoms, it indicates that the child is not infected with rotavirus, hepatitis A virus, or varicella-zoster virus.

A Muslim mother refuses treatment of her newborn who has been diagnosed with asphyxia and hypoxemia. The mother believes that only Allah can cure the newborn. Which is an appropriate nursing action? 1 Taking the newborn to the neonatal intensive care unit immediately 2 Informing the mother that modern medicine may be the only choice at this moment 3 Refraining from treating the newborn and contacting the primary health care provider 4 Explaining to the mother that Allah at times chooses to help through the efforts of humans

4 As the patient has belief in Allah, the nurse should explain to her that Allah can work through the efforts of humans at times. The nurse should not take the newborn to the intensive care unit without the mother's consent. The nurse should not show disrespect for the mother's religious beliefs by emphasizing only modern medicine. Refraining from providing treatment to the newborn may worsen the newborn's condition

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: 1 "It's important not to give in to this kind of temper tantrum at this age. Simply ignore the behavior and the mess." 2 "You need to try different types of utensils, bowls, and plates. Some are specifically designed for young children." 3 "It's important to let him make a mess. Just try not to worry about it so much." 4 "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."

4 At 12 months, the child should be self-feeding. Because children this age eat primarily finger foods, it is useful to offer the parent suggestions for keeping the mess to a minimum. 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 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.

The nurse is observing a child who is sitting on the parent's lap. The child is able to speak one word completely. What does the nurse interpret from the observation? The child: 1 Is bored with the present situation. 2 Appears to be mentally challenged. 3 Is developmentally delayed. 4 Is probably around 12 months old.

4 At the age of 12 months, the child can speak one-word sentences. It is a language characteristic seen in early toddlers. A bored child may cry, eat, or sleep. A mentally challenged child may show characteristic features like banging the head, continuous movement of hands, or screaming. There is not enough information in the question to infer if the child's development is delayed.

The nurse is assessing a child during a checkup and notes the child has all permanent teeth and is a healthy weight for his age. What would be the approximate weight of the child? 1. 16 to 26.3 kg (35.5 to 58 pounds) 2. 17.7 to 30 kg (39 to 66.5 pounds) 3. 19.5 to 39.5 kg (43 to 87 pounds) 4. 24.5 to 58 kg (54 to 128 pounds)

4 By the age of 10 to 12 years, the permanent teeth have erupted in children. Therefore the child is probably in this age group. A healthy weight of a child in the age group of 10 to 12 years is 24.5 to 58 kg (54 to 128 pounds). A 6-year-old child may have a weight of 16 to 26.3 kg (35.5 to 58 pounds). This is the age where loss of first teeth occurs in the children. A 7-year-old may have a weight of 17.7 to 30 kg (39 to 66.5 pounds). The child's teeth start forming at this stage. An 8-year-old child may have a weight of 19.5 to 39.5 kg (43 to 87 pounds). Lateral incisors (maxillary) and mandibular cuspids erupt at this age

What is an important consideration related to childhood stress? 1 Children should be protected from stress. 2 Children do not have coping strategies. 3 Parents cannot prepare children for stress. 4 Some children are more vulnerable to stress than others.

4 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.

During the assessment of a 5-year-old child whose parents are from Southeast Asia, the nurse notices small burn injuries on the skin. The nurse learns that the child has a history of temper tantrums. Which is the immediate nursing action? 1 Call the police. 2 Report child abuse. 3 Inform the health care provider. 4 Ask the parents about the injury.

4 Communication is important to avoid wrong diagnosis and interpretations. The nurse should ask the parents about the burn injuries to understand their cultural and religious practices. If the child exhibits temper tantrums, some Southeast Asian cultural groups follow the practice of causing burn injuries on the skin for treatment. These burn injuries are not considered to be abusive by this cultural group even though the dominant culture and legal system may consider this to be child abuse. Therefore, there is no need to call the police or report child abuse. The nurse can inform the health care provider after discussing with the parents.

A patient asks the nurse what a consanguineous relationship is. What is the most appropriate example that the nurse can give to answer this query? The relationship between a: 1 child and a teacher. 2 husband and a wife. 3 father and a stepchild. 4 father and a daughter.

4 Consanguineous relationships are blood relations. The best example of a consanguineous relationship is father and daughter. A child and a teacher may not be related by blood. A husband and wife are not related by blood. A father and a stepchild also are not related by blood

What is the characteristic of the type of play that is organized by children playing with other children with the purpose of accomplishing a goal? 1 The group members play independently. 2 The group members act according to their own wishes. 3 The group members do have assigned leadership roles. 4 The group members plan activities even if the group is formed loosely.

4 Cooperative play features one child supplementing another child's function with a common aim of goal completion. In cooperative play, the group may be loosely formed but the members plan activities with the aim of accomplishing a task. The group members play independently among others in parallel play. The members act according to individual wishes in associative play. There is no leadership assignment in associative play.

The nurse is talking to a group of parents about different types of play in which children engage. Which statement made by a parent indicates a correct understanding of the teaching? 1 "Parallel-play children borrow and lend play materials and sometimes attempt to control who plays in the group." 2 "In associative play, children play independently but among other children." 3 "During onlooker play, children play alone with toys different from those used by other children in the same area." 4 "Cooperative play is organized, and children play in a group with other children."

4 Cooperative play is play that is organized; children play in a group with other children and plan activities for purposes of accomplishing an end. 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.

The nurse is assessing the oral cavity of a child. The nurse instructs the child to floss the teeth regularly and use a fluoride toothpaste for brushing. Why did the nurse give this instruction to the child? The child had: 1 A dental injury from sports. 2 A reimplanted tooth. 3 An eruption of a permanent tooth. 4 Bleeding gums with plaque.

4 Dental problems are commonly observed in children, but most of them are ignored. The child who has inflammation that causes the gums to bleed and has plaque most likely has gingivitis. The nurse should recommend that the child regularly brush and floss the teeth. Fluoride-based toothpaste is also used to reduce plaque. When the child experiences a dental injury from sports or any other cause, it may cause a fracture, chipping, and dislocation of the teeth. This needs immediate attention by a dentist. When a tooth is reimplanted in a child, it is recommended to not floss for a particular duration of time. Children develop their permanent teeth when they are school-age

The nurse is assessing a child who is macrobiotic and has inadequate intake of proteins and calories. What is the right nursing intervention to promote protein intake? 1 Assess and refer the child to a pediatrician. 2 Consider this as age-related change and ignore it. 3 Start administration of supplemental formulations. 4 Plan a diet according to the child's requirements.

4 Due to the picky eating habit of toddlers, they may develop nutritional deficiency. Therefore, the nurse should plan the child's diet according to the child's requirement and need for specific nutrition. The nurse refers the child to a pediatrician only if the child develops any illness. The nurse should not consider this as age-related change and should clearly communicate with the parents. The nurse cannot start the administration of nutritional supplemental formulations without the health care provider's order.

The nurse is talking with the parents of a toddler to obtain the dietary history. The nurse learns that the child consumes dairy products and has fish sticks on rare occasions but does not eat any other meat at all. Which type of vegetarian diet does the child's family follow? 1 Macrobiotic 2 Semi-vegetarian 3 Lacto-vegetarian 4 Lacto-ovo vegetarian

4 During the nutritional assessment, it is important to list exactly what the diet includes and excludes. Major deficiencies can occur in strict vegan diets. There are many types of vegetarian diets. The child would be considered to follow a lacto-ovo vegetarian diet as the diet excludes meat but includes dairy products and sometimes fish. A macrobiotic diet is even more restrictive than a pure vegetarian one, allowing only a few types of fruits, vegetables, and legumes. A semi-vegetarian consumes a lacto-ovo vegetarian diet with some fish and poultry. A lacto-vegetarian excludes meat and eggs but drinks milk.

The nurse is planning a diet chart for a child with diarrhea and dental caries. Which food does the nurse exclude in the child's diet chart? 1 Milk 2 Baked food 3 Legumes 4 Fruit juices

4 Fruit juices and sweet beverages contain high amounts of sugar and calories. Consuming fruit juices may worsen dental caries. Therefore they should be excluded from the child's diet chart. Milk and dairy products are rich sources of calcium. Calcium is required for optimal growth and development in the child. Therefore milk should not be excluded from the child's diet. Baked bread has high whole grain content and is a rich source of carbohydrates, so it can be given to the child. Legumes contain high amounts of proteins, which are building blocks of the body. Therefore they must be included in the child's diet.

Which is an appropriate nursing action if, while assessing a newborn, the nurse finds that the mother of Vietnamese origin avoids eye contact with the nurse and hesitates to ask questions? 1 Maintaining eye contact with the mother to facilitate communication 2 Referring the mother to a psychiatrist as it can be postpartum psychosis 3 Providing counseling to the mother to help manage postpartum depression 4 Considering it as a sign of respect from the mother to the nurse, the nurse continues with the tasks

4 In Vietnamese culture, avoiding eye contact and not asking questions are signs of respect. The nurse should consider the mother's behavior as a sign of respect and continue with the tasks. Maintaining eye contact is considered disrespectful and this can hinder the communication. The signs and symptoms of postpartum psychosis include extreme mood swings, hallucinations, and irritability. As these signs are absent in the mother, the nurse does not have to refer her to a psychiatrist. The signs and symptoms of postpartum depression include low mood, sadness, anxiety, and irritability, which are absent in the mother. Therefore, the nurse need not provide counseling for depression

The parents of a 7-month-old infant report to the nurse that the solid food they feed to the baby passes through the gastrointestinal tract unchanged. Which response of the nurse would help to relieve the parent's anxiety? 1 "It indicates an intestinal infection." 2 "The infant has a metabolic disorder." 3 "The infant has slow development." 4 "It is a normal finding at this age."

4 In a 7-month-old infant, the digestive processes are immature and solid food is not completely digested. As a result of underdeveloped digestion, solid foods pass through without being digested into feces. It is a normal finding at this age. By the end of the first year, the infant will be able to digest food. Therefore it is not a symptom of an intestinal infection, nor does it indicate that the infant has metabolic disorder or slow development.

The nurse works in a hospital with patients from different cultural backgrounds. The nurse understands that certain practices in some cultures may be considered abusive by a dominant culture. Which cultural practice is considered nonabusive? 1 Cupping against the skin surface 2 Forced kneeling for a long time 3 Applying garlic over the skin 4 Saying words into a newborn's ears

4 Islamic people utter few religious words into the ears of a newborn, and this practice is considered to be nonabusive. Cupping is an old world practice where a container with steam is placed on the body surface to draw out the poison or evil elements in the body. Forced kneeling is a measure of disciplining children practiced in some Caribbean families. Some Yeminite Jews apply crushed garlic cloves on to the wrist to prevent infectious diseases.

The health care provider has prescribed a liquid iron supplement for an infant with iron deficiency. What advice does the nurse give to the parents to prevent the infant's teeth from staining from the liquid iron supplement? 1 Use a supplement with a low iron content. 2 Mix the iron with any kind of citrus fruit juice. 3 Dilute with whole cow's milk or milk products. 4 Use a dropper toward the back of the mouth.

4 Liquid iron supplements may stain the teeth, so the nurse should advise the parents to administer the liquid iron supplement with a dropper toward the back of the mouth. The nurse should instruct the parents not to switch to a low-iron-containing formula because the child already is deficient in iron. The parents can administer the liquid iron supplement with citrus fruit juice, but it does not solve the problem of teeth staining. The nurse should advise the parents to not administer the liquid iron supplement with whole cow's milk or milk products as these products bind with free iron and prevent its absorption.

The parents of a child report that their child has difficulty chewing and they are worried about the arrangement of the child's teeth. What type of dental issue should the nurse assess for in the child? 1 Gingivitis 2 Dental caries 3 Periodontitis 4 Malocclusion

4 Malocclusion is the condition where the relationship between upper and lower arches of the jaw is inappropriate. This condition may result in difficulty in chewing and sometimes causes a cosmetic concern. The patient with gingivitis would primarily complain about bleeding gums. Malocclusion of the teeth is not related to gingivitis. Dental caries or cavities are common problems that occur at all ages; when left untreated, they result in total destruction of the teeth. Periodontal diseases are inflammatory diseases involving gums and tissues of the teeth. Bleeding gums and loss of teeth observed in the child would hardly impact the arrangement of the teeth

A 9-month-old infant is seen in the emergency department after developing an 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? 1 Potatoes 2 Green beans 3 Spinach 4 Peanut butter

4 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, green beans, and spinach are not highly allergenic foods.

The nurse is teaching the parents of a toddler about toilet training. What is the right age to start toilet training a child? 1. 12 to 16 months 2. 17 to 20 months 3. 21 to 24 months 4. 25 to 30 months

4 One of the major tasks of toddlerhood is toilet training. Five things need to occur in order for a child to be ready to toilet train. This includes bladder readiness, bowel readiness, cognitive readiness, motor readiness, and psychological readiness. At the age of 30 months, the child has mastered the essential gross motor skills, can communicate intelligently, and becomes aware of the ability and control of the body parts. At 25 to 30 months of age, the child's physiologic and psychological development becomes complete. At 12 to 16 months, children may not be able to control their bowels and bladder. They also may not be able to effectively communicate to the parents. At 17 to 20 months, the child's physiologic and psychological development is still not at a level where the child can practice effective toilet training. At 21 to 24 months, children may be able to control their bowel and bladder in the daytime only but have frequent nighttime accidents.

A single working parent says that caring for a child and managing work is becoming difficult. The nurse determines that the patient is exhausted by these responsibilities. Which is the most appropriate service that would benefit the patient? 1 Hospital 2 Change of job 3 Adoption service 4 Respite child care

4 Respite child care is a service available to help parents to relieve exhaustion and avoid burnout. Therefore, the patient should seek respite child care services. Hospitals are for patients who need medical attention. It would not be appropriate to change jobs because the stress of working would still be there. Adoption services are inappropriate in this situation.

The parents tell the nurse that their child experiences dizziness during the school day. The child does not have this symptom during weekends. The nurse assesses the child and asks the parents to observe the child for symptoms over the holidays. What does the nurse suspect the child to have? 1 Sleep disorder 2 Learning disability 3 Impulsive disorder 4 Fear about school

4 School phobia or fear of going to school is a condition where children experience dizziness, headaches, or nausea on school days and have no symptoms on days off. The nurse should therefore tell the parents to observe the child during holidays when there is time away from school. Sleep disorders are generally seen in schoolchildren when they have difficulty falling asleep. A learning disability is a serious disorder where the child has difficulty understanding, reasoning, or learning mathematical skills. This requires medical supervision for treatment. Impulsive disorders or poor control in impulse activity is a characteristic of attention deficit hyperactive disorder (ADHD), which is treated by using psychostimulant agents.

What does the nurse ask of the parents to determine if the toddler has dyssomnias? 1 "Does your child have any nightmares?" 2 "Have you ever noticed your child sleepwalking?" 3 "Does your child move the head a lot while sleeping?" 4 "Are there any problems with falling asleep?"

4 Sleep disturbances can be classified as dyssomnias, which occur when the child has difficulty falling asleep or staying asleep. The nurse asks the parent if there are any problems falling asleep when the nurse is assessing for dyssomnias. The other classification of sleep disturbances is parasomnias. This includes nightmares, sleepwalking, or rhythmic movement disorders. Rhythmic movement disorders would be assessed by asking the parent if their child moves the head a lot while sleeping.

The nurse is evaluating the quality of evidence of research found in the field of infectious diseases in infants. The nurse found unusually strong evidence from unbiased observational studies. What grade should be given to this research according to the GRADE criteria? 1 Low 2 High 3 Very low 4 Moderate

4 The GRADE criteria are used for grading the evidence of research by nurses. According to this, if evidence is found to be unusually strong from unbiased observational studies, it should be graded as moderate. Low grade is given to the evidence with at least one critical outcome from the observation studies. High grade is given to the studies with exceptionally strong evidence from unbiased observational studies and very low grade is given to studies with at least one critical outcome from very indirect evidence.

Which characteristic of fine motor skills does the nurse expect to find in a 5-month-old infant? 1 Strong grasp reflex 2 Neat pincer grasp 3 Able to build a tower of two cubes 4 Able to grasp object voluntarily

4 The ability to grasp an object voluntarily is appropriate for a 5-month-old infant. A strong grasp reflex is characteristic of a 1-month-old infant. A neat pincer grasp is characteristic of an 11-month-old infant. The ability to build a tower of two cubes is characteristic of a 15-month-old infant.

The nurse is assessing a child with attention deficit hyperactivity disorder (ADHD) and finds underdeveloped fine motor skills. The nurse instructs the teacher to provide the child with a computer. Which findings in the child prompt the nurse to do so? The child has: 1 A vision defect. 2 A learning disability. 3 A hearing problem. 4 Difficulty in writing.

4 The child who has ADHD would face difficulty in writing, which is referred to as dysgraphia. The child should be assisted by integrating a computer into the classroom for the child's use because handwriting may not improve. A visual defect is not a sign of ADHD. In such a case, the child must be evaluated by a medical professional. A learning disability is a disorder in which children find difficulty in learning new things. Children with ADHD have reduced attention span, which may impair their ability to learn. However, learning disability is not a sign of fine motor impairment. Hearing impairment is not a sign associated with ADHD.

During a home visit, the parents report to the nurse that they are worried about their 3-year-old child's behavior. The child lacks discipline and writes on the walls. Which nursing advice would be helpful for the parents for limiting the child's behavior? 1 "Send the child to his or her bedroom for a time-out." 2 "Seclude the child in the store room for a punishment." 3 "Scold the child in a firm, loud tone for the misbehavior." 4 "Instruct the child to stand in play yard for some time."

4 The child's motor skills and mobility increase as the child gets older, so the child becomes more active. The child does not differentiate between good and bad behavior because of lack of understanding. The nurse should advise the parents to discipline the child by using the time-out method. The nurse teaches the parents to select an area for time-out that is safe, convenient, and unstimulating and where the child can be monitored. After staying in an isolated place, the child may feel bored and change his or her behavior to get out of time-out. Therefore the parents should instruct the child to stay in time-out for some time. The parents should not seclude the child in his or her room or store room because there are chances that the child could get hurt. The parents should not scold the child in a firm, loud tone in order to maintain good and friendly relationship with the child.

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: 1 suffocation. 2 child abuse. 3 infantile apnea. 4 sudden infant death syndrome (SIDS).

4 The death is consistent with the characteristics of 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.

A 3.5-year-old boy talks to himself and sometimes talks to the toys. The child has telegraphic speech. What should the nurse tell the parent of the boy? 1 "Talking to toys is normal but talking to oneself is abnormal." 2 "Talking to oneself is normal but talking to toys is abnormal." 3 "By this age, your child should be able to form sentences of about 14 words." 4 "Read stories to your child as it programs words into the memory bank."

4 The parents should be encouraged to read stories to the child as there is evidence indicating that this programs words into the child's memory bank. The nurse should reassure the parent that it is normal for the child to talk to himself or to the toys at this age. The children of this age group talk constantly in spite of others attention. Talking to toys or dolls is normal behavior in children. By the age of 4 years a child is expected to make sentences of 3 to 4 words. Therefore, it is normal for the child to have telegraphic speech.

The parents of a school-age child tell the nurse that to maintain proper nutrition, they give small amounts of food to the child every 2 hours after school. What advice does the nurse offer the child's parents to prevent stomach pain? 1 "Let your child go outside and play after coming home from school." 2 "Make sure that the child takes a nap after coming home from the school." 3 "Do not give snacks to your child after coming home from school." 4 "As children get older, they do not need to eat every 2 hours."

4 The gastrointestinal system of the school-age child is well developed, which results in fewer stomach upsets. The caloric needs of the school-age child is smaller than that of the preschooler. Therefore these children need not be fed as frequently as the preschooler, so the nurses instruct the parents to avoid feeding the child every 2 hours. Allowing the child to play may help increase the physical activity of the child and promote physical development. The parents must be advised to maintain a normal sleep schedule. The child must be involved in physical activities and homework after school instead of taking a nap. The child is usually hungry and tired after coming from school, so the parents must be advised to give nutritious snacks to the child after coming home from school.

The nurse notices a child refuses to drink milk at the hospital. When the nurse asks the child about it, the nurse discovers that at home the child drinks milk in a small glass. What is the most acceptable nursing intervention? The nurse: 1 Compels the child to drink milk as it is healthy. 2 Asks the child's parents to give the milk to the child. 3 Tells the child that both glasses have the same amount. 4 Pours the milk into a small glass for the child to drink.

4 The inability to conserve is one of the characteristics of preoperational thoughts in toddlers. They cannot process the fact that a small and a large glass can contain the same amount of liquid. They just see that the smaller glass is full and the larger glass is half empty.Therefore it is better to pour the milk into a small glass and then give it to the child. It is unethical to force or frighten the child, and the child may become frightened of the nurse. If the child does not want to drink milk from a large glass, the child will not drink even if the parent gives it. Telling the child that the milk in both glasses is same may not be useful as the child may not have adequate cognitive development to understand it.

The nurse is caring for a 2-month-old infant with the flu. The infant is crying due to colicky pain. The nurse tries to soothe the infant, but the infant continues to cry. What does the nurse do in this situation? 1 Offer the infant a bottle of diluted juice. 2 Offer milk products to the infant. 3 Change the diaper before returning the infant to the crib. 4 Walk with the infant's face down and with the body across a parent's arm.

4 The infant is crying due to colicky pain. The nurse should advise a parent to walk with the infant's face down and with the body across an arm so that the infant can feel a little bit comfortable. The nurse should avoid offering diluted juice and other milk products to the infant. They may lead to vomiting in the infant, which may increase the pain and worsen the condition. The nurse should inspect the diaper and change if needed, but the child is crying due to colicky pain, and it may not be helpful in this situation

During assessment, the nurse asks the parents, "How does your child act when annoyed?" What aspect of child care does the nurse assess by asking this question? 1 Value-belief pattern 2 Role-relationship pattern 3 Cognitive-perceptual pattern 4 Self-perception-self-concept pattern

4 The nurse asks how the child acts when annoyed in order to assess the self-perception-self-concept pattern in the child. This information helps the nurse identify the child's needs by observing behavioral changes. For assessing the value-belief pattern, the nurse should ask the parents about their religion. For assessing the role-relationship pattern, the nurse should ask the parents about the family. For assessing the cognitive-perceptual pattern, the nurse should ask the parents about sensory perception.

The parent of a 6-year-old child reports that the child is unable to brush teeth without assistance. The child finds it difficult to cut meat or spread jam on bread with a table knife. When the child is asked to count backwards from 20 to 1, the child fails to do so. Which activity of the child is a cause of concern? 1 Needing assistance in brushing teeth 2 Difficulty in using a knife to cut meat 3 Inability to count backwards from 20 to 1 4 Difficulty in using a knife to spread jam on bread

4 The nurse should be aware of normal developmental skills of a school-aged child. The ability to spread butter or jam on bread with a table knife should be attained by the age of 6 years. However, the ability to brush teeth and the ability to cut meat with a table knife is attained by 7 to 8 years. Counting numbers backwards from 20 to 1 can be done by a child who is 8 or 9 years of age

The primary health care provider (PHP) prescribed MMR vaccine (containing measles vaccine, mumps vaccine, and rubella vaccine) to a child. What should the nurse assess before administering the vaccine to the child? 1 Family history of seizures 2 History of an allergy to duck feathers 3 Family history of a penicillin allergy 4 History of allergy reaction to neomycin

4 The nurse should check for any history of an allergy or anaphylactic reaction to neomycin in the child before administering MMR vaccine. Measles and mumps vaccines are grown on chick embryo tissue cultures, so the vaccines contain a significant amount of egg cross-reacting proteins. Neomycin is added to the vaccine to prevent a cross-reaction from the proteins. If it is administered in to the child who has an allergy to neomycin or has had an anaphylactic reaction to neomycin, it can produce a severe reaction in the child. Family history of seizures, history of an allergy to duck feathers, and family history of penicillin allergy are not necessary because they does not have any impact on the vaccination.

The nurse is providing postoperative care for a child. The child continually asks for help in all aspects of self-care. The nurse observes that the child is able to get dressed without any help. What would be the nurse's best intervention? 1 Instructing the parents to assist their child 2 Scolding the child in a firm tone and punishing the child 3 Assisting the child with self-care activities 4 Encouraging the child to perform self-care

4 The nurse should encourage the child to perform activities of self-care that he or she can do independently. In addition, the nurse should give positive feedback to increase the child's confidence. The nurse should not instruct the parents to assist the child because it can make the child dependent. The nurse should not scold the child in a firm tone because the child may get frightened and may not attempt to perform self-care activities in the future. The nurse should not assist the child for performing self-care when the child can perform it.

The nurse is assessing the oral cavity of a child who is approximately 7 to 8 years of age. The nurse notices that the lateral incisor in the mandible and central incisor in the maxilla have already been lost. Which teeth would erupt when the child is about 11 to 12 years old? 1 The first molar in both the maxilla and in the mandible 2 The third molar in both the maxilla and in the mandible 3 The second bicuspid in both the maxilla and the mandible 4 The second bicuspid in the mandible and the cuspid in the maxilla

4 The second bicuspid teeth in the mandible and the cuspid in the maxilla would erupt in the child who is about 11 to 12 years. The first molar in both the maxilla and the mandible erupts in a 6- to 7-year-old child. The third molar in both the maxilla and the mandible would erupt somewhere between the ages of 17 to 21 years. The second bicuspid in the mandible would erupt between the ages of 11 to 12 years, and the second bicuspid in the maxilla would erupt during 10 to 12 years of age.

The nurse is caring for a toddler with a severe illness. The toddler is frightened by the insertion of a rectal thermometer. What would be the best nursing intervention to alleviate the toddler's fears? 1 Ask the parent to sit next to the toddler and hold the child still. 2 Have the toddler turn to face the window to distract the child. 3 Give a favorite toy to distract the toddler during the procedure 4 Substitute a different method for temperature measurement.

4 The toddler is afraid to have the rectal thermometer inserted for fear it may cause harm. The nurse should use another method to measure the child's temperature. The nurse can obtain an axillary temperature or use an electronic or tympanic membrane device. Making a family member sit beside the toddler is not helpful because it does not decrease the toddler's fear. Moving the toddler to face the window or giving a favorite toy to the toddler is helpful to physically restrain the toddler. However, it is not helpful to relieve the toddler's fear.

Which intervention should the nurse incorporate to prevent hypothermia in an infant? 1 Give hot milk or hot water to the infant at regular intervals. 2 Place the unclothed, diapered infant in the sun for few hours. 3 Feed the infant formula, which is higher in calories. 4 Put the unclothed, diapered infant on the mother's bare chest.

4 Thermoregulation is not well developed in infants. As a result, babies are at risk for hypothermia. Kangaroo care is an effective way to prevent hypothermia in the infant. In this method, an unclothed, diapered infant is placed on the mother's bare chest. This provides physiological warmth to the infant. It is not advisable to give hot milk or hot water to the infant because it can damage their tissues. An unclothed infant must not be kept in the sun for a long time because the sun's ultraviolet rays can cause skin damage. There is no difference in calories between breast milk and formula.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? 1 Help the toddler complete tasks. 2 Provide opportunities for the toddler to play with other children. 3 Help the toddler learn the difference between right and wrong. 4 Encourage the toddler to do things for himself or herself when he or she is capable of doing them.

4 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, which does not foster autonomy. Helping the toddler learn the difference between right and wrong is too advanced for toddlers and does not contribute to autonomy.

The parents of a toddler express frustration to the nurse because their child is a fussy eater." The nurse's best response is: 1" You should provide larger servings of different foods . " 2 "Provide more bland food varieties because toddlers have few food preferences." 3 "Table manners will improve if you provide finger foods . " 4 "Becoming a fussy eater is expected during the toddler years

4 Toddlers have physiologic anorexia that contributes to fussy eating. Toddlers have a decrease in appetite. Toddlers have strong taste preferences. The use of finger foods contributes to unpredictable table manners.

The nurse is educating a group of parents about the dental health for infants. Which statement made by the parent indicates effective learning? 1 "Milk bottles should be given to the child in the bed." 2 "Fruit juices should be given to the child in a bottle." 3 "Fluoridated toothpaste should be used for the child." 4 "A damp cloth can be used to wipe the child's teeth."

4 Tooth decay is a common problem during the early childhood. The nurse should suggest that the parents use a damp cloth to clean the child's teeth by wiping. It prevents accumulation of plaque and keeps the teeth clean. A milk bottle should not be given to the child in the bed because it increases risk of early childhood dental caries. Fruit juices should not be given to the child in a bottle before 6 months of age. This increases the chances of tooth decay. Fluoridated toothpaste should not be used for the child because infants may swallow the toothpaste, which can cause fluoride toxicities.

The nurse is working with the parents of an 8-year-old child and discovers that the child has bedtime problems. The nurse instructs the parents to encourage a quiet activity before bedtime. Why does the nurse recommend this intervention? The child: 1 Talks in his or her sleep. 2 Often wets the bed. 3 Snores during sleep. 4 Does not go to sleep.

4 When children have difficulty going to bed, they need quiet activities such as reading or coloring. These activities decrease the amount of stimuli and help them relax and be ready to go to sleep. This, in turn, helps resolve bedtime problems. Talking in the sleep is common in children and does not require intervention. Bed-wetting is normal in preschoolers and occasionally in young school-age children. However, if the problem continues in later ages, a medical consultation is necessary. The child may snore a little during sleep, but this does not necessitate quiet activities before bedtime.

.The nurse is assessing a child for attention deficit hyperactivity disorder (ADHD). The nurse rates the child's characteristics as eight symptoms of hyperactivity-impulsivity and three symptoms of inattention. What type of ADHD does the child have? 1 Signs of a cognitive learning disability 2 Symptoms of a combined type of ADHD 3 The predominantly inattentive type 4 Predominantly hyperactive-impulsive

4 When the child has eight symptoms of hyperactivity-impulsivity and three symptoms of inattention, then these characteristics belong to the predominantly hyperactive-impulsive type of ADHD. A cognitive learning disability is a serious disorder where the child is unable to listen, understand, reason, or use mathematical skills. This requires medical supervision for treatment. The combined type of ADHD occurs when a child shows six symptoms of hyperactivity-impulsivity and six inattention symptoms. The predominantly inattentive type is one of the major forms of inattention seen in children. Children with predominantly inattentive type of ADHD have fewer than six symptoms of hyperactivity and impulsivity.

The nurse is planning care for a patient with a cultural background different from that of the nurse. An appropriate goal is to: 1 strive to keep cultural background from influencing health needs. 2 encourage continuation of cultural practices in the hospital setting. 3 attempt in a nonjudgmental way to change cultural beliefs. 4 adapt as necessary cultural practices to health needs.

4 Whenever possible, nursing care should facilitate the integration of cultural practices into health needs. The cultural background is part of the individual; it would be very difficult to eliminate its influence. The cultural practices need to be evaluated within the context of the health care setting to determine whether they are conflicting. The cultural background is part of the individual; it would be very difficult to eliminate its influence.

During an assessment, the nurse finds that a child is depressed and frightened and has low grades in school. By which age-group do children usually worry about school grades? 1. 5 and 6 years of age 2. 6 and 7 years of age 3. 7 and 8 years of age 4. 8 and 9 years of age

4 Worrying about school grades is an adaptive behavior in children that happens between 8 and 9 years of age. Children who are between 5 and 6 years of age are at their initial schooling age, and their development is not sophisticated enough to bother about the grading system at school. Children who are between 6 and 7 years of age try to be independent in their school environment. They are less bothered about grading. Children who are between 7 and 8 years of age are more involved in playing with their peers.

While assessing an adolescent, the nurse learns that the client's parents are divorced and the child lives primarily with one parent who works double shifts and is frequently absent from home. In spite of these conditions, the client is well adjusted, in good health, and excelling at school. Which factor is likely to have the largest impact on the healthy development of this adolescent client? 1 Culture 2 Education 3 Socialization 4 Community support

4 Community support Community services such as after-school programs may have a significant effect on the development of children whose parents cannot meet their needs and look after their well-being. Culture does not have a significant effect on the development of a child as they are far more influenced by their families. Education and socialization with peers alone are not enough to ensure the normal growth and development of children whose parents are absent.

The community nurse has conducted a survey on the frequency of occurrences of various diseases and health problems such as acne, headache, diarrhea, and upper respiratory tract infections (URTI) in children. What trend would the nurse most likely notice from the survey? The frequency of: 1 Acne decreases with age 2 URTI increases with age 3 Diarrhea increases with age 4 Headaches increases with age

4 Headaches increases with age Children who have had a particular type of problem are more likely to have that problem again. Therefore, the frequency of headaches increases with age. The activity of sebaceous glands increases with age and therefore the frequency of acne also increase with age. The immune system becomes stronger with age in children. Therefore, the frequency of upper respiratory tract infections (URTI) and diarrhea decreases with age.

The nurse recognizes a delay in the child's developmental pattern and refers the child for further testing. Which characteristics of this child might the nurse have identified? Select all that apply: 1 Dermatological disorders 2 Impaired hearing ability 3 Immunocompromise 4 Improper communication 5 Impaired social interaction

4, 5 Inability to communicate properly or delays in speech may signify developmental delays. When a child is found to have difficulty making friends or has impaired social interactions, the child should be referred for testing. In this condition, the nurse should provide further interventions for the child to support his or her development. Dermatological disorders are assessed in a child to check for genetic abnormalities. Impaired hearing is assessed through testing of the child's auditory function. Impaired hearing does not directly affect a child's behavior. A child who is immunocompromised has a weakened immune system and is at higher risk for infections.

During an assessment, the nurse notices that a school-age child is under stress. What signs of stress in the child warrant further investigation? Select all that apply. 1 Slightly increased heart rate 2 Red and flushed face 3 Jittery and flustered behavior 4 Sucking their thumb 5 Trouble concentrating

4, 5 Many factors may cause stress in children. Stress in children can manifest itself in many ways, and the nurse should be alert to these signs. Thumb-sucking in school-age children is a sign of regression and needs further assessment of what may be causing the stress. When the child has difficulty concentrating, the nurse should explore further for the cause. A slightly increased heart rate is a standard sign of stress that does not need to be explored further. The red face and jittery appearance are also common signs of stress that do not need to be investigated.

The parents of an 8-year-old child tell the nurse that they are going to get a pet dog for the child. However, they are worried as their 4-year-old child is very scared of dogs. What advice should the nurse give to the parents? 1 "Never have a pet dog at home if the child is scared of it." 2 "Ask the younger child to touch the dog even if he resists." 3 "Have the younger son approach the dog even if he refuses." 4 "Let the younger child watch other children play with the dog." 5 "Do not let the younger child touch the dog unless the child is fearless."

4, 5 Preschoolers experience a great number of fears including the fear of animals like dogs. The best way to help them is by actively encouraging them to find ways to practically deal with their fears. If a child is scared of dogs, he should be allowed to watch other children play with a dog. This experience with the dogs should be introduced gradually. This kind of experience, where the child sees other children interacting fearlessly with a dog, can help him overcome his own fears. It is inappropriate to ask the parents not to have a pet at all. The child should never be forced to approach or touch the dog against his wishes.

42. A 6-year-old presents to the ER with respiratory distress and stridor. The child is diagnosed with RSV. The parent asks the child's nurse how the child will be treated. Which is the nurse's best response? 1. "We will treat your child with intravenous antibiotics." 2. "We will treat your child with intravenous steroids." 3. "We will treat your child with nebulized racemic epinephrine." 4. "We will treat your child with alternating doses of Tylenol and Motrin."

42. 1. RSV is a viral illness and is not treated with antibiotics. 2. Steroids are not used to treat RSV. *3. Racemic epinephrine promotes mucosal vasoconstriction.* 4. Tylenol and Motrin can be given to the child for comfort, but they do not improve the child's respiratory status.

43. The parent of a pediatric client calls the ER. The parent reports that the child has had a barky cough for the last 3 days and it always gets worse at night. The parent asks the nurse what to do. Which is the nurse's best response? 1. "Take your child outside in the night air for 15 minutes." 2. "Bring your child to the ER immediately." 3. "Give your child an over-the-counter cough suppressant." 4. "Give your child warm liquids to soothe the throat."

43. *1. The night air will help decrease sub glottic edema, easing the child's respi ratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider.* 2. There is no immediate need to bring the child to the ER. The child's symptoms will likely improve on the drive to the hospital because of the child's exposure to the night air. 3. Over-the-counter cough suppressants are not recommended for children because they reduce their ability to clear secretions. 4. Warm liquids may increase subglottic edema and actually aggravate the child's symptoms. Cool liquids or a popsicle are the best choice.

45. A pediatric client is seen in the ER with a nonproductive cough, clear nasal drainage, and congestion. The child is diagnosed with nasopharyngitis. What information should the nurse include in the discharge instructions? 1. Inform the parents to complete the entire prescription of antibiotics. 2. Recommend that the parents avoid sending the child to day care. 3. Educate the parents on comfort measures for the child. 4. Instruct the parents to restrict the child to clear liquids for 24 hours.

45. 1. Nasopharyngitis is a viral illness and does not require antibiotic therapy. 2. Children who attend day care are more prone to catching viral illnesses, but it is not the nurse's place to tell the parents not to send their child to day care. Often families do not have a choice about using day care. *3. Nursing care for nasopharyngitis is primarily supportive. Keeping the child comfortable during the course of the illness is all the parents can do. Nasal congestion can be relieved using normal saline drops and a bulb suction. Tylenol can also be given for discomfort or a mild fever.* 4. There is no reason to restrict the child to clear liquids. Many children have a de creased appetite during a respiratory ill ness, so the most important thing is to keep them hydrated.

46. A 15-month-old is brought to the ER. The parents tell the nurse that the child has not been eating well and has had an increased respiratory rate. Which of the following assessments is of greatest concern? 1. The patient is lying down and has moderate retractions, low-grade fever, and nasal congestion. 2. The patient is in the tripod position and has diminished breath sounds and a muffled cough. 3. The patient is sitting up and has coarse breath sounds, coughing, and fussiness. 4. The patient is restless, crying, has bilateral wheezes and poor feeding.

46. 1. Retractions, low-grade fever, and nasal congestion are common symptoms of a respiratory illness and are not overly concerning. *2. When children are sitting in the tripod position, that is an indication they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds indicate that there is fluid in* the lungs and are indicative of a worsening condition. A muffled cough indicates that the child has some subglottic edema. This child has several signs and symptoms of a worsening respiratory condition. 3. Coarse breath sounds, cough, and fussiness are common signs and symptoms of a respiratory illness. 4. Restlessness, wheezes, poor feeding, and crying are common signs and symptoms of a respiratory illness

47. A 3-year-old female is admitted to the ER with drooling, difficulty swallowing, sore throat, and a fever of 39°C (102.2° F). The physician suspects epiglottitis. The parents ask the nurse how the physician will know for sure if their daughter has epiglottitis. Which is the nurse's best response? 1. "A simple blood test will tell us if your daughter has epiglottitis." 2. "We will swab your daughter's throat and send it for culture." 3. "We will do a lateral neck x-ray of the soft tissue." 4. "The diagnosis is made based on your daughter's signs and symptoms."

47. 1. A blood test does not indicate a diagnosis of epiglottitis. A CBC may show an in creased white blood cell count indicating that the child has some sort of infection. 2. A throat culture is not done to diagnose epiglottitis. It is contraindicated to insert anything into the mouth or throat of any patient who is suspected of having epiglot titis. Inserting anything into the throat could cause the child to have a complete airway obstruction. *3. A lateral neck x-ray is the method used to diagnose epiglottitis definitively. The child is at risk for complete airway obstruction and should always be ac companied by a nurse to the x-ray department.* 4. Epiglottitis is not diagnosed based on signs and symptoms. A lateral neck film is the definitive diagnosis.

48. A 2-year-old child is brought to the ER with a high fever, dysphagia, drooling, rapid pulse, and tachypnea. What should the nurse's first action be? 1. Prepare for immediate IV placement. 2. Prepare for immediate respiratory treatment. 3. Place the child on a stretcher for a thorough physical assessment. 4. Allow the child to sit in the parent's lap while awaiting an x-ray.

48. 1. This child is exhibiting signs and symp toms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. 2. Respiratory treatments often frighten chil dren. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. 3. This child is exhibiting signs and symp toms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. The child should be allowed to remain on the parent's lap and kept as comfortable as possible until a lateral neck film is obtained. *4. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent's lap until a lateral neck film is obtained for a definitive diagnosis.*

50. A 3-year-old is admitted to the hospital with a diagnosis of epiglottitis. The child is in severe distress and needs to be intubated. The mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response? 1. "Children this age rarely get epiglottitis; you should not blame yourself." 2. "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen." 3. "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son's symptoms." 4. "Epiglottitis is rapidly progressive; you could not have predicted that his symptoms would worsen so quickly."

50. 1. Epiglottitis is most common in children from 2 to 5 years of age. The onset is very rapid. Telling parents not to blame themselves is not effective. Parents tend to blame themselves for their child's illnesses even though they are not responsible. 2. The nurse should not tell the parent to seek medical attention for any and all signs of illness. 3. Epiglottitis is rapidly progressive and can not be predicted. *4. Epiglottitis is rapidly progressive and cannot be predicted.*

52. A 5-year-old is brought to the ER with a temperature of 99.5° F (37.5°C), a barky cough, stridor, and hoarseness. Which of the following nursing interventions should the nurse prepare for? 1. Immediate IV placement. 2. Respiratory treatment of racemic epinephrine. 3. A tracheostomy set at the bedside. 4. Informing the child's parents about a tonsillectomy.

52. 1. The child is exhibiting signs and symp toms of croup and is not in any significant respiratory distress. 2. The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine. 3. A tracheostomy is not indicated for this child. A tracheostomy would be indicated for a child with a complete airway obstruction. 4. This child is exhibiting signs and symptoms of croup and has no indication of tonsillitis. A tonsillectomy is usually reserved for chil dren who have recurrent tonsillitis.

55. Which of the following children diagnosed with pneumonia would benefit most from hospitalization? 1. A 14-year-old with a fever of 38.6°C (101.5°F), rapid breathing, and a decreased appetite. 2. A 15-year-old who has been vomiting for 3 days and has a fever of 38.5°C (101.3°F). 3. A 13-year-old who is coughing, has coarse breath sounds, and is not sleeping well. 4. A 16-year-old who has a cough, chills, fever of 38.5°C (101.3°F), and wheezing.

55. 1. These are all common symptoms of pneu monia and should be monitored but do not require hospitalization. Most people with pneumonia are treated at home, with a focus on treating the symptoms and keeping the patient comfortable. Comfort measures include cool mist, CPT, an tipyretics, fluid intake, and family support. 2. The teen who has been vomiting for several days and is unable to tolerate oral fluids and medication should be admitted for intravenous hydration. 3. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization. 4. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization.

56. A pediatric client is admitted to the hospital with left-sided pneumonia. The client is complaining of pain and wants to be repositioned in the bed. The nurse knows the patient may be most comfortable in which position? 1. Lying in the Trendelenburg position. 2. Lying on the left side. 3. Lying on the right side. 4. Lying in the supine position.

56. 1. The Trendelenburg position is not effective for improving respiratory difficulty. Patients with pneumonia are usually most comfortable in a semierect position. 2. Lying on the left side may provide the patient with the most comfort. Lying on the left splints the chest and reduces the pleural rubbing. 3. It is most comfortable for the patient to lie on the affected side. Lying on the left splints the chest and reduces the pleural rubbing. 4. Lying in the supine position does not provide comfort for the patient and does not improve the child's respiratory effort.

57. A pediatric client with severe cerebral palsy is admitted to the hospital with aspira tion pneumonia. What is the most beneficial educational information that the nurse can provide to the parents? 1. The signs and symptoms of aspiration pneumonia. 2. The treatment plan for aspiration pneumonia. 3. The risks associated with recurrent aspiration pneumonia. 4. The prevention of aspiration pneumonia.

57. 1. The nurse should instruct the parents on signs and symptoms of aspiration pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 2. The nurse should instruct the parents on the treatment plan of aspiration pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 3. The nurse should instruct the parents on the risks associated with recurrent aspiration pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 4. The most valuable information the nurse can give the parents is how to prevent aspiration pneumonia from occurring in the future.

58. A 3-year-old is brought to the ER with coughing and gagging. The parent reports that the child was eating carrots when she began to gag. What diagnostic evaluation will be used to determine if the child has aspirated the carrot? 1. A chest x-ray will be taken. 2. A bronchoscopy will be performed. 3. A blood gas will be drawn. 4. A sputum culture will be done.

58. 1. A chest x-ray will only show radiopaque items (items that x-rays cannot go through easily), so it is not helpful in determining if the child aspirated a carrot. 2. A bronchoscopy will allow the physi cian to visualize the airway and will help determine if the child aspirated the carrot. 3. A blood gas will identify whether the child has suffered any respiratory compromise, but the blood gas cannot definitively determine the cause of the compromise. 4. A sputum culture may be helpful several days later to determine if the child has developed aspiration pneumo nia. Aspiration pneumonia may take several days or a week to develop following aspiration.

59. The parent of a 9-month-old calls the ER because his child is choking on a marble. The parent tells the nurse that he knows cardiopulmonary resuscitation. The parent asks how to help his child while waiting for Emergency Medical Services. Which is the nurse's best response? 1. "You should administer five abdominal thrusts followed by five back blows." 2. "You should try to retrieve the object by inserting your finger in your daughter's mouth." 3. "You should perform the Heimlich maneuver." 4. "You should administer five back blows followed by five chest thrusts."

59. 1. Abdominal thrusts are not recommended for children younger than 1 year. 2. Inserting a finger in the child's mouth may cause the object to be pushed further down the airway, making it more difficult to remove. 3. The Heimlich should be performed only on adults. 4. The current recommendation for in fants younger than 1 year is to admin ister five back blows followed by five chest thrusts.

60. The community health nurse is teaching a child-safety class to parents of toddlers. Which information will be most helpful in teaching the parents about the primary prevention of foreign body aspiration? 1. Knowledge of the signs and symptoms of foreign body aspiration. 2. Knowledge of the therapeutic management of foreign body aspiration patients. 3. Knowledge of the most common objects that toddlers aspirate. 4. Knowledge of the risks associated with foreign body aspiration.

60. 1. Teaching the parents signs and symptoms of foreign body aspiration is important, but it is a tertiary means of prevention and will not help the parents prevent the aspiration. 2. Teaching the parents the therapeutic management of foreign body aspiration is important, but it is a tertiary means of prevention and will not help the parents prevent the aspiration. 3. Teaching parents the most common objects aspirated by toddlers will help them the most. Parents can avoid having those items in the household or in locations where toddlers may have access to them. 4. Teaching the parents the risks associated with foreign body aspiration is important but it is a tertiary means of prevention and will not help the parents prevent the aspiration.

61. What does the therapeutic management of CF patients include? Select all that apply. 1. Providing a high-protein, high-calorie diet. 2. Providing a high-fat, high-carbohydrate diet. 3. Encouraging exercise. 4. Minimizing pulmonary complication. 5. Encouraging medication compliance.

61. 1, 3, 4, 5. 1. Children with CF have difficulty ab sorbing nutrients because of the block age of the pancreatic duct. Pancreatic enzymes cannot reach the duodenum to aid in digestion of food. These chil dren often require up to 150% of the caloric intake of their peers. The nutri tional recommendation for CF patients is high-calorie and high-protein. 2. A high-fat, high-carbohydrate diet is not recommended for adequate nutrition. 3. Exercise is effective in helping CF patients clear secretions. 4. Minimizing pulmonary complications is essential to a better outcome for CF patients. Compliance with CPT, nebulizer treatments, and medications are all components of minimizing pulmonary complications. 5. Medication compliance is a necessary part of maintaining pulmonary and gastrointestinal function.

While caring for a child, the nurse provides small toys and works overtime to take care of the child, and even calls the hospital during off-duty time to find out whether the child is improving. The nurse regularly meets the mother outside of the hospital. The nurse asks the mother if she is involved in care of the child. Which actions of the nurse indicate a nontherapeutic nurse-patient relationship? Select all that apply. Correct Incorrect A Giving a toy to the child Correct Incorrect B Working overtime to look after the child Correct Incorrect C Calling the hospital frequently to inquire about the child Correct Incorrect D Asking whether the mother is involved in care of the child Correct Incorrect E Meeting the mother outside of the hospital to discuss the child

A, B, C, E Giving toys, clothes, food, and other items to the patient; working overtime to take care of a particular patient; calling the hospital or patient's home frequently to inquire about the patient's health; and meeting the patient or family outside of the hospital indicate that the nurse is overinvolved with the child and the family. Thus, such actions should be avoided to develop a good nurse-patient relationship. Asking if the mother is involved in the child's care indicates that the nurse is concerned about the patient and the family. It indicates a therapeutic relationship between the nurse and the child and family

A 9-month-old child has been treated after a choking incident. Which advice does the nurse give to the parents to prevent further incidents? Select all that apply. A "Never leave your child unattended." B "Your child is too young to be allowed to eat solid food." C "Make sure all cabinets, drawers, and containers are childproof." D "Marbles and LEGOs are not appropriate toys for children at that age." E "Allowing your child to crawl on the floor increases the risk for injury

A, C, D Crawling infants may explore their environments through taste and touch. They tend to put everything in their mouths. Therefore, the nurse should advise the parents to always keep a watch on their child and never leave their child unattended. Children at 9 months of age will begin to be able to pull themselves up to standing positions, potentially giving them access to cabinets, drawers, and containers that they were unable to access before. Therefore, the parents need to thoroughly childproof the home. The parents should be warned about providing small, colorful toys or leaving small objects on the floor because the child will be attracted to such objects and may attempt to swallow them, which may result in choking. The child is 8 months old. By this age, solid foods are permitted. The child should be allowed to play and crawl on the floor, as this is helpful for the development of the child's gross motor skills

The nurse is assessing a 3-month-old infant who has a runny nose, skin rashes, and diarrhea. The infant's mother informs the nurse that she gives the infant commercial fruit juice, formula milk, and water when the baby is thirsty. She doesn't think she can give breast milk because she works during the day. Which food should the nurse encourage the parent to give to improve the health of the baby? Breast milk Formula milk Mineral water Fresh fruit juice

Breast milk Skin rashes, runny nose, and diarrhea are caused by infections. Breast milk has micronutrients, immunologic properties, and several enzymes with digestive properties. Thus, it is the ideal food of choice for healthy growth and development. Educating the parents about the benefits of breastfeeding is essential. If the patient is working, the nurse can suggest the use of a breast pump and explain the methods of storing breast milk. Formula milk does not provide immunity to infants. Mineral water and fresh fruit juice are not recommended for 3-month-old infants

A couple has a 3-year-old child whom they adopted at 6 months old. What advice is most appropriate for the nurse to give the couple about explaining the child's adoption to him? Select all that apply. A "It's better if the child doesn't know about the adoption." B "You are legally required to inform the child about the adoption at some point." C "The child can be informed, but at an age when he can understand." D "The child can be told, but it's best to wait until he is old enough to start school." E "You can tell your son that you found each other through fate or that God sent him to you."

C Though there are no strict guidelines for telling a child about his or her adoption, most authorities suggest that child should be informed at an age young enough to avoid conflicts in relationship but old enough to understand. Explaining the adoption in a way that makes the child an active participant in the process can help alleviate feelings of abandonment. Concealing the adoption information is not advisable and may weaken the relationship; however, there is no legal requirement to tell the child. If the child is old enough to enroll in school, there is a chance of the child learning about the adoption from third parties, so parents should discuss the adoption before that time, if they choose to do so. The nurse should not offer specific explanations of the adoption for the parents to give to the child, because these decisions are deeply personal and should be made by the parents directly.