Peds Exam 1 Ch. 9, 11, 12, 14, 15

WE CAN DO THIS YALL!

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The estimated average requirement of calcium for an adolescent is _____ milligrams. (Record your answer in a whole number.)

ANS: 1100 The EAR (estimated average requirement) for calcium in adolescents 14 to 18 years of age is 1100 mg.

The recommendation for calcium for children 1 to 3 years of age is _____ milligrams. (Record your answer in a whole number.)

ANS: 500 While limiting fat consumption, it is important to ensure diets contain adequate nutrients such as calcium. The recommendation for daily calcium intake for children 1 to 3 years of age is 500 mg, and the recommendation for children 4 to 8 years of age is 800 mg.

Place in order the expected sequence of fine motor developmental milestones for an infant beginning with the first milestone achieved and ending with the last milestone achieved. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e). a. Voluntary palmar grasp b. Reflex palmar grasp c. Puts objects into a container d. Neat pincer grasp e. Builds a tower of two blocks, but fails

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

Place in order the sequence of maturational changes for girls. Begin with the first change seen, sequencing to the last change. Provide answer in using lowercase letters, separated by commas (e.g., a, b, c, d, e). a. Growth of pubic hair b. Rapid increase in height and weight c. Breast changes d. Menstruation e. Appearance of axillary hair

ANS: c, b, a, e, d The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs.

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

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

7. Which aspect of cognition develops during adolescence? a. Capability to use a future time perspective b. Ability to place things in a sensible and logical order c. Ability to see things from the point of view of another d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: A Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit these characteristic thought processes.

15. A child has an evulsed (knocked-out) tooth. Which medium should the nurse instruct the parents to place the tooth in for transport to the dentist? a. In cold milk b. In cold water c. In warm salt water d. In a dry, clean jar

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

9. Steven, 16 months old, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. Steven is acting in an age-appropriate manner.

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

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

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

ANS: A Bottles cannot be heated safely in microwave ovens even if safe guidelines are followed and regardless of the amount to be heated due to uneven heating and possible burns.

10. Bullying can be common during the school-age years. The nurse should recognize that which applies to bullying? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being bullied

ANS: A Bullying in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

34. Which figure depicts an expected developmental milestone for a 7-month-old infant? a. b. (no images provided) c. d.

ANS: A By 6 to 7 months of age, infants are able to bear all their weight on their legs with assistance. Infants can stand holding on to furniture at 9 months. While standing, the infant takes a deliberate step at 10 months. Crawling (propelling forward with the belly on the floor) progresses to creeping on hands and knees (with the belly off of the floor) by 9 months.

7. In terms of fine motor development, what should the infant of 7 months be able to do? a. Transfer objects from one hand to the other and bang cubes on a table. b. Use thumb and index finger in crude pincer grasp and release an object at will. c. Hold a crayon between the fingers and make a mark on paper. d. Release cubes into a cup and build a tower of two blocks.

ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline, and bang objects on a hard surface. The crude pincer grasp is apparent at about age 9 months, and releasing an object at will is seen around 8 months. The child can scribble spontaneously at age 15 months. At age 12 months, the child can release cubes into a cup and build a small tower.

6. An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. How should the nurse interpret this statement? a. A common belief at this age b. A belief that forms the basis for most religions c. Suggestive of excessive family pressure d. Suggestive of a failure to develop a conscience

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined misdeed. The belief in divine punishment is common for an 8-year-old child.

6. A nurse is planning a teaching session for a group of adolescents. The nurse understands that by adolescence the individual is in which stage of cognitive development? a. Formal operations b. Concrete operations c. Conventional thought d. Postconventional thought

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

17. Which accurately describes the speech of the preschool child? a. Dysfluency in speech patterns is normal. b. Sentence structure and grammatic usage are limited. c. By age 5 years, child can be expected to have a vocabulary of about 1000 words. d. Rate of vocabulary acquisition keeps pace with the degree of comprehension of speech.

ANS: A Dysfluency includes stuttering and stammering, a normal characteristic of language development. Children speak in sentences of three or four words at age 3 to 4 years and eight words by age 5 years. At 5 years, children have a vocabulary of 2100 words. Children often gain vocabulary beyond degree of comprehension.

29. What is the most fatal type of burn in the toddler age group? a. Flame burn from playing with matches b. Scald burn from high-temperature tap water c. Hot object burn from cigarettes or irons d. Electric burn from electric outlets

ANS: A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group. High-temperature tap water, hot objects, and electrical outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use.

14. A young adolescent boy tells the nurse he "feels gawky." How should the nurse explain why this occurs in adolescents? a. Growth of the extremities and neck precedes growth in other areas b. Growth is in the trunk and chest c. The hip and chest breadth increases d. The growth spurt occurs earlier in boys than it does in girls

ANS: A Growth in length of the extremities and neck precedes growth in other areas, and, because these parts are the first to reach adult length, the hands and feet appear larger than normal during adolescence. Increases in hip and chest breadth take place in a few months followed several months later by an increase in shoulder width. These changes are followed by increases in length of the trunk and depth of the chest. This sequence of changes is responsible for the characteristic long-legged, gawky appearance of early adolescent children. The growth spurt occurs earlier in girls than in boys.

22. The nurse is guiding parents in selecting a daycare facility for their infant. Which is especially important to consider when making the selection? a. Health practices of facility b. Structured learning environment c. Socioeconomic status of children d. Cultural similarities of children

ANS: A Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not adhered to. A structured learning environment is not suitable for this age child. The socioeconomic status of children should have little effect on the choice of facility. Cultural similarities of children may be important to the families, but the health care practices of the facility are more important.

6. A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. How should the nurse interpret this action? a. Normal development b. Significant developmental lag c. Slightly delayed development due to prematurity d. Suggestive of a neurologic disorder such as cerebral palsy

ANS: A Holding a rattle but not voluntarily grasping it is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task and the behavior is age appropriate. No evidence of neurologic dysfunction is present.

11. A 14-year-old boy seems to be always eating, although his weight is appropriate for his height. What is the best explanation for this? a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs.

ANS: A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. Seemingly always eating describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern.

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

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

25. Which is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Congenital disorders d. Childhood diseases

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

20. Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." Which intervention should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should help the child develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response.

5. Which statement characterizes moral development in the older school-age child? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them.

ANS: A Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. The situation and the morality of the rule itself influence reactions.

12. A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily but lately has been somewhat aggressive and stubborn in the classroom. How should the nurse interpret this behavior? a. A sign of stress b. A developmental delay c. A physical problem d. A lack of adjustment to school

ANS: A Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. This child is exhibiting signs of stress.

20. Parents are concerned that their child is showing aggressive behaviors. Which suggestion should the nurse make to the parents? a. Supervise television viewing. b. Ignore the behavior. c. Punish the child for the behavior. d. Accept the behavior if the child is male.

ANS: A Television is also a significant source for modeling at this impressionable age. Research indicates there is a direct correlation between media exposure, both violent and educational media, and preschoolers exhibiting physical and relational aggression (Ostrov, Gentile, and Crick, 2006). Therefore, parents should be encouraged to supervise television viewing. The behavior should not be ignored because it can escalate to hyperaggression. The child should not be punished because it may reinforce the behavior if the child is seeking attention. For example, children who are ignored by a parent until they hit a sibling or the parent learn that this act garners attention. The behavior should not be accepted from a male child; this is using a "double standard" and aggression should not be equated with masculinity.

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

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

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

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

4. A nurse is assessing a 6-month-old infant. The nurse recognizes the posterior fontanel usually closes at which age? a.6 to 8 weeks b.10 to 12 weeks c.4 to 6 months d.8 to 10 months

ANS: A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks; 10 to 12 weeks, 4 to 6 months, and 8 to 10 months are too late. The posterior fontanel is usually closed by age 8 weeks.

18. Which technique is best for dealing with the negativism of the toddler? a. Offer the child choices. b. Remain serious and intent. c. Provide few or no choices for child. d. Quietly and calmly ask the child to comply.

ANS: A The child should have few opportunities to respond in a negative manner. Questions and requests should provide choices. This allows the child to be in control and reduces opportunities for negativism. The child will continue trying to assert control. The toddler is too young for verbal explanations. The negativism is the child testing limits. These should be clearly defined by structured choices.

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

ANS: A The feel of the water while the infant is splashing will provide tactile stimulation. Various colored blocks would provide visual stimulation for a 4- to 6-month-old infant. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation.

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

ANS: A The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may help to keep the child's foot in the shoe. Inflexible shoes can delay walking and can aggravate in-toeing and out-toeing and impede development of the supportive foot muscles.

28. The parent of a 16-month-old toddler asks, "What is the best way to keep our son from getting into our medicines at home?" The nurse's best advice is: a. "All medicines should be locked securely away." b. "The medicines should be placed in high cabinets." c. "The child just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize as dangerous all the different forms of medications that may be available in the home. It is not feasible to not keep medicines in the homes of small children. Many parents require medications for chronic illnesses. Parents must be taught safe storage for their home and when they visit other homes.

31. A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddler's preoperational thinking is the nurse using? a. Inability to conserve b. Magical thinking c. Centration d. Irreversibility

ANS: A The nurse is using the toddler's inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told.

2. What is the earliest age at which puberty begins? a. 9 b. 10 c. 11 d. 12

ANS: A There is no universal age at which children assume the characteristics of prepubescence. The first physiologic signs appear at about 9 years of age (particularly in girls) and are usually clearly evident in 11- to 12-year-old children.

3. The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. How should the nurse interpret this finding? a. Normal finding b. Finding requiring a referral c. Abnormal finding d. Normal finding, but requires rechecking in 1 month

ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. No further intervention is required.

4. A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is included in which statement? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

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

12. Which is a useful skill that the nurse should expect a 5-year-old child to be able to master? a. Tie shoelaces b. Use knife to cut meat c. Hammer a nail d. Make change out of a quarter

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

In terms of gross motor development, which should the nurse expect a 5-month-old infant to do? (Select all that apply.) a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position. f. Adjust posture to reach an object.

ANS: A, B Rolling from abdomen and to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position. The 8-month-old infant adjusts posture to reach an object.

2. Which toys should a nurse provide to promote imaginative play for a 3-year-old hospitalized child? (Select all that apply.) a. Plastic telephone b. Hand puppets c. Jigsaw puzzle (100 pieces) d. Farm animals and equipment e. Jump rope

ANS: A, B, D To promote imaginative play for a 3-year-old child, the nurse should provide: dress-up clothes, dolls, housekeeping toys, dollhouses, play-store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, or medical kits. A 100-piece jigsaw puzzle and a jump rope would be appropriate for a young, school-age child but not a 3-year-old child.

The nurse is teaching parents about appropriate pacifier selection. Which characteristics should the pacifier have? (Select all that apply.) a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material

ANS: A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks.

A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.) a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games

ANS: A, B, E School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child.

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

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

A nurse is teaching a parent about administration of iron supplements to a 7-month-old infant. Which should the nurse include in the teaching session? (Select all that apply.) a. Administer the iron supplement with a dropper toward the side and to the back of the mouth b. Administer the iron supplement with feedings. c. Your infant's stools may look tarry green. d. Your infant may have some diarrhea initially. e. Follow the iron supplement with 4 ounces of juice.

ANS: A, C, E Liquid iron supplements may stain the teeth; therefore, administer them with a dropper toward the back of the mouth (side). Ideally, iron supplements should be administered between meals for greater absorption. Avoid administration of liquid iron supplements with whole cow's milk or milk products because they bind free iron and prevent absorption. Educate parents that iron supplements will turn stools black or tarry green. Iron supplements may cause transient constipation, not diarrhea. In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz).

The nurse should teach the adolescent that the long-term effects of tanning can cause which conditions? (Select all that apply.) a. Phototoxic reactions b. Increased number of moles c. Premature aging d. Striae e. Increased risk of skin cancer

ANS: A, C, E Long-term effects of tanning include premature aging of the skin, increased risk of skin cancer, and, in susceptible individuals, phototoxic reactions. There has been no correlation to an increase in moles or striae (streaks or stripes on the skin, usually on the abdomen) development.

A 13-year-old is being seen in the clinic for a routine health check. The adolescent has not been in the clinic for 3 years but was up to date on immunizations at that time. Which immunizations should the adolescent receive? (Select all that apply.) a. DTaP (tetanus, diphtheria, acellular pertussis) b. MMR (measles, mumps, rubella) c. Hepatitis B d. Influenza e. MCV4 (meningococcal)

ANS: A, D, E The DTaP (tetanus, diphtheria, acellular pertussis) vaccine is recommended for adolescents 11 to 18 years old who have not received a tetanus booster (Td) or DTaP dose and have completed the childhood DTaP/DTP series. Meningococcal vaccine (MCV4) should be given to adolescents 11 to 12 years of age with a booster dose at age 16 years. Annual influenza vaccination with either the live attenuated influenza vaccine or trivalent influenza vaccine is recommended for all children and adolescents. The adolescent, previously up to date on vaccinations, would have received the MMR and hepatitis B as a child.

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

ANS: B A 4-year-old child understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. I will tell you every time I see you how much longer it will be assumes the child understands the concepts of hours and minutes, which are not developed until age 5 or 6 years.

15. The parent of a 4-year-old boy tells the nurse that the child believes that monsters and boogeymen are in his bedroom at night. What is the nurse's best suggestion for coping with this problem? a. Let the child sleep with his parents. b. Keep a night-light on in the child's bedroom. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and boogeymen do not exist.

ANS: B A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old child is in the preconceptual age and cannot understand logical thought.

18. A 14-year-old adolescent never had chickenpox as a child. What should the nurse expect the health care provider to recommend? a. One dose of the varicella vaccination b. Two doses of the varicella vaccination 4 weeks apart c. One dose of the varicella immune globulin d. No vaccinations—the child is past the age to receive it

ANS: B All adolescents should also be assessed for previous history of varicella infection or vaccination. Vaccination with the varicella vaccine is recommended for those with no previous history; for those with no previous infection or history, the varicella vaccine may be given in two doses 4 or more weeks apart to adolescents 13 years or older. The varicella immune globulin is given to immunosuppressed children exposed to chickenpox to boost immunity; it is only temporary. The varicella vaccination should be given to adolescents, no matter the age, who have not had chickenpox as a child.

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

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

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

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

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

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7 pounds at birth would weigh approximately 15 pounds; 10 pounds is too little. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 20 to 25 pounds is too much. The infant would have tripled the birth weight at 6 months.

12. Which predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age group

ANS: B During growth spurts, the need for sleep increases. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue.

13. Which statement best describes fear in the school-age child? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years, children experience a wide variety of fears, but new fears relate predominantly to school and family. During the middle-school years, children become less fearful for body safety than they were as preschoolers. Parents and other persons involved with children should discuss children's fears with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding their fears does not end them and may lead to phobias.

10. Which should the nurse expect for a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of holophrases d. Approximately one third of speech understandable

ANS: B During the second year of life, level of comprehension and understanding of speech increases and is far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old child has a vocabulary of 10 or more words. At this age, the child does not use the one-word sentences that are characteristic of the 1-year-old child. The child has a limited vocabulary of single words that are comprehensible.

23. What is the most effective way to clean a toddler's teeth? a. Child to brush regularly with a toothpaste of his or her choice b. Parent to stabilize the chin with one hand and brush with the other c. Parent to brush the mandibular occlusive surfaces, leaving the rest for the child d. Parent to brush the front labial surfaces, leaving the rest for the child

ANS: B For young children, the most effective cleaning of teeth is by the parents. Different positions can be used if the child's back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child's teeth. The child can participate in brushing, but for a thorough cleaning, adult intervention is necessary.

4. A nurse, instructing parents of a hospitalized preschool child, explains that which is descriptive of the preschooler's understanding of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms like "yesterday" appropriately

ANS: B In a preschooler's understanding, time has a relation with events such as "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

CHAPTER 14 SCHOOL-AGE CHILD 1. The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which statement made by a participant, indicates the correct understanding of the teaching? a. "My body weight will be almost triple in the next few years." b. "I will grow an average of 2 inches per year from this point on." c. "There are not that many physical differences among school-age children." d. "I will have a gradual increase in fat, which may contribute to a heavier appearance."

ANS: B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, children's weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

26. Kimberly's parents have been using a rearward-facing, convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child reaches which age? a. 1 b. 2 c. 3 d. 4

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

16. The nurse is discussing development and play activities with the parent of a 2-month-old. Recommendations should include giving a first rattle at about which age? a. 2 months b. 4 months c. 7 months d. 9 months

ANS: B It is recommended that a brightly colored toy or rattle be given to the child at age 4 months. Grasping has begun as a deliberate act, and the infant grasps, holds, and begins shaking to hear a noise; 2 months is too young. The infant still has primarily reflex grips; 7 to 9 months is too old for the first rattle. The child should be given toys that provide for further exploration.

28. Which information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.

ANS: B One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months. Mixing solid foods in a bottle has no effect on the transition to solid food. Iron-fortified cereal should be the first solid food introduced into the infant's diet.

17. A nurse is conducting parenting classes for parents of adolescents. Which parenting style should the nurse recommend? a. Laissez-faire b. Authoritative c. Disciplinarian d. Confrontational

ANS: B Parents should be guided toward an authoritative style of parenting in which authority is used to guide the adolescent while allowing developmentally appropriate levels of freedom and providing clear, consistent messages regarding expectations. The authoritative style of parenting has been shown to have both immediate and long-term protective effects toward adolescent risk reduction. The laissez-faire method would not give adolescents enough structure. The disciplinarian and confrontational styles would not allow any autonomy or independence.

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

ANS: B Physiologically and developmentally, the 4- to 6-month-old infant is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding; 2 to 3 months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. Infant birth weight triples at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

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

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

9. A school nurse observes school-age children playing at recess. Which is descriptive of the play the nurse expects to observe? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States.

30. Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Lego b. Set of large plastic building blocks c. Brightly colored balloon d. Coloring book and crayons

ANS: B Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Large plastic blocks are appropriate for a toddler in isolation. Small plastic toys such as Lego can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler.

6. A 4-year-old child is hospitalized with a serious bacterial infection. The child tells the nurse that he is sick because he was "bad." Which is the nurse's best interpretation of this comment? a. Sign of stress b. Common at this age c. Suggestive of maladaptation d. Suggestive of excessive discipline at home

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

24. Which is an appropriate recommendation for preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

ANS: B Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

21. Parents of a 12-year-old child ask the clinic nurse, "How many hours of sleep should our child get?" The nurse should respond that 12-year-old children need how many hours of sleep at night? a. 8 b. 9 c. 10 d. 11

ANS: B School-age children usually do not require naps, but they do need to sleep approximately 11 hours at age 5 years and 9 hours at age 12 years each night.

18. A nurse is teaching parents about language development for preschool children. Which dysfunctional speech pattern is a normal characteristic the parents might expect? a. Lisp b. Stammering c. Echolalia d. Repetition without meaning

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

21. A parent asks the nurse "when will my infant start to teethe?" The nurse responds that the earliest age at which an infant begins teething with eruption of lower central incisors is _____ months. a. 4 b. 6 c. 8 d. 12

ANS: B Teething usually begins at age 6 months with the eruption of the lower central incisors; 4 months is too early for teething. By age 8 months, the infant has the upper and lower central incisors. At age 12 months, the infant has six to eight deciduous teeth.

2. A school nurse is teaching a group of preadolescent girls about puberty. Which is the mean age of menarche for girls in the United States? a. 9 years b. 12 years c. 16 years d. 14 years

ANS: B The average age of menarche is 12 years 9.5 months in North American girls, with a normal range of to 15 years. Ages , ,and 14 are within the normal range for menarche, but these are not the average ages. (seems to be missing words...)

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

ANS: B The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child. The infant must be rear facing to protect the head and neck in the event of an accident. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

14. Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Allow children unrestricted permission to satisfy this curiosity. d. Get counseling for this unusual and dangerous behavior.

ANS: B Three-year-olds become aware of anatomic differences and are concerned about how the other "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. Encouraging the children to ask questions of the parents and redirecting their activity are more appropriate than giving permission. Exploration is age-appropriate and not dangerous behavior.

5. According to Erikson, which psychosocial task is developing in adolescence? a. Intimacy b. Identity c. Initiative d. Independence

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

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

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

18. When teaching injury prevention during the school-age years, what should the nurse include? a. Teach children to fear strangers. b. Teach basic rules of water safety. c. Avoid letting child cook in microwave ovens. d. Caution child against engaging in competitive sports.

ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check for sufficient water depth before diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes instructing children to not go with strangers, not wear personalized clothing in public places, tell parents if anyone makes child feel uncomfortable, and say "no" in uncomfortable situations. Teach child safe cooking. Caution against engaging in hazardous sports such as those involving trampolines.

Which are characteristic of physical development of a 30-month-old child? (Select all that apply.) a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. f. Left- or right-handedness is established.

ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at age 12 to 18 months. Birth length is doubled around age 4. Left- or right-handedness is not established until about age 5.

A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.) a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor.

ANS: B, C, D Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children's social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.

Which screening tests should the school nurse perform for the adolescent? (Select all that apply.) a. Glucose b. Vision c. Hearing d. Cholesterol e. Scoliosis

ANS: B, C, E The school nurse should perform vision, hearing, and scoliosis screening tests according to the school district's required schedule. Glucose and cholesterol screening would be performed in the medical clinic setting.

Which should the nurse teach to parents of toddlers about accidental poison prevention? (Select all that apply.) a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants.

ANS: B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, know the number of the nearest poison control center, and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances.

A nurse is teaching a parent about introduction of solid foods into an infant's diet. Which should the nurse include in the teaching session? (Select all that apply.) a. Solid food introduction can be started at 2 months of age. b. Rice cereal is introduced first. c. Begin the introduction of solid foods by mixing with formula in the bottle. d. Introduce egg white in small quantities (1 tsp) toward the end of the first year. e. Introduce one food at a time, usually at intervals of 4 to 7 days.

ANS: B, D, E Rice cereal, because of its low allergenic potential, is the first solid food introduced to an infant at 4 to 6 months of age. Introduce one food at a time, usually at intervals of 4 to 7 days, to identify food allergies. Introduce egg white in small quantities (1 tsp) toward the end of the first year to detect an allergy. Solid food introduction should be started at 4 to 6 months of age. Never introduce foods by mixing them with the formula in a bottle.

In terms of language and cognitive development, a 4-year-old child would be expected to have which traits? (Select all that apply.) a. Think in abstract terms. b. Follow directional commands. c. Understand conservation of matter. d. Use sentences of eight words. e. Tell exaggerated stories. f. Comprehend another person's perspective.

ANS: B, E Children ages 3 to 4 years can give and follow simple commands and tell exaggerated stories. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. Five-year-old children use sentences with eight words with all parts of speech. A 4-year-old child cannot comprehend another's perspective.

16. A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many "mood swings" throughout the day. How should the nurse interpret this behavior? a. Requires a referral to a mental health counselor b. Requires some further lab testing c. It is normal behavior d. Related to feelings of depression

ANS: C Adolescents vacillate in their emotional states between considerable maturity and childlike behavior. One minute they are exuberant and enthusiastic; the next minute they are depressed and withdrawn. Because of these mood swings, adolescents are frequently labeled as unstable, inconsistent, and unpredictable, but the behavior is normal. The behavior would not require a referral to a mental health counselor or further lab testing. The mood swings do not indicate depression.

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

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

3. The child of 15 to 30 months is likely to be struggling with which developmental task? a. Trust b. Initiative c. Autonomy d. Intimacy

ANS: C Autonomy vs shame and doubt is the developmental task of toddlers. Trust vs mistrust is the developmental stage of infancy. Initiative vs guilt is the developmental stage of early childhood. Intimacy and solidarity vs isolation is the developmental stage of early adulthood.

15. A nurse is reviewing hormone changes that occur during adolescence. What is the hormone responsible for the growth of beard, mustache, and body hair in the male? a. Estrogen b. Pituitary c. Androgen d. Progesterone

ANS: C Beard, mustache, and body hair on the chest, upward along the linea alba, and sometimes on other areas (e.g., back and shoulders) appears in males and is androgen dependent. Estrogen and progesterone are produced by the ovaries in the female and do not contribute to body hair appearance in the male. The pituitary hormone does not have any relationship to body hair appearance in the male.

3. A nurse is assessing a preschool-age child and notes the child exhibits magical thinking. According to Piaget, which describes magical thinking? a. Events have cause and effect. b. God is like an imaginary friend. c. Thoughts are all-powerful. d. If the skin is broken, the child's insides will come out.

ANS: C Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all-powerful. Cause-and-effect implies logical thought, not magical thinking. Thinking God is like an imaginary friend is an example of concrete thinking in a preschooler's spiritual development. Thinking that if the skin is broken, the child's insides will come out is an example of concrete thinking in development of body image.

13. A parent asks the nurse "at what age do most infants begin to fear strangers?" The nurse should give which response? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation-individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

13. In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. What should the nurse recognize in this situation? a. Blocks at this age are used primarily for throwing b. Toddlers are too young to imitate the behavior of others c. Toddlers are capable of building a tower of blocks d. Toddlers are too young to build a tower of blocks

ANS: C Building with blocks is a good parent-child interaction. The 18-month-old child is capable of building a tower of three or four blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. The 18-month-old child imitates others around him or her.

22. Developmentally, what should most children at age 12 months be able to do? a. Use a spoon adeptly b. Relinquish the bottle voluntarily c. Eat the same food as the rest of the family d. Reject all solid food in preference to the bottle

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

4. Which describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

3. A school nurse is teaching a group of preadolescent boys about puberty. By which age should concerns about pubertal delay be considered? a. 12 years b. 13 years c. 14 years d. 15 years

ANS: C Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes from to 14 years. Ages 12 to years is too young for initial concern.

12. A nurse is conducting a teaching session for parents of infants. The nurse explains that which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

ANS: C During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. Between ages 8 and 12 weeks, infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect is part of secondary schemata development.

7. Although a 14-month-old girl received a shock from an electric outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of the inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

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

19. What should injury prevention efforts emphasize during the preschool period? a. Constant vigilance and protection b. Punishment for unsafe behaviors c. Education for safety and potential hazards d. Limitation of physical activities

ANS: C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age because preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate.

31. The parent of a 2-week-old infant, exclusively breastfed, asks the nurse if fluoride supplements are needed. What is the nurse's best response? a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 4 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 4 months if the child is not drinking adequate amounts of fluoridated water. The amount of water that is ingested and the amount of fluoride in the water are taken into account when supplementation is being considered.

26. A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What should the nurse recommend the infant be given? a. Skim milk b. Whole cow's milk c. Commercial iron-fortified formula d. Commercial formula without iron

ANS: C For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

19. A nurse is teaching parents of kindergarten children general guidelines to assist their children in school. Which statement by the parents indicates they understand the teaching? a. "We will only meet with the teacher if problems occur." b. "We will discourage hobbies so our child focuses on schoolwork." c. "We will plan a trip to the library as often as possible." d. "We will expect our child to make all As in school."

ANS: C General guidelines for parents to help their child in school include sharing an interest in reading. The library should be used frequently, and books the child is reading should be discussed. Hobbies should be encouraged. The parents should not expect all As. They should focus on growth more than grades.

CHAPTER 9 INFANT 1. A nurse is assessing a 12-month-old infant. Which statement best describes the infant's physical development a nurse should expect to find? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

10. The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. How should this practice be interpreted? a. Not appropriate in a school setting b. Never appropriate because adolescents are minors c. Important in establishing trusting relationships d. Suggestive that the nurse is meeting his or her own needs

ANS: C Health professionals who work with adolescents should consider adolescents' increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, in some circumstances, such as self-destructive behavior or maltreatment by others, they are not able to maintain confidentiality. Confidentiality and privacy are necessary to build trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction.

11. According to Piaget, the 6-month-old infant should be in which developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

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

21. Which snack should the nurse recommend parents offer to their slightly overweight preschool child? a. Carbonated beverage b. 10% fruit juice c. Low fat chocolate milk d. Whole milk

ANS: C Milk and dairy products are excellent sources of calcium and vitamin D (fortified). Low-fat milk may be substituted, so the quantity of milk may remain the same while limiting fat intake overall. Parents should be educated regarding non-nutritious fruit drinks, which usually contain less than 10% fruit juice yet are often advertised as healthy and nutritious; sugar content is dramatically increased and often precludes an adequate intake of milk by the child. In young children, intake of carbonated beverages that are acidic or that contain high amounts of sugar is also known to contribute to dental caries. Low fat milk should be substituted for whole milk if the child is slightly overweight.

10. By which age should the nurse expect an infant to be able to pull to a standing position? a. 6 months b. 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs. Any infant who cannot pull to a standing position by age 1 year should be referred for further evaluation.

22. A nurse planning care for a school-age child should take into account that which thought process is seen at this age? a. Animism b. Magical thinking c. Ability to conserve d. Thoughts are all-powerful

ANS: C One cognitive task of school-age children is mastering the concept of conservation. At an early age (5 to 7 years), children grasp the concept of reversibility of numbers as a basis for simple mathematics problems (e.g., 2 + 4 = 6 and 6 - 4 = 2). They learn that simply altering their arrangement in space does not change certain properties of the environment, and they are able to resist perceptual cues that suggest alterations in the physical state of an object. Animism, magical thinking, and believing that thoughts are all powerful are thought processes seen in preschool children.

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

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

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

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

32. Parents need further teaching about the use of car safety seats if they make which statement? a. "Even if our toddler helps buckle the straps, we will double-check the fastenings." b. "We won't start the car until everyone is properly restrained." c. "We won't need to use the car seat on short trips to the store." d. "We will anchor the car seat to the car's anchoring system."

ANS: C Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings; do not start the car until everyone is properly restrained; and anchor the car safety seat securely to the car's anchoring system and apply the harness snugly to the child.

7. A 4-year-old child tells the nurse that she does not want another blood sample drawn because "I need all my insides, and I don't want anyone taking them out." Which is the nurse's best interpretation of this? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

ANS: C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.

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

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

25. The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

20. At what age does an infant start to recognize familiar faces and objects, such as a feeding bottle? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is able to anticipate feeding after seeing the bottle.

16. A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation? a. Punish the child. b. Leave the child alone until the tantrum is over. c. Remain close by the child but without eye contact. d. Explain to child that this is wrong.

ANS: C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common in toddlers as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The parent's presence is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

8. Parents are concerned about the number of hours their teenage daughter spends with peers. The nurse explains that peer relationships are important during adolescence for which reason? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

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

13. The nurse is guiding parents in selecting a daycare facility for their child. Which is especially important to consider when making the selection? a. Structured learning environment b. Socioeconomic status of children c. Cultural similarities of children d. Teachers knowledgeable about development

ANS: D A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others, so cultural similarities are not necessary.

14. At what age should the nurse expect a child to give both first and last names when asked? a. 15 months b. 18 months c. 24 months d. 30 months

ANS: D At 30 months, the child is able to give both first and last names and refer to self with an appropriate pronoun. At 15 and 18 months, the child is too young to give his or her own name. At 24 months, the child is able to give first name and refer to self by that name.

11. By which age should the nurse expect that most children could obey prepositional phrases such as "under," "on top of," "beside," and "behind"? a. 18 months b. 24 months c. 3 years d. 4 years

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

10. Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Describes an object according to its composition d. Talks incessantly regardless of whether anyone is listening

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

17. The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching? a. "Most bicycle injuries occur from a fall off the bicycle." b. "Head injuries are the major causes of bicycle-related fatalities." c. "I should replace my helmet every 5 years." d. "I can ride double with a friend if the bicycle has an extra-large seat."

ANS: D Children should not ride double. Most injuries result from falls. The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. The child should always wear a properly fitted helmet approved by the US Consumer Product Safety Commission and should replace the helmet at least every 5 years.

30. Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on which statement? a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.

ANS: D Co-sleeping, or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently under way; no evidence at this time supports or condemns the practice for safety reasons. Co-sleeping is a cultural practice. One year is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon.

27. The nurse recommends to parents that peanuts are not a good snack food for toddlers. What is the nurse's rationale for this action? a. Low in nutritive value b. High in sodium c. Cannot be entirely digested d. Can be easily aspirated

ANS: D Foreign-body aspiration is common during the second year of life. Although they chew well, this age child may have difficulty with large pieces of food, such as meat and whole hot dogs, and with hard foods, such as nuts or dried beans. Peanuts have many beneficial nutrients, but should be avoided because of the risk of aspiration in this age group. The sodium level may be a concern, but the risk of aspiration is more important. Many foods pass through the gastrointestinal tract incompletely undigested. This is not necessarily detrimental to the child.

13. What is the most common cause of death in the adolescent age group? a. Drownings b. Firearms c. Drug overdoses d. Motor vehicles

ANS: D Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death.

32. The parents of a 12-month-old child ask the nurse whether the child can eat hot dogs. The nurse's reply should be based on which statement? a. Child is too young to digest hot dogs. b. Child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut.

2. The psychosocial developmental tasks of toddlerhood include which characteristic? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

3. Which describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Are capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

ANS: D In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill.

CHAPTER 16 ADOLESCENT 1. What is the initial indication of puberty in girls? a. Menarche b. Growth spurt c. Growth of pubic hair d. Breast development

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

23. A school-age child falls on the playground and has a small laceration on the forearm. The school nurse should do which to cleanse the wound? a. Slowly pour hydrogen peroxide over wound. b. Soak arm in warm water and soap for at least 30 minutes. c. Gently cleanse with sterile pad and a non-stinging povidone-iodine solution. d. Wash wound gently with mild soap and water for several minutes.

ANS: D Lacerations should be washed gently with mild soap and water or normal saline. A sterile pad is not necessary, and hydrogen peroxide and povidone-iodine should not be used because they have a cytotoxic effect on healthy cells and minimal effect on controlling infection. Soaking the arm will not effectively clean the wound.

11. Which is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain.

ANS: D Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. In this age group, children are able to distinguish between fact and fantasy. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems.

33. The nurse is teaching parents of toddlers about animal safety. Which should be included in the teaching session? a. Petting dogs in the neighborhood should be encouraged to prevent fear of dogs. b. The toddler is safe to approach an animal if the animal is chained. c. It is permissible for your toddler to feed treats to a dog. d. Teach your toddler not to disturb an animal that is eating.

ANS: D Parents should be taught that toddlers should not disturb an animal that is eating, sleeping, or caring for young puppies or kittens. The child should avoid all strange animals and not be encouraged to pet dogs in the neighborhood. The child should never approach a strange dog that is confined or restrained. The inexperienced child should not feed a dog (if the child pulls back when the animal moves to take the food, this can frighten and startle the animal).

7. Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides: a. opportunity to become defiant. b. time to remain dependent on their parents for a longer time. c. time to establish a one-on-one relationship with the opposite sex. d. security as they gain independence from their parents.

ANS: D Peer-group identification is an important factor in gaining independence from parents. Children learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. Becoming defiant in a peer-group relationship may lead to bullying. Peer-group identification helps in gaining independence rather than remaining dependent. One-on-one opposite sex relationships do not occur until adolescence. School-age children form peer groups of the same sex.

23. Austin, age 6 months, has six teeth. How should the nurse interpret this finding? a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier-than-normal tooth eruption

ANS: D Six months is earlier than expected. Most infants at age 6 months have two teeth. Although unusual, it is not dangerous.

20. A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth? a. Twice a day b. Three times a day c. After meals d. After meals, after snacks, and at bedtime

ANS: D Teeth should be brushed after meals, after snacks, and at bedtime. Children who brush their teeth frequently and become accustomed to the feel of a clean mouth at an early age usually maintain the habit throughout life. Twice a day, three times a day, or after meals would not be often enough.

5. A nurse is planning care for a 17-month-old child. According to Piaget, which stage should the nurse expect the child to be in cognitively? a. Trust b. Preoperational c. Secondary circular reaction d. Tertiary circular reaction

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

12. Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips and can hop in place on one foot b. Rides tricycle and broad jumps c. Jumps with both feet and stands on one foot momentarily d. Walks up and down stairs and runs with a wide stance

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step and runs with a wide stance. Skipping and hopping on one foot are achieved by 4-year-old children. Jumping with both feet and standing on one foot momentarily are achieved by 30-month-old children. Tricycle riding and broad jumping are achieved at age 3.

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

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

15. The parents of a newborn say that their toddler "hates the baby; he suggested that we put him in the trash can so the trash truck could take him away." Which is the nurse's best reply? a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

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

21. A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. What should the nurse explain to the father? a. A sign the child is spoiled b. A way to exert unhealthy control c. Regression, common at this age d. Ritualism, common at this age

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

5. The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stools. The nurse's explanation of this is based on which statement? a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is normal for the child and is a normal part of the maturational process; no further investigation is necessary.

17. A parent asks the nurse about negativism in toddlers. Which is the most appropriate recommendation? a. Punish the child. b. Provide more attention. c. Ask child not always to say "no." d. Reduce the opportunities for a "no" answer.

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

9. An adolescent boy tells the nurse that he has recently had homosexual feelings. What knowledge should the nurse's response be based on? a. This indicates the adolescent is homosexual. b. This indicates the adolescent will become homosexual as an adult. c. The adolescent should be referred for psychotherapy. d. The adolescent should be encouraged to share his feelings and experiences.

ANS: D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society's reaction to the behavior. The nurse's first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentiality, appreciate his feelings, and remain sensitive to his need to talk about the topic. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing self-labels one or more times during their adolescence. An assessment must be made about any risks to himself or others. If these do not exist, the adolescent needs a supportive person to talk with.

9. The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. What knowledge should the nurse's response should be based? a. Unacceptable because of the risk of sudden infant death syndrome (SIDS) b. Unacceptable because it does not encourage achievement of developmental milestones c. Acceptable to encourage fine motor development d. Acceptable to encourage head control and turning over

ANS: D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development.

14. The father of a 12-year-old child tells the nurse that he is concerned about his son getting "fat." His son is at the 50th percentile for height and the 75th percentile for weight on the growth chart. What is the most appropriate nursing action? a. Reassure the father that his child is not fat b. Reassure the father that his child is just growing c. Suggest a low-calorie, low-fat diet d. Explain that this is typical of the growth pattern of boys at this age

ANS: D This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and the child and develop a plan to maintain physical exercise and a balanced diet. It is false reassurance to tell the father that his son is not fat. His weight is high for his height. The child needs to maintain his physical activity. The father is concerned, so an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.

2. In terms of fine motor development, which should the 3-year-old child be expected to do? a. Lace shoes and tie shoelaces with a bow. b. Use scissors to cut pictures, and print a few numbers. c. Draw a person with seven parts and correctly identify the parts. d. Draw a circle and name what has been drawn.

ANS: D Three-year-olds are able to accomplish this fine motor skill. Being able to lace shoes and tie shoelaces with a bow, use scissors to cut pictures, and print a few numbers, or draw a person with seven parts and correctly identify the parts are fine motor skills of 4- or 5-year-olds.

CHAPTER 12 PRESCHOOLER 1. Which should the nurse expect of a healthy 3-year-old child? a. Jump rope b. Ride a two-wheel bicycle c. Skip on alternate feet d. Balance on one foot for a few seconds

ANS: D Three-year-olds are able to accomplish this gross motor skill. Jumping rope, riding a two-wheel bicycle, and skipping on alternate feet are gross motor skills of 5-year-olds.

CHAPTER 11 TODDLER 1. Which factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue.

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

16. The school nurse has been asked to begin teaching sex education in the fifth grade. What should the nurse recognize about this age group? a. Children in fifth grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development.

ANS: D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth-graders are usually 10 or 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.