Peds Exam 1

An adolescent asks the nurse what the term "puberty" means. What is the nurse's best response?

"It is the age at which one first becomes capable of sexual reproduction." Adolescence is a period of rapid growth with dramatic changes in body size and proportions. It is the time between puberty and the end of physical growth. During this time, sexual characteristics develop and reproductive maturity occurs. Puberty is the point at which an individual becomes capable of sexual reproduction. Puberty starts at different ages for males and females. Puberty is defined as sexual maturity only. It does not describe emotional maturity.

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response?

"That is a good pretend answer but tell me the names of the brothers you really have." Stretching stories to make them seem more interesting is a phenomenon frequently encountered in preschoolers. This kind of storytelling should not be encouraged. The child should be helped to separate fact from fiction. The nurse should ask the child to say the names of the brothers the child really has. The nurse should not insult the child's counting ability. The nurse should not accuse the child of lying or making the child seem more important by having more brothers.

The nurse is assessing 2-year-old twins. The parent states, "My twins will not play together, only alongside each other." Which action will the nurse take first?

Explain that this is normal behavior for toddlers. Playing beside one another is parallel play and typical of toddlerhood. The nurse would explain this is normal behavior for the twins and then document the finding. The nurse would not need to observe the twins at play or ask additional questions as this is an expected finding.

Which of the following is defined as physical skills that involve the large muscles?

Gross motor skills

A mother states that her 6-year-old has starting biting nails and regressing to baby talk since beginning school. What instructions are best for the nurse to give the mother regarding this behavior?

Make time each day to spend with the child individually. Many first graders are capable of mature action at school but appear less mature when they return home. They may bite their fingernails, suck their thumb, or talk baby talk. Scolding, nagging, threatening, or punishing does not stop the problem and can actually make them worse. Methods such as bad-flavored nail polish or restraining the child's hands make the problems worse. These behaviors stop when the underlying stress is discovered and alleviated. Parents should be urged to spend time with the child after school or in the evening so the child continues to feel secure in the family and does not feel pushed out by being sent to school.

A parent with a 2-year-old invites a friend with a toddler over for a play date when they notice their children are not really interacting while playing. The children are playing side-by-side when one toddler gets up and grabs a toy car out of the hands of the other toddler, which results in both toddlers crying. To prevent this from occurring again, which intervention should the parents make?

Parents should ensure that toys in front of each child are "similar" to prevent fighting over one toy. All during the toddler period, children play beside other children, not with them. This side-by-side play (parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Caution parents that if two toddlers are going to play together, they must provide similar toys because an argument over one toy is likely to occur. Avoiding introducing playing with others, time out, or lecturing toddlers about "sharing" concept are inappropriate at this time.

The nurse teaches parents of adolescents that teenagers need the support of parents and nurses to facilitate healthy lifestyles. What should be a priority focus of this guidance?

Reducing risk-taking behavior The adolescent experiences drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. With this rapid growth during adolescence, the development of secondary sexual characteristics, and interest in the opposite sex, the adolescent needs the support and guidance of parents and nurses to facilitate healthy lifestyles and to reduce risk-taking behaviors. Promoting physical growth, maximizing learning potential, and teaching hygiene are secondary to reducing risky behavior.

Which of the following is a gross motor skill?

Skipping

A nurse in the clinic observes a school-age child pushing another child. The parent is watching without disciplining the child and tells the nurse, "He just does what he wants to and doesn't listen to anything I say." What can the nurse inform that parent about the development of self-confidence in the child? Select all that apply.

The child needs consistent rules to develop self-confidence. The child needs positive attention to develop self-confidence. The child needs clear expectations to develop self-confidence. The school-aged child needs consistent rules, positive attention, and clear expectations in order to develop self-confidence.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. What is an appropriate response to this concern?

Treat the action in a matter-of-fact manner, emphasizing safety. Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

Parents and their nearly 3-year-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay?

Uses two-word sentences or phrases A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.

Adam is very adept with the joystick that guides his favorite computer game. This activity relies on his _____ motor skills.

fine

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

having the child wear a personal flotation device whenever near or on the water. Preschool children are safe around water only when adult supervision is constant. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car. At 5 years old, most preschoolers are mature enough to become swimmers, yet knowing how to swim does not make the preschooler safe without supervision. CPR is a life-saving skill and using sunscreen will protect the skin, but neither will be a factor in preventing drowning.

Most deaths from injuries, especially among preschool aged children, in the United States

home

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence?

nocturnal emissions Involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in the body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum and emergence of pubic hair.

The nurse is teaching safety to a group of adolescents. Which common cause of death among adolescents will the nurse include in the teaching?

unintentional injuries Unintentional injuries are among the leading causes of death in adolescents. Injuries kill more adolescents than all diseases combined, with a large percentage being due to motor vehicle accidents. Falls are more common among geriatric populations. Poisoning is more common among young children. Diseases are more common among older adults and geriatrics.

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening?

viewing her baby sister's illness as her fault Since the preschool-age child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

The parent of a four year-old child has expressed concern that the child is wetting her bed several times each week. What should the nurse teach the parent?

Bed wetting is not an unexpected behavior at this age Bed wetting is not normally considered a problem unless it persists after the ages of 5 to 7. Limiting fluids after midafternoon may create a risk for dehydration.

The nurse is speaking with the parent of a 4-year-old child. Which statement by the parent would suggest a need for further investigation?

"When we go to the park, my child never wants to play with the other children." Preschool aged children start to play together. This is defined as cooperative play. Imaginative play such as dress-up, role play, and utilizing toys/objects for other purposes other than they were intended is common in this age.

A hospitalized 7-year-old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise?

A feeling of inferiority Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.

The nurse is assessing a toddler's fine motor skills. Which finding will concern the nurse?

Ability to turn door knobs Turning knobs opens doors and may allow the child access to the outdoors or unsafe areas within the home. Close to follow will be the ability to unscrew lids, creating poisoning risks. The other abilities promote growth and development and involve lesser safety hazards.

A nurse is assigned to care for a 7-year-old child. The child wants to show the nurse a collection of baseball cards. The nurse understands that the collection of objects is common in this age group and is known as what type of thinking?

Classification An important change in thinking during the school-age period is classification. This is the ability to divide things in different sets and identify their relationships to each other. Children in this age group love to collect sports cards, insects, rocks, stamps, coins, etc. These collections may be only a short-term interest, but they are of utmost importance to the child when he or she is collecting them. Decentration occurs in the concrete operational stage from ages 7 to 12 years. It is the ability to consider multiple aspects of a situation. The preoperational stage occurs between ages 2 and 7 years. During this time thinking is at a symbolic level. One part of the preoperational stage is egocentrism. In this stage, the child has the inability to see things from another's point of view.

While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their back yard a few days ago. The nurse explains that this is an instance of which of the following?

Deferred imitation Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time. Toddlers engage in assimilation when they learn to change a situation (or how they perceive it) because they are not able to change their thoughts to fit the situation, such as shaking a toy hammer as if it were a rattle, because they are more familiar with rattles than hammers. All during the toddler period, children play beside children next to them, not with them. This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Autonomy, or independence, is the primary developmental task of the toddler years, according to Erikson. Although this child's act may be a sign of autonomy, it is more specifically an act of deferred imitation.

During a health history, the nurse explores the sleeping habits of a 3-year-old boy by interviewing his parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group?

"We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.

During early (toddler, preschool) childhood, children grow ___ per year.

2 to 3 inches

The nurse is performing a physical assessment of a 10-year-old child. The nurse notes that 1 year ago the child weighed 80 lb (36.3 kg). Which weight, if noted during this assessment, would alert the nurse to further assess the child for appropriate growth and development?

82 lb (37.2 kg) From 6 to 12 years of age, an increase of 7 lb (3 to 3.5 kg) per year in weight is expected, so a target weight of 87 lb (39.5 kg). A child weighing near 87 lb, such as 86 lb (39 kg) or 88 lb (40 kg), would be considered appropriate. If the child weighed only 82 lb (37.2 kg), this would alert the nurse to further assess the child for lagging growth.

The nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test?

Help the child to pretend that the CT scan machine is a camera. Because preschoolers' imagination is so active, this leads to several fears such as fear of the dark and mutilation. The nurse needs to help the child understand that the CT scanner is like a camera to take pictures of the body parts. Threatening the child to follow directions or becoming hurt plays into the child's fear of mutilation. Telling the child to behave creates a fear of punishment. Telling the child that the CT scan is a picture of the body's dark parts plays into the child's fear of the dark.

Thirteen-year-old Jeff and his mother are in the office for an annual visit. His mother jokes openly in front of you about the changes in her son's voice and the fact that now he has hair under his armpits. What is an appropriate response for the nurse when she is talking with the mother?

"Remember, he is probably very self-conscious and may be embarrassed by your statements." It is important for the nurse to reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring their attention to a delicate situation. During this period, the child may become very modest and self-conscious. Adults must avoid even "good-natured" teasing because it may cause embarrassment as the child becomes extremely sensitive about his or her body image. It is never appropriate to discuss what is happening with a patient in a way that is demeaning and hurtful. You can share your experiences with the patient and the family but that should not lead the discussion. Parents can share their experiences with the child but they have to be open to this discussion or it can lead to an awkward experience for the adolescent.

The parents of a 30-month-old toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding?

A tantrum preceded the event. Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler is old enough to verbalize feelings. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.

A nurse in a busy pediatric clinic is educating a group of parents with toddlers about the nutritional needs of this age group. Which concepts should be addressed in this educational presentation? Select all that apply.

Active, "busy" toddlers may need up to 1,400 cal/day. Try to limit the fat intake to less than 35% of total calories. Milk is still important to incorporate in the diet for bone health. Active children in this age group may need up to 1,400 kcal daily. Children over 2 years old should have a total fat intake between 30% and 35% of calories, with most fat coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils, the same as adults. Adequate calcium and phosphorus intake is important for bone mineralization. Milk should be whole milk until age 2 years, after which 2% milk can be introduced. Trans fats should be kept to a minimum. Diets high in sugar (like cookies) should be avoided to help prevent toddler obesity.

The nurse is helping parents enhance the developmental task of initiative in their preschool-age child. Which activity would the nurse suggest the parents implement?

Allow the child to experiment with molding clay. To gain a sense of initiative, preschoolers need exposure to a wide variety of play materials so they can learn as much about how things work as possible. The parents should be urged to provide play materials that encourage creative play such as modeling clay. Any experience with free-form play is helpful. Street-crossing safety, following rules, and providing clothes that snap will not support the developmental task of initiative as much as providing a substance to experiment during play.

Which nursing action will best assist a 15-year-old client accomplish the developmental task according to Erikson?

Allow the client's friends to visit while the client is hospitalized The developmental task of adolescence is to develop a sense of identity, or deciding who and what kind of person one is. Friends and peers are important to facilitating the adolescent in determining one's identity. Permitting the client to make decisions assists in developing autonomy, which is a toddler task. Praising facilitates initiative, which is a preschool task. Independently performing tasks assists in developing industry, which is a school-age task.

The parent of a 2-year-old toddler tells the nurse she needs to constantly scold the toddler for having wet pants. The parent says the toddler was potty trained at 12 months, but since starting to walk, the toddler wets the pants all the time. Which nursing diagnosis would be most applicable?

Deficient parental knowledge related to inappropriate method for toilet training Myelination of the spinal cord is achieved around 2 years of age. When this occurs, the toddler can exercise voluntary control over the sphincters. It is probable that a toddler toilet trained at 12 months of age was not truly trained, because the infant would not be developmentally able to complete the task. It is most likely the parent used a training method of reminding the infant or placing the infant on a toilet frequently during the day. When the toddler begins to play independently, the toddler forgets the regimented schedule. This toddler is not toilet trained independently. The toddler does not display total urinary incontinence. The toddler is only incontinent when playing and not reminded to potty. A 2-year-old toddler has limited coping skills. Frequent wetting of the pants does not indicate too much fluid intake. It is a symptom that the toddler does not feel the urge to urinate until the bladder is too full and the toddler cannot get to the toilet on time.

A nurse is developing a plan of care for a 4-year-old client with cystic fibrosis who has frequent hospitalizations related to his illness. Which would be the most appropriate nursing diagnosis for this client?

Delayed growth and development related to frequent illness This client has frequent hospitalizations and is at risk for delayed growth and development. For a client at this age, play, socialization, exploring, and imagination are all important parts of normal growth and development.

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?

Imagination Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschoolers is keener than it will be at any other time in their lives. They imitate behavior that they see exactly.

The nurse is teaching the parents of a preschool-age child about injury prevention. Which method would the nurse advise for the parents as the best way to enforce injury prevention?

Repetition and reinforcement Injury prevention involves adults actively searching the indoor and outdoor environment of the home and other areas where the child may frequently spend time. This keeps the environment "explorable," prevents conflicts, and enables the child to expand on skills that need mastering. Safety rules and constant vigilance are only a small part of enforcing injury prevention.

When interviewed by the school nurse, a 13-year-old adolescent female states she has a boyfriend and that her parents do not talk about sex with her. She says is confused about the facts and wants to know the truth. Which approach would best address this adolescent's concerns?

Sit down with her and openly discuss her concerns and questions in an honest, straightforward manner. Discussions about human sexuality need to be open, honest and straightforward with adolescents. Parents and health care providers must remain nonjudgmental if they want adolescents to come to them with questions. Sitting down with the student and addressing her questions is the best way to establish a trusting relationship with her. Recommending that she talk with her parents will not help her since they are apparently not open to discussing the topic. Brochures cannot answer her specific questions and may result in more confusion on her part. Referring her to the health department is passing the nurse's responsibility to someone else, and there is no indication that any pregnancy prevention is needed.