PEDS Unit 1

In which of the following phases of child hospital care would the nurse use the child's favorite toys to establish rapport? A. Introduction B. Building a trusting relationship C. Decision-making phase D. Providing comfort and reassurance

B. Building a trusting relationship. The nurse would use the child's favorite toys to establish rapport in the building a trusting relationship phase of nursing care. Rationale: The initial phase involves collecting information to form the basis of the trusting relationship. The decision-making phase involves allowing the children to help make decisions about their health care plan. Providing comfort and reassurance refers to using techniques to reinforce the trusting relationship, such as praising the child.

The successful resolution of developmental tasks for the school-age child, according to Erikson, would be identified by: A. Learning from repeating tasks B. Developing a sense of worth and competence C. Using fantasy and magical thinking to cope with problems D. Developing a sense of trust

B. Developing a sense of worth and competence Rationale: School-age children develop a sense of worth and competence. Toddlers learn from repeating tasks. Preschoolers use fantasy and magical thinking. It is in infancy that the child develops a sense of trust.

The nurse praises a 3-year-old child for using the potty. Which of the following theorists focuses on the satisfaction/frustration of expelling feces? A. Piaget B. Freud C. Erickson D. Kohlberg

B. Freud Freud's theory focuses on the satisfaction and/or frustration of expelling feces (anal stage). Rationale: Piaget's theory focuses on development of the senses of the toddler; Erickson's theory focuses on achievement of autonomy and self-control; Kohlberg's theory focuses on the moral development of the toddler.

The nurse is conducting a physical assessment of a teenager and asks about his daily routine. What aspect of the health history is the nurse assessing? A. Developmental history B. Functional history C. Family health history D. Demographics

B. Functional history. The functional history involves asking about the child's daily routine. Rationale: The developmental history determines the age when landmarks in gross motor control were achieved. The family health history obtains information about the family's health, and demographics refers to data such as the child's name, birth date, gender, race, ethnicity, and language spoken.

To gain cooperation from a toddler, what is the best approach by the nurse? A. Immediately pick the toddler up from the mother's lap. B. Kneel in front of the toddler while he or she is on the mother's lap. C. Do the nursing tasks quickly so the toddler can play. D. Ask the toddler if it is okay if you begin the needed task.

B. Kneel in front of the toddler while he or she is on the mother's lap. Rationale: Being at the toddler's level and allowing the toddler to stay with his mother allow him to feel more secure. If the toddler perceives the nurse to be nonthreatening, the nurse is more likely to gain cooperation. Toddlers ordinarily answer "no," so asking the toddler's permission is not helpful. Simply jumping in and starting the task without allowing the toddler to warm up will threaten the child.

The mother of two sons, ages 6 and 9, states they want to play on the same baseball team. As the school nurse, what advice would you give their mother? A. Having the boys on the same team will make it more convenient for the mother. B. Levels of coordination and concentration differ, so the boys need to be on different teams. C. Put the boys on the same team because they are both school-age children. D. It is best to avoid putting the boys on the same team to prevent sibling rivalry.

B. Levels of coordination and concentration differ, so the boys need to be on different teams. Rationale: With age, concentration and coordination increase, so the 9-year-old would be operating at a higher level of maturity.

Which is associated with early adolescence? (Choose all that apply.) A. Uses scientific reasoning to solve problems B. Still at times wants to be dependent upon parents C. Incorporates own set of morals and values D. Is influenced by peers and values memberships in cliques

B. Still at times wants to be dependent upon parents D. Is influenced by peers and values memberships in cliques Rationale: During early adolescence (11 to 14 years of age), adolescents are in conflict over becoming independent from their parents. They still at times want the role of the parents to be as it was during the school-age years. They are influenced by peers and value membership in cliques. Adolescents develop scientific reasoning and incorporate their own set of morals and values in middle and late adolescence.

A 4-year-old child is having a vision screening performed. Which screening chart would be best for determining the child's visual acuity? A. Snellen B. Ishihara C. Allen figures D. CVTME

C. Allen figures Rationale: The Allen figures chart is reliable for assessing visual acuity in a preschooler. Although the Snellen chart can be used if the child has a good knowledge of the alphabet, that is not an expectation for a 4-year-old child. The Ishihara and CVTME charts are designed to assess color vision discrimination and not visual acuity

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse? A. "It's okay to start pureed solids at this age if fed via the bottle." B. "Infants don't require solid food until 12 months of age." C. "Solid foods should be delayed until age 6 months, when the infant can handle a spoon on his own." D. "The tongue extrusion reflex disappears at age 4-6 months, making it a good time to start solid foods."

D. "The tongue extrusion reflex disappears at age 4-6 months, making it a good time to start solid foods."

A 2-year-old is having a temper tantrum. What advice should the nurse give the mother? A. For safety reasons, the toddler should be restrained during the tantrum. B. Punishment should be initiated, as tantrums should be controlled. C. The mother should promise the toddler a reward if the tantrum stops. D. The tantrum should be ignored as long as the toddler is safe.

D. The tantrum should be ignored as long as the toddler is safe. Rationale: Ignoring tantrums is the best method for discouraging them. Any additional attention received because of the outburst may only contribute to another occurrence in the future.

The mother of a 4-year-old asks for advice on using time-out for discipline with her child. What advice should the nurse give the mother? A. If spanking is not working, then time-out is not likely to be helpful either. B. Place the child in time-out for 4 minutes. C. Use time-out only if removing privileges is unsuccessful. D. The child should stay in time-out until crying ceases.

B. Place the child in time-out for 4 minutes. Rationale: The generally accepted guidelines recommend keeping the child in time-out for 1 minute per year of age.

When giving parents guidance for the adolescent years, the nurse would advise the parents to: (Choose all that apply.) A. Accept the adolescent as a unique individual B. Provide strict, inflexible rules C. Listen and try to be open to the adolescent's views D. Screen all of his or her friends E. Respect the adolescent's privacy F. Provide unconditional love

A. Accept the adolescent as a unique individual C. Listen and try to be open to the adolescent's views E. Respect the adolescent's privacy F. Provide unconditional love Rationale: Adolescents need to be accepted as unique individuals. Parents should provide unconditional love, respect their privacy, and listen to them. Screening all of their friends and providing strict, inflexible rules would only lead to poor interactions between the parents and the adolescent.

A 10-year-old child on a regular diet refuses to eat the food on her meal tray. She requests chicken nuggets, French fries, and ice cream. What is the best nursing action? A. Ask that the child's desired foods be sent up from the kitchen. B. Negotiate with the child to eat at least part of the food on the tray. C. Remove a privilege. D. Offer the child cereal and milk from stock on the nursing unit.

A. Ask that the child's desired foods be sent up from the kitchen. Rationale: Within reason, the child on an unrestricted diet should be allowed to choose the foods that she likes. This increases the likelihood that she will get enough nutrition to support the healing process.

The nurse is assessing a 3 year old for gross motor skill development. Which of the following would the nurse expect this preschooler to have accomplished? A. Bend over without falling B. Standing on one foot for 10 seconds C. Skipping D. Swimming

A. Bend over without falling. The 3 year old should be able to bend over without falling. Rationale: At age 4, the preschooler hops on one foot and stands on one foot up to 5 seconds. At 5 years old the preschooler stands on one foot for 10 seconds, may skip, and may learn to skate and swim.

Which of the following has the most influence in deterring an adolescent from beginning to drink alcohol? A. Drinking habits of parents B. Drinking habits of peers C. Drinking philosophy of adolescent's culture D. Drinking philosophy of adolescent's religion

A. Drinking habits of parents

The nurse is assessing a 4-year-old for gross motor skill development. Which of the following would the nurse expect this preschooler to have accomplished? A. Hopping on one foot B. Standing on one foot for 10 seconds C. Skipping D. Swimming

A. Hopping on one foot. The 4-year-old should be able to hop on one foot. Rationale: At age 4, the preschooler hops on one foot and stands on one foot up to 5 seconds. At 5 years old the preschooler stands on one foot for 10 seconds, may skip, and may learn to skate and swim.

The successful resolution of developmental tasks for the school-age child, according to Erikson, would be identified by... A. Learning from repeating tasks B. Developing a sense of worth and competence C. Using fantasy and magical thinking to cope with problems D. Developing a sense of trust

A. Learning from repeating tasks

The father of a 2-month-old girl is expressing concern that his infant may be getting spoiled. The nurse's best response is: A. "She just needs love and attention. Don't worry; she's too young to spoil." B. "Consistently meeting the infant's needs helps promote a sense of trust." C. "Infants need to be fed and cleaned; if you're sure those needs are met, just let her cry." D. "Consistency in meeting needs is important, but you're right, holding her too much will spoil her."

B. "Consistently meeting the infant's needs helps promote a sense of trust." Rationale: Infants need to have both their physical needs (e.g., feeding, changing, clothing) and their emotional needs (e.g., attention, holding) met consistently so that they can develop a sense of trust, which is the basis for the later development of self-esteem.

The nurse would most likely assess separation anxiety in which child? A. A 2-month-old-infant B. A 15-month-old toddler C. A 4-year-old preschooler D. An 11-yearold

B. A 15-month-old toddler

A sleeping 5-month-old is being held by the mother when the nurse comes in to do a physical examination. What assessment should be done initially? A. Listening to the bowel sounds B. Counting the heart rate C. Checking the temperature D. Looking in the ears

B. Counting the heart rate

What approach by the nurse would most likely encourage a child to cooperate with an assessment of physical and developmental health? A. Explain to the child what's going to happen when the child ask questions. B. Explain what is going to happen in words the child can understand. C. Force them to cooperate by having a parent hold them down. D. Give the child a sticker before beginning the examination.

B. Explain what is going to happen in words the child can understand.

The nurse is caring for a hospitalized 30-month-old who is resistant to care, is angry, and yells "no" all the time. The nurse identifies this toddler's behavior as A. Problematic, as it interferes with needed nursing care. B. Normal for this stage of growth and development. C. Normal because the child is hospitalized and out of his routine.

B. Normal for this stage of growth and development. Rationale: Negativism is characteristic of the stage, no matter what the situation (hospital or home).

The mother of a 15-month-old is concerned about a speech delay. She describes her toddler as being able to understand what she says, sometimes following commands, but using only one or two words with any consistency. What is the nurse's best response to this information? A. The toddler should have a developmental evaluation as soon as possible. B. If the mother would read to the child, then speech would develop faster. C. Receptive language normally develops earlier than expressive language. D. The mother should ask her child's physician for a speech therapy evaluation

C. Receptive language normally develops earlier than expressive language. Rationale: Young toddlers understand far more language than they can actually express themselves.

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior? A. Crying when left with the sitter may indicate difficulty with building trust. B. Stranger anxiety should not occur until toddler-hood; this concern should be investigated. C. Separation anxiety is normal at this age; the infant recognizes parents as separate beings. D. Perhaps the sitter doesn't meet the infant's needs; choose a different sitter.

C. Separation anxiety is normal at this age; the infant recognizes parents as separate beings.

Is the following statement true or false? A colorful simple board game that requires multiple players to cooperate with each other for a common goal would be the best type of toy for toddlers.

False. Toddlers tend to engage in parallel, solitary play and are not likely to cooperate in a group game situation because of their basic egocentric nature. Rationale: The best toys for toddlers are familiar household items, child-size household items, blocks, cars, plastic figures, stuffed animals, dolls, doll beds, and carriages. Manipulative toys with knobs and buttons that make things happen, shapes to insert into matching holes, puzzles, chalk, buckets and shovels, and floating toys are also recommended. Appropriate gross motor toys include gyms, tricycles, pull toys, and wagons.

Is the following statement true or false? The nurse caring for an adolescent should teach the parents to monitor their adolescent's interaction with peer groups.

True. The nurse caring for an adolescent should teach the parents to monitor their adolescent's interaction with peer groups. Rationale: Adolescents who do not have parental or adult supervision and opportunities for conversation with adults may be more susceptible to peer influences and at higher risk for poor peer selections.

Which of the following are reasons that stealing occurs in school-age children? (Choose all that apply.) A. To escape punishment B. High self-esteem C. Low expectations of family/peers D. Lack of sense of property E. Strong desire to own something

A. To escape punishment D. Lack of sense of property E. Strong desire to own something Rationale: Stealing in the school-age years occurs for multiple reasons: to escape punishment, because of a lack of sense of propriety or ownership, and because of a strong desire to own something they do not have because of lack of money or refusal by parents. Stealing also occurs when a school-age child has low self-esteem and high expectations from his family or peers that the child cannot meet.

The nurse is caring for a hospitalized 4-year-old who insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler's behavior as: A. Problematic; the child is old enough to begin to have a basis in reality. B. Normal, because the child is hospitalized and out of her routine. C. Normal for this stage of growth and development. D. Problematic, as it interferes with needed nursing care.

C. Normal for this stage of growth and development. Rationale: Imaginary friends help the preschooler cope with stress in his or her life.

The nurse is preparing a 5-year-old boy for surgery on his lower leg. His mother is helping him into the hospital gown and the boy fights removal of his underwear. What is the most appropriate nursing action? A. Allow the mother to remove the underwear. B. Tell the boy he is acting childishly. C. Notify the OR that the underwear is on. D. Allow the boy to keep his underwear on.

C. Notify the OR that the underwear is on.

Is the following statement true or false? In 2008, the World Health Organization defined health as "an absence of disease or infirmity."

False - In 2008, the World Health Organization defined health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity."

Is the following statement true or false? The nurse is examining an infant and documents "cyanosis." This condition is a decreased pinkness in light-skinned children or an ashy-gray color in dark- skinned children caused by anemia, shock, fever, or syncope.

False. Cyanosis is blueness of the lips, tongue, oral mucosa, or trunk caused by hypoxia or circulatory collapse. Rationale: Pallor is decreased pinkness in light-skinned children or an ashy-gray color in dark-skinned children caused by anemia, shock, fever, or syncope.

Is the following statement true or false? Fine motor skills develop in a cephalocaudal fashion (from the center to the periphery).

False. Fine motor skills develop in a proximodistal fashion (from the center to the periphery). Rationale: Gross motor skills develop in a cephalocaudal fashion (from the head to the tail).

Is the following statement true or false? The community can be a contributor to a child's health or it can be the cause of his or her illnesses.

True. The community can be a contributor to a child's health or it can be the cause of his or her illnesses. Rationale: The child is a member of a community as well as a family and a culture. The child's health cannot be totally separated from the health of the surrounding community. Each community has unique strengths, weaknesses, and values that can affect a child's health.

Is the following statement true or false? The nurse is assessing a 6-month-infant and obtains the following measurements: weight: 15 lbs; length: 26 in.; head circumference: 17 in. It has been determined that these are average measurements for a 6-month-old infant.

True. The following measurements: weight: 15 lbs; length: 26 in.; and head circumference: 17 in. are average measurements for a 6-month-old infant. Rationale: The average weight for a 6-month-old infant is 15 lbs, the average length is 25 to 27 in., and the average head circumference is 16.5 to 17.5 in.

Which of the following are reasons that stealing occurs in school-age children? Select all that apply. A. To escape punishment B. High self-esteem C. Low expectations of family/peers D. Lack of sense of propriety E. Strong desire to own something

A. To escape punishment D. Lack of sense of propriety E. Strong desire to own something

In developing a weight-loss plan for an adolescent, which would the nurse include? (Choose all that apply.) A. Have parents make all of the meal plans. B. Eat slowly and place the fork down between each bite. C. Have the family exercise together. D. Refer to an adolescent weight-loss program. E. Keep a food and exercise diary.

B. Eat slowly and place the fork down between each bite. C. Have the family exercise together. D. Refer to an adolescent weight-loss program. E. Keep a food and exercise diary. Rationale: These are steps that promote weight loss in adolescents. Adolescents want to be involved in the process, so having parents make all of the meal plans would not promote acceptance by the adolescent.

The nurse is assessing a 5-year-old child for signs of developmental delay. Which of the following would alert the nurse to a potential problem? A. The child can build a tower of six blocks B. The child does not play with other children C. The child engages in fantasy play D. The child separates from parent easily

B. The child does not play with other children. This is a sign of a potential developmental delay. Rationale: Signs of developmental delay in preschool-age children include not playing with other children, not being able to build a block tower of six to eight blocks, not engaging in fantasy play, and not separating from the parent without major protest.

A 5-year-old boy visits the pediatric office with an upper respiratory infection. Which approach would give the nurse the most information about the child's developmental level? A. Playing a game with the child. B. Talking with the child about the teddy bear next to him. C. Using a screening tool during a follow-up office visit. D. Asking the 10-year-old sibling about the child.

C. Using a screening tool during a follow-up office visit. Rationale: Assessment of development should not be done when a child is ill. It is more accurate when the child is alert and able to participate fully.

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse? A. "It's okay to start puréed solids at this age if fed via the bottle." B. "Infants don't require solid food until 12 months of age." C. "Solid foods should be delayed until age 6 months, when the infant can handle a spoon on his own." D. "The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."

D. "The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods." Rationale: As the tongue extrusion reflex disappears, the infant is better able to accept the spoon and learn to take solid foods.

The nurse is preparing a child for a vision screening. How far would the nurse place the child from the chart? A. 5 feet B. 10 feet C. 15 feet D. 20 feet

D. 20 feet Rationale: When screening for vision, the nurse would place the chart at the child's eye level, place a mark on the floor 20 feet from the chart, and align the child's heels on the mark.

Is the following statement true or false? The best type of toys for toddlers are store-bought interactive electronic toys.

False. Toddlers do not need store-bought expensive toys. The best toys for toddlers are familiar household items, child-size household items, blocks, cars, plastic figures, stuffed animals, dolls, doll beds, and carriages. Manipulative toys with knobs and buttons that make things happen, shapes to insert into matching holes, puzzles, chalk, buckets and shovels, and floating toys are also recommended. Appropriate gross motor toys include gyms, tricycles, pull toys, and wagons.

What is the number-one cause for mortality among children? A. Human immunodeficiency virus B. Congenital anomalies C. Motor vehicle accidents D. Low birth-weight

C. Motor vehicle accidents

What is the best advice about nutrition for the toddler? A. Encourage cup drinking and give water between meals and snacks. B. Encourage unlimited milk intake, because toddlers need the protein for growth. C. Avoid sugar-sweetened fruit drinks and allow as much natural fruit juice as desired. D. Allow the toddler unlimited access to the sippy cup to ensure adequate hydration.

A. Encourage cup drinking and give water between meals and snacks. Rationale: The toddler should wean to the cup by age 12 to 15 months. Limit real fruit juice to 4 to 6 oz per day and milk to 16 to 24 oz per day, and give it with meals and snacks. Offer water between meals and snacks.

The mother of a 3-year-old is concerned about her child's speech. She describes her preschooler as hesitating at the beginning of sentences and repeating consonant sounds. What is the nurse's best response? A. Hesitancy and dysfluency are normal during this period of development. B. Reading to the child will help model appropriate speech. C. Expressive language concerns warrant a developmental evaluation. D. The mother should ask her child's physician for a speech therapy evaluation.

A. Hesitancy and dysfluency are normal during this period of development Rationale: Preschoolers often have a period of dysfluency and hesitancy in their language development, but it usually resolves by about age 4 years.

Which statement indicates the best sequence for the nurse to conduct an assessment in a non-emergency situation? A. Introduce yourself, ask about any problems, take a history, do the physical examination B. Perform the physical examination and then ask the family if there are any problems in the child's life. C. Do the physical examination while at the same time asking about the child's previous illnesses; then talk about the family's concerns. D. Get a complete history of the family's health beliefs and practices, then assess the child.

A. Introduce yourself, ask about any problems, take a history, do the physical examination

In developing a pregnancy prevention program at school for 15-17 year olds, the school nurse must take into consideration that... A. Teenagers think that no harm will come to them B. Teenagers will learn best from their parents C. Teenagers can only think in the here and now D. Teenagers will learn best from professionals

A. Teenagers think that no harm will come to them

The nurse is caring for a 2-year-old in the hospital, and the mother expresses concern that the toddler will be scared. Which response by the nurse would be most appropriate? A. "Don't worry; we practice family-centered and atraumatic care here." B. "We will do our best to minimize the stress that your child experiences." C. "It will probably be upsetting for you as well, so you should stay home." D. "Our practice of atraumatic care will eliminate all pain and stress for your child."

B. "We will do our best to minimize the stress that your child experiences." Rationale: Pediatric nurses practice the concept of atraumatic care, intervening to minimize physical and psychological distress for children and their families by identifying stressors, minimizing separation of the child from the family, and providing nursing care that decreases stressful situations and minimizes pain and bodily injury. It is impossible to eliminate all pain and stress for a child. Telling the mother not to worry and recommending that she stay home are inappropriate and isolating the mother from involvement in the child's care.

A 2-year-old boy is scheduled to undergo an endoscopic procedure. His parents are asking when they should tell him about it. Based on the nurse's understanding of the child's developmental stage, when would be the most appropriate time to prepare the child for the procedure? A. About 1 week before the scheduled date B. A few days in advance of the scheduled date C. About 1 hour before the procedure is to occur D. Just before the procedure is to be performed

B. A few days in advance of the scheduled date Rationale: When applying patient- and family-centered care, the nurse recognizes the family as central to the child's life, respecting the family's strengths and diversity and empowering the family through honesty, support, flexibility, and collaboration.

Which facility fulfills the characteristics of a medical home? A. An urgent care center B. A primary care pediatric practice C. A mobile outreach immunization program D. A dermatology practice

B. A primary care pediatric practice Rationale: A primary care pediatric practice is most likely to fulfill the characteristics of a medical home. Answer "A" does not provide preventive care activities. Answer "C" would not provide for any care requiring hospitalization. Answer "D" is unlikely to provide service outside its area of expertise.

When working with children and families, which is a critical strategy for promoting therapeutic communication? A. Detailed explanations B. Attentive listening C. Comforting touch D. Closed-ended questions

B. Attentive listening Rationale: Attentive or active listening conveys interest, allows the nurse to discover information, and establishes trust. Eye contact and reflection of the child's and parents' statements are also critical parts of therapeutic communication.

A 9-month-old infant's mother is questioning why cow's milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response? A. It is permissible to substitute cow's milk for formula at this age as he is so close to 1 year old. B. Cow's milk is poor in iron and does not provide the proper balance of nutrients for the infant. C. As long as the mother provides whole milk, rather than skim, she can start cow's milk in infancy. D. If the mother cannot afford the infant formula, she should dilute it to make it last longer.

B. Cow's milk is poor in iron and does not provide the proper balance of nutrients for the infant. Rationale: Although whole milk contains a sufficient quantity of fat, cow's milk is inappropriate for use in infancy as it does not provide the appropriate balance of nutrients (especially iron) and may overload the infant's renal system with inappropriate amounts of sodium, protein, and minerals. Cow's milk use should be delayed until 1 year of age. Infant formula should always be reconstituted according to the manufacturer's recommendations.

When planning education for a child and parents, what is the first step the nurse should take? A. Decide which procedures and medications the child will be discharged on. B. Determine the child's and family's learning needs and styles. C. Ask the family if they have ever performed this type of procedure. D. Tell the child and family what the goals of the teaching session are.

B. Determine the child's and family's learning needs and styles. Rationale: Always assess the child's and family's learning needs and preferred style of learning first.

Which of the following will promote weight loss in an obese school-age child? Select all that apply. A. Unlimited computer and TV time B. Role modeling by family C. Becoming active in sports D. Eating unstructured meals E. Involving child in meal planning and grocery shopping F. Drinking three glasses of water/day

B. Role modeling by family E. Involving child in meal planning and grocery shopping

An infant boy is at your facility for his initial health supervision visit. He is 2 weeks old and responds to a bell during his examination. You review all his birth records and find no documentation that a newborn hearing screening was performed. What is the best action by the nurse? A. Do nothing; responding to the bell proves the infant does not have a hearing deficit. B. Schedule the infant immediately for newborn hearing screening. C. Ask the mother to observe for signs that the infant is not hearing well. D. Screen again with the bell at the infant's 2-month health supervision visit.

B. Schedule the infant immediately for newborn hearing screening. Rationale: Guidelines for infant hearing screening recommend universal screening with ABR or EOAE by 1 month of age. All the other answers rely on behavioral observation. Studies have shown that behavioral observation is not a reliable method of screening for hearing loss.

When caring for children, how does the nurse best incorporate the concept of family-centered care? A. Encourages the family to allow the physician to make health care decisions for the child B. Uses the concepts of respect, family strengths, diversity, and collaboration with family C. Advises the family to choose a pediatric provider who is on the child's health care plan D. Recognizes that families undergoing stress related to the child's illness cannot make good decisions

B. Uses the concepts of respect, family strengths, diversity, and collaboration with family

The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant's oral health? A. "Start brushing her teeth after all the baby teeth come in." B. "Use a washcloth with toothpaste to clean her mouth." C. "Clean your baby's gums, then new teeth, with a washcloth." D. "Rinse your baby's mouth with water after every feeding."

C. "Clean your baby's gums, then new teeth, with a washcloth." Rationale: The infant's mouth should be cleansed with a damp washcloth as should the baby's new teeth. It is important to clean the mouth and the teeth in order to prevent dental caries. Toothpaste is unnecessary in infancy. Rinsing the infant's mouth would present a safety hazard.

The nurse is assessing developmental milestones for a 7-month-old premature infant born at 28 weeks' gestation. What would be the adjusted age upon which the nurse would base the assessment? A. 2 months B. 3 months C. 4 months D. 5 months

C. 4 months. The nurse assessing developmental milestones for a 7-month-old premature infant born at 28 weeks' gestation would adjust the age to 4 months. Rationale: The infant was born 12 weeks early (3 months); therefore, the nurse would subtract 3 months from the chronological age of 7 months to obtain an adjusted age of 4 months. Healthy growth would be demonstrated if the infant were the size of a 4-month-old and achieved the developmental milestones of a 4-month-old.

The nurse is conducting developmental surveillance on a child and his family. Which of the following is a component of this process? A. Measuring the child's head circumference B. Administering vaccinations C. Addressing parental concerns D. Performing a physical assessment

C. Addressing parental concerns is a component of developmental surveillance. Rationale: Developmental surveillance is an ongoing collection of skilled observations made over time during health care visits and includes noting and addressing parental concerns. Measuring the head circumference, administering vaccinations, and performing a physical assessment are components of the screenings conducted at the health supervision visit.

When developing the preoperative plan of care for an adolescent, the nurse plans interventions to address the adolescent's anxieties and fears related to... A. Separation from parents B. Punishment for wrongdoings C. Changes in body image D. Magical thinking

C. Changes in body image

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior? A. Crying when left with the sitter may indicate difficulty with building trust. B. Stranger anxiety should not occur until toddlerhood; this concern should be investigated. C. Separation anxiety is normal at this age; the infant recognizes parents as separate beings. D. Perhaps the sitter doesn't meet the infant's needs; choose a different sitter.

C. Separation anxiety is normal at this age; the infant recognizes parents as separate beings. Rationale: As the infant realizes she is separate from her parents, it may distress her when the parents leave, as she understands they are no longer with her.

As the school nurse conducting screening for vision in a 6-year-old child, you would refer the child to a specialist if the visual acuity in both eyes is: A. 20/20 B. 20/25 C. 20/30 D. 20/50

D. 20/50 Rationale: Visual acuity of 20/20 is not expected until 7 years of age.

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A. A lack of fully developed hearing. B. A less discriminating sense of touch. C. Visual acuity that has not fully developed. D. A less discriminating sense of taste.

D. A less discriminating sense of taste. Rationale: The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

When providing atraumatic care to a child, which action would be the most appropriate? A. Applying restraints for any procedure that would be uncomfortable B. Keeping the lights on in the child's room throughout the day and night C. Limiting the use of topical anesthetics for painful injections D. Allowing parents and children an informed choice about being together

D. Allowing parents and children an informed choice about being together Rationale: Atraumatic care involves strategies and interventions to minimize distress. Allowing parents and children an informed choice helps to promote family-centered care and minimizes parent and child separation. Restraints should be used only as a last resort. Keeping the lights on in the child's room throughout the day and night interferes with the child's ability to sleep, leading to physical distress. Topical anesthetics are appropriate for use any time a procedure would be a source of pain or distress.

A 5-year-old child is not gaining weight appropriately. Organic problems have been ruled out. What is the priority action by the nurse? A. Allow the child unlimited access to the sippy cup to ensure adequate hydration. B. Encourage sweets for the extra caloric content. C. Teach the mother about nutritional needs of the preschooler. D. Assess the child's usual intake pattern at home.

D. Assess the child's usual intake pattern at home. Rationale: The nurse must first assess the child's current intake to determine if there is a deficiency.

Is the following statement true or false? Suicide is the third leading cause of death in adolescents 15 to 19 years of age.

True. Suicide is the third leading cause of death in adolescents 15 to 19 years of age. Rationale: In a nationwide CDC study, 15% of adolescents surveyed reported that they had seriously considered suicide within the past 12 months, with 11% creating a plan and 7% attempting to take their own life

A 15-month-old girl is having her first health supervision visit at your facility. Her mother has not brought a copy of the child's immunization record but believes she is fully immunized: "She had immunizations 3 months ago at the local health department." Which would be the best action by the nurse? A. Ask the mother to bring the records to the 18-month health supervision visit. B. Start the "catch-up" schedule because there are no immunization records. C. Keep the child at the facility while the mother returns home for the records. D. Call the local health department and verify the child's immunization status.

D. Call the local health department and verify the child's immunization status. Rationale: Contacting the agency provides several benefits. It allows the nurse's facility to have a copy of the child's immunization record for the permanent records. It also avoids repeating vaccinations unnecessarily. Answer "A" is incorrect because accepting the mother's recollection of the infant's immunization status puts the infant at risk of not being fully immunized. This would be a "missed opportunity" by the nurse to provide needed vaccinations. The scenario may also be repeated at the 18-month well-child visit if the mother again forgets the record. Answer "B" is inappropriate because contacting the other facility is an option. Needlessly immunizing the infant increases risk to the child and wastes health care resources. Answer "C" is inappropriate because the child would be very anxious while the mother was gone.

The nurse is performing a physical assessment of a 16-year-old girl. Which of the following is a recommended guideline for interviewing a child at this developmental stage? A. During the interview ask the caregiver to answer any questions the teen is too embarrassed to answer B. Keep up a running dialogue with the caregiver, explaining each step as it is performed C. Perform the genital exam first, and then use a head-to-toe approach to examine other systems D. Explain to the caregiver that the teen needs privacy and ask him or her to wait outside the room

D. Explain to the caregiver that the teen needs privacy and ask the caregiver to wait outside the room during the physical examination. Rationale: The nurse performing a physical examination of the older teenager should ask the caregiver to wait outside to provide privacy for the teen. The nurse should explain confidentiality to the teen and caregiver and interview each together and separately. The nurse should also use a head-to-toe approach with the genital exam performed last.

Is the following statement true or false? The nurse is correct in assuming that children's fears are similar to adult fears of the unknown.

True. Children's fears are similar to adult fears of the unknown Rationale: Normal fears of childhood include the fear of separation from their parents and family or guardians, loss of control, and bodily injury, mutilation, or harm. Children's fears are similar to adult fears of the unknown, including fear of unfamiliar environments and losing control.

The nurse is assessing the cognitive development of an adolescent. Which of the following statements accurately represents a normal finding at this stage? A. The adolescent progresses from an abstract to a concrete framework of thinking B. The adolescent develops the ability to think outside the present C. All adolescents achieve formal operational reasoning at the same time D. Adolescent thinking starts out very introspective and then becomes egocentric

B. The adolescent develops the ability to think outside the present. Rationale: According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one. During this period, the adolescent develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. Not all adolescents achieve formal operational reasoning at the same time. Adolescent thinking starts out egocentric and then becomes very introspective and idealistic.

In an effort to control health care costs, what is the best recommendation by the nurse? A. "Shop around to find the most inexpensive health insurance plan." B. "Find a job that provides family health insurance at a minimal cost." C. "Stress primary prevention, using the health care system for check-ups." D. "Avoid seeing a health care provider until your child becomes ill."

C. "Stress primary prevention, using the health care system for check-ups."

During the health interview, the mother of a 4-month-old says, "I'm not sure my baby is doing what he should be." What is the nurse's best response? A. "I'll be able to tell you more after I do his physical." B. "Fill out this developmental screening questionnaire and then I can let you know." C. "Tell me more about your concerns." D. "All mothers worry about their babies. I'm sure he's doing well."

C. "Tell me more about your concerns." Rationale: An underlying tenet of the medical home is the partnership between the family and the nurse. The mother has intimate knowledge of the infant and can provide invaluable information. Her concerns provide the structure for the nurse's assessment. Answer "A" cuts the health interview short and dismisses any contributions the mother can make. Answer "B" is incorrect because a screening questionnaire is no substitute for a developmental assessment. Answer "D" cuts off the communication between the mother and the nurse.

Is the following statement true or false? The nurse is eliciting a health history from an adolescent. It is recommended that the nurse acts like the teenager's peer in order to gain respect and acceptance.

False. It is not recommended that the nurse acts like the teenager's peer in order to gain respect and acceptance. Rationale: The nurse should remain in the role of the health care provider while demonstrating respect and acceptance toward the teen. The nurse should also clarify the meaning of jargon or slang that the teen uses, but not use these words in the interview; the teen will simply not accept the nurse as a peer.

Is the following statement true or false? The nurse observes that a hospitalized 5-year-old child shows signs of distress when her mother leaves to get a cup of coffee. This child is experiencing the condition known as regression.

False. The child showing signs of distress when her mother leaves to get a cup of coffee is experiencing the condition known as separation anxiety. Rationale: Separation of children from their homes, families, friends, and what is familiar to them may result in separation anxiety. Regression refers to a return to a previous stage of development due to anxiety.

Is the following statement true or false? The nurse providing pediatric health supervision should focus on the illness of children.

False. The nurse providing pediatric health supervision should focus on the wellness of children. Rationale: The health supervision visit provides an opportunity to maximize health promotion for the child, family, and community and nurses have the ability to promote optimal health during these encounters. Health supervision visits should be viewed as part of a continuum of care, not as the accomplishment of isolated tasks.

Is the following statement true or false? The nurse researcher would measure the number of cases of asthma in children in an inner-city population to determine mortality.

False. The nurse researcher would measure the number of cases of asthma in children in an inner-city population to determine morbidity. Rationale: The nurse would measure mortality by researching the number of individuals who died over a specific period.

Tell whether the following statement is true or false. The nurse is counseling parents of a 5-year-old who are concerned that their child is masturbating. The recommended intervention for this situation is to advise parents to discourage their child from this practice using firm discipline.

False. The recommended intervention for a 5-year-old child who is masturbating is to treat it in a matter-of-fact way, making sure the child knows nudity and masturbation are not acceptable in public. Rationale: If parents overreact to this behavior, it may occur more frequently. The child should also be taught that no other person can touch his or her private parts.

Is the following statement true or false? The school-age child's peer group values usually dominate when parental and peer group values come into conflict.

False. The school-age child's family values usually dominate when parental and peer group values come into conflict. Rationale: Although the peer group is influential, the family's values usually predominate when parental and peer group values come into conflict. Even though the school-age child may question the parents' values, the child will usually incorporate the values from parents into his or her values.