PEDS Week 1 - Book/Online

4. Which of the following 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.

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. (CH 15 pg 575)

7 .Which of the following should the nurse include when giving parents guidelines about helping their children in school? A. Punish children who fail to perform adequately. B. Help children as much as possible with their homework. C. Communicate with teachers if there appears to be a problem. D. Accept responsibility for children's successes and failures.

C Communication between the parent and teachers is essential. It demonstrates that parents consider school important and that education is a shared responsibility. Excessive pressure or lack of encouragement from parents can inhibit the development of the child's maximum potential. Children need to be responsible for their schoolwork. By being responsible, children learn to meet deadlines and be successful. (CH 15 pg 585)

10. A significant common side effect that occurs with opioid administration is A. euphoria. B. diuresis. C. constipation. D. allergic reactions.

C Constipation is one of the most common side effects of opioid administration. Preventive strategies should be implemented to minimize this problem. Sedation is a more common result than euphoria. Urinary retention, not diuresis, may occur with opiates. Rarely, some individuals may have pruritus.(CH 5 pg 179)

12. The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. Which of the following should the nurse suggest to help them deal with this problem? A. Let her cry herself back to sleep. B. Put her in parents' bed to cuddle. C. Start putting her to bed while still awake and while the parent is present. D. Give her a bottle of formula instead of breastfeeding her so often at night.

C Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Co-bedding could be unsafe at this age. The type of feeding will not affect the child's sleep pattern. (CH 10 pg 441)

9. The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. Which of the following is an important consideration in managing the child's pain? A. Give only an opioid analgesic at this time. B. Increase the dosage of analgesic until the child is adequately sedated. C. Plan a preventive schedule of pain medication around the clock. D. Give the child a clock and explain when she or he can have pain medications.

C For severe postoperative pain, a preventive around-the-clock schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present but is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Giving the child a clock and explaining when she or he can have pain medications is counterproductive. It focuses the child's attention on how long he or she will need to wait for pain relief.(CH 5 pg 176)

3. Maria is a Spanish-speaking 5-year-old girl who has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. What is the best explanation for this behavior? A. She lacks adequate maturity for attending school. B. She lacks the knowledge needed in school. C. She is experiencing cultural shock. D. She is experiencing minority group discrimination.

C Homeless individuals lack the resources and community ties necessary to provide for their own adequate shelter. One of the most pressing problems in the United States is the rapidly increasing number of homeless families, which currently account for 50% of the nation's homeless. "Runaway" or throwaway adolescents are often victims of physical and social abuse. Although it is a significant issue, these adolescents do not represent the fastest-growing segment of the homeless population. Migrant farm workers are some of the most severely disadvantaged in the United States. They have a mobile existence that is detrimental for children. They do not constitute the fastest-growing segment of the homeless population. Individuals with mental disorders may be homeless. They do not constitute the fastest-growing segment of the homeless population.(CH 2 pg 23)

3. What are some legal and ethical issues that arise for the nurse when using an interpreter? A. Direct the questions to the interpreter. B. Ask several questions at a time. C. The family should be fully informed of all aspects of procedures before consenting. D. Discourage the interpreter and client from discussing topics not included in the interview.

C In obtaining informed consent through an interpreter, the nurse should fully inform the family of all aspects of the particular procedure to which they are consenting. The communication is with the family members. The nurse directs the questions toward the family while observing nonverbal cues. Questions are asked one at a time to allow the interpreter and family to translate, process, and answer the question. The interpreter and client should build a rapport. Discussion of topics outside of the interview allows the two parties to become acquainted.(pg 94)

4. The nurse is assessing a 6-month-old infant who has head lag. The nurse should recognize which of the following? A. This is normal. B. The child is probably cognitively impaired. C. Developmental-neurologic evaluation is needed. D. The parent needs to work with the infant to stop head lag

C Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months, head control should be well established. Developmental-neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified. (CH 10 pg 418)

3. What is the leading cause of death from unintentional injuries in children? A. Poisoning B. Drowning C. Motor vehicles D. Fires and burns

C Motor vehicle-related injuries are responsible for more than half of the injury-related deaths in children. Half of all poisonings occur in children younger than the age of 4 years, and it is the third leading cause of injury in those 15 to 24 years of age. Drowning and burns are among the top three causes of death for boys and girls throughout childhood.(CH 1pg 3)

5. A group of boys ages 9 and 10 have formed a "boys only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as which of the following? A. Behavior that encourages bullying and sexism B. Behavior that reinforces poor peer relationships C. Characteristic of social development of this age D. Characteristic of children who are later at risk for membership in gangs

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. Forming a boys-only club at this age does not have a direct correlation with later gang activity. (CH 15 pg 576)

3. Imaginary playmates are beneficial to the preschool child because they do which of the following? 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.

C One purpose of an imaginary friend is to be a friend in times 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. (CH 13 pg 531)

2. Which of the following is most likely to encourage parents to talk about their feelings related to their child's illness? A. Be sympathetic. B. Ask direct questions. C. Use open-ended questions. D. Avoid periods of silence.

C Open-ended questions require the parent to answer with more than a brief answer. Closed-ended questions should be avoided when attempting to elicit parents' feelings. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, they may be considered threatening by the parent. Silence can be an effective interviewing tool. It allows a sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.(CH 4 pg 93)

7. A 5-year-old has patient-controlled analgesia (PCA) for pain management after abdominal surgery. Your explanation to the parents should include A. the child will be pain free. B. only the child is allowed to push the button for a bolus. C. the pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. D. there is a high risk of overdose, so monitoring is done every 15 minutes.

C The PCA prescription can be set for a basal rate for a continued infusion of pain medication to prevent pain from returning during sleep and when the patient cannot control the infusion. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a child who is 5 years old, the parents and nurse must assess the child to ensure that adequate medication is being given. A child who is 5 years old may not be able to understand the concept of pushing a button. Evidence suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.(CH 5 pg 176)

3. Which of the following self-report pain rating scales can be used in children as young as 3 years of age? A. Poker Chip Tool B. Visual Analog Scale C. FACES Pain Rating Scale D. Word-Graphic Rating Scale

C The Poker Chip Tool has been validated for children 4 years of age who have been determined to have the cognitive ability to identify the larger of two numbers. The Visual Analog Scale can be used for children older than 4 years of age but is most appropriate for ages 7 and older. The FACES Pain Rating Scale is for children as young as 3 years of age. The Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age.(pg 155)

4. In 1935 Title V of the Social Security Act was passed. This was significant in the evolution of child health care in the United States because it established what? A. Medicaid B. Children's Bureau C. Child Welfare Services D. White House Conferences on Children

C This legislation provided for federal grants to be given to states for three major programs, Maternal Child Health, Crippled Children's Services, and Child Welfare Services. Medicaid was created in 1965 to reduce financial barriers to health care for poor individuals. The Children's Bureau was established in 1912 and was placed under the Department of Health, Education and Welfare. The White House Converences on Children was first convened in 1909. (CH 1 pg 9)

2. The school nurse is discussing testicular self-examination with adolescent male students. Why is this important? A. Epididymitis is common during adolescence. B. Asymptomatic sexually transmitted infections may be present. C. Testicular tumors during adolescence are generally malignant. D. Testicular tumors, although usually benign, are common during adolescence.

C Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation. Epididymitis is not common in adolescence. Asymptomatic sexually transmitted infections would not be evident during testicular self-examination. The focus of this examination is on testicular cancer. Testicular tumors are most commonly malignant.(CH 17 pg 652)

9. The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse's suggestions regarding participation in sports at this age should include which of the following? A. Organized sports such as soccer are not appropriate at this age. B. Competition is detrimental to the establishment of a positive self-image. C. Sports participation is encouraged if the type of sport is appropriate to the child's abilities. D. Girls should compete only against girls because at this age boys are larger and have more muscle mass.

C Virtually every child is suited for some type of sport. Participation should be encouraged if the chosen sport and level are appropriate for the child's abilities and her physical and emotional make-up. Organized sports can be very beneficial for this age-group. School-age children enjoy competition. With appropriate guidance, children can be taught the proper techniques and safety measures to avoid injuries. Before puberty, there is no essential difference in strength and size between boys and girls. (CH 15 pg 595)

1. Which of the following statements is true concerning the increased use of telephone triage by nurses? A. Health care costs have increased as a result. B. Emergency department visits are not recommended. C. Access to high-quality health care services has increased. D. Home care is recommended when it is not appropriate.

C With well-designed telephone triage programs, access to high-quality health care services and patient satisfaction have increased. With the reduction in unnecessary emergency department and clinic visits, health care costs have decreased. Emergency department visits are recommended based on the response to screening questions and when the child's condition is in doubt. Guidelines are given for home management if the triage assessment indicates that level of care. Parents are given instructions about changes in the child's condition to report.(CH 4 pg 92)

8. Which of the following approaches is the most appropriate when performing a physical assessment on a toddler? A. Demonstrate use of equipment. B. Perform traumatic procedures first. C. Use minimum physical contact initially. D. Always proceed in a head-to-toe direction.

C Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimum physical contact initially to gain the cooperation of the child. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children.(CH 4 pg 112)

4. When preparing parents to teach their children about human sexuality, the nurse should emphasize which of the following? A. Parents should determine exactly what the child knows and wants to know before answering a question about sex. B. A parent's words may have a greater influence on the child's understanding than the parent's actions. C. Parents should avoid using correct anatomic terms because they are confusing to preschoolers. D. Parents should allow children to satisfy their sexual curiosity by "playing doctor."

A. Parents should be told that there are two rules that should be followed: find out what the child knows and be honest. Parents should model sexual behavior that is consistent with what they are teaching their children. Anatomic terms, although sometimes difficult to pronounce, will lay the groundwork for honest discussions later. Parents should not condone or condemn "playing doctor," which is an extension of curiosity. (CH 13 pg 534)

1. The typical play activity in which toddlers engage is called: A. Solitary B. Parallel C. Associative D. Cooperative

B

2. Pain scales for infants and their uses include but are not limited to: A. CRIES: Crying, Requiring increased oxygen, Inability to console, Expression, and Sleeplessness B. FLACC: child's face, legs, activity, cry, and consolability C. NCCPC: parent and health care giver questionnaire assessing acute and chronic pain D. NPASS: neonatal pain, agitation, and sedation scale for infants from 3 to 6 months

B

2. When her preschool son is in the hospital, the parent tells the nurse, "I think there is something wrong with him because he is so skinny." The most appropriate answer by the nurse is: A. Most preschoolers weigh between 10 and 14 kilograms. B. The legs of a preschooler, rather than the trunk, increase in length, which may make him look slimmer. C. Preschoolers usually keep that pot-bellied appearance until about 4 years old. D. Most preschoolers gain 2 to 3 pounds per year.

B

3. As the nurse is getting Nathan ready for surgery, his doctor asked you to explain preemptive analgesic to Nathan's mother. Which response leads you to believe his mother needs more teaching? A. "I understand that preemptive analgesia is giving Nathan pain medication before he has pain and could be given before surgery." B. "This medication will control Nathan's pain so he doesn't feel anything." C. "Giving this medicine early may help prevent complications after surgery." D. "By controlling Nathan's pain, he will be more comfortable and may be able to go home sooner."

B

3. Characteristics of bullying include: A. Unintentional harm inflicted upon another person that is part of the socialization process in childhood B. The infliction of repetitive physical, verbal, or emotional abuse upon another person with intent to harm C. An attempt to gain acceptance and be liked by same-sex peers D. An early sign of a severely disturbed personality disorder that escalates in adulthood

B

4. One of the concerns of the preschool period is adequate nutrition. What can the nurse say to give anticipatory guidance to parents? A. Preschoolers are growing during this period and need to increase their caloric intake to 110 kcal/kg, for an average daily intake of 2200 calories. B. There is some evidence that children self-regulate their caloric intake. If they eat less at one meal, they compensate at another meal or snack. C. To monitor fat intake, dairy and meat should be limited to twice a day. D. For children who do not like milk, consumption of fruit juices is a healthy alternative.

B

4. The overriding goal of atraumatic care is: A. Prevent or minimize the child's separation from the family B. Do no harm C. Promote a sense of control D. Prevent or minimize bodily injury and pain

B

6. One of the primary reasons for monitoring the toddler's activities and intervening to prevent accidental injury is that: A. Toddlers have oppositional defiant behavior and negativism B. Toddlers do not understand the concept of "cause and effect," so explaining that certain actions will result in serious injury is useless C. Toddlers will often listen to reasoning about why an activity should be avoided D. Toddlers enjoy making their parents worry about their safety and like to see the parents' reactions to the behavior

B

5. When the nurse interviews an adolescent, which of the following is especially important? A. Focus the discussion on the peer group. B. Display a genuine interest in the adolescent. C. Emphasize that confidentiality will always be maintained. D. Use the same type of language as the adolescent.

B Adolescents accept anyone who shows a genuine interest in them. Although peers are important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.(pg 97)

5. In planning sex education and contraceptive teaching for adolescents, the nurse should consider which of the following? A. Both sexual activity and contraception require planning. B. Teenagers frequently lack a fundamental understanding of fertility. C. Most teenagers today are knowledgeable about reproductive anatomy and physiology. D. Most teenagers who become pregnant do so as an act of hostility, especially toward their parents.

B Adolescents may not have sufficient knowledge of reproductive anatomy and physiology. This can lead to misunderstanding about when pregnancy can occur and proper usage of contraceptives. Teenagers may avoid having contraceptives available because it removes the spontaneity of the sexual act. Although adolescents may be aware of their own sexuality, they often lack correct information about reproductive physiology. Some teenagers may become pregnant to be seen as adults.(CH 17pg 676)

11. Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? A. 1 month B. 3 to 4 months C. 6 to 8 months D. 12 months

B Binocularity is usually achieved by age 3 to 4 months. One month is too young for binocularity. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus.(CH 4 pp 127-128)

1. The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse should expect the infant to now weigh approximately how many kilograms? A. 5.2 B. 6.3 C. 8.7 D. 9.6

B Birth weight doubles at about ages 5 to 6 months. At 6 months, a child who weighed 3.2 kg at birth would weigh approximately 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth weight by 6 months; 8.7 kg to 9.6 kg is too much.(CH 10 pg 413)

8. Sleep problems in school-age children are often demonstrated by A. night terrors that awaken them. B. delaying tactics because they do not wish to go to bed. C. somatic illness that awakens them. D. increasing need for sleep time as they get older.

B Children in middle childhood must be reminded to go to sleep. Older children up to age 11 years are particularly resistant, and they may demonstrate delaying tactics because they do not wish to go to bed. Night terrors are common in the preschool-age child. If somatic illness is present, a thorough assessment is indicated. The amount of sleep needed decreases as children get older. (CH 15 pg 593)

8. Sara, age 4 months, 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 full term. The nurse should explain that A. infants tend to become more difficult over time. B. infants become less difficult if they are kept on scheduled feedings and structured routines. C. Sara's behavior is suggestive of failure to completely bond with her parents. D. Sara's difficult temperament is the result of painful experiences in the neonatal period.

B Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. 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. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament. (CH 10 pg 429)

1. When teaching the adolescent about the management of acne, the nurse should include which of the following interventions? A. Clean face with an antibacterial soap twice a day. B. Clean face gently with a mild soap once or twice a day. C. Avoid foods with a high fat content such as French fries and chocolate. D. Express comedones by gentle squeezing them followed by cleansing with alcohol.

B Cleansing the face with mild soap and water will remove surface dirt and oil. Antibacterial soaps may be too drying when used in combination with topical medications. No relationship has been established between food intake and acne. Squeezing can break down the ductal walls of the lesions and cause the acne to worsen.(pg 669)

6. Which of the following behaviors indicates that an infant has developed object permanence? A. Secures objects by pulling on a string B. Actively searches for a hidden object C. Recognizes familiar face, such as mother D. Recognizes familiar object, such as bottle

B 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. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. 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.(CH 10 pg 422)

6. Recommendations for parents of toddlers to meet fluoride requirements include all of the following except A. supervise the use of toothpaste. B. supervise the use of fluoride rinses. C. store fluoride products out of reach. D. administer fluoride supplements if water fluoride content is low.

B Fluoride rinses are only suggested for children at high risk for cavities or over the age of 6 years. Toothpaste supervision, storage of fluoride products out of reach, and administration of fluoride supplements if water fluoride content is low are all recommended for toddlers. (CH 12 pg 510)

13. Which of the following vaccines is recommended for administration at birth? A. MMR (measles, mumps, and rubella) B. Hepatitis B C. Hepatitis A D. Haemophilus influenzae type b (Hib)

B Hepatitis B immunization is recommended early. Hepatitis B virus infections that occur during childhood can lead to fatal consequences from cirrhosis or liver cancer during adulthood. MMR is recommended for children ages 12 to 15 months. The hepatitis A series should begin between 12 and 23 months. Hib is administered beginning at age 2 months. (CH 10 pg 413)

2. Which of the following is descriptive of a preschooler's concept of time? A. Has no understanding of time B. Associates time with events C. Can tell time on a clock D. Uses terms such as "yesterday" appropriately

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. (CH 13 pg 526)

1. Which of the following statements accurately describes physical development during the school-age years? A. The child's weight almost triples. B. The child grows an average of 5 cm (2 inches) per year. C. Few physical differences are apparent among children of different genders at the end of middle childhood. D. Fat gradually increases, which contributes to the child's heavier appearance.

B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 5 cm (2 inches) per year. In middle childhood, children's weight will almost double; they gain 3 kg (6.6 lb) per 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. (CH 15 pg 561)

11. What information should the nurse give a mother regarding the introduction of solid foods during infancy? A. Fruits and vegetables should be introduced into the diet first. B. Foods should be introduced one at a time at intervals of 5 to 7 days. C. Solid foods can be mixed in a bottle to make the transition easier for the infant. D. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.

B One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant's diet. Mixing solid foods in a bottle has no effect on the transition to solid food. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months. (CH 10 pg 438)

8. A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that to achieve equianalgesia (equal analgesic effect), the oral dose will be which of the following? A. Same as the intravenous dose B. Greater than the intravenous dose C. One half of the intravenous dose D. One fourth of the intravenous dose

B Oral morphine undergoes significant metabolism from the first-pass effect. For this reason, a higher oral dose is necessary to achieve the same effect as parenteral morphine. The same dose given orally will provide less pain relief. A dose larger than the intravenous dose must be given to achieve an equianalgesic effect.(CH 5 pg 187)

3. Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. Which of the following 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.

B Play develops from the solitary play of infancy to the parallel play of toddlers. A toddler plays alongside other children, not with them. When a child grabs a toy from another child, it is typical behavior of the toddler and is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because a 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. (CH 12 pg 493)

4. An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is which of the following? A. Notify her parents. B. Refer her for prenatal care. C. Explain the importance of not smoking. D. Discuss dietary needs for adequate fetal growth.

B Teenage girls and their unborn children are at greater risk for complications during pregnancy and delivery compared with older women. With improved therapies, the mortality rate for teenage pregnancy is decreasing, but the morbidity is high. A pregnant teenager needs careful assessment by the nurse to determine the level of social support available to her and possibly her partner. Guidance from the adults in her life would be invaluable, and the nurse should support the adolescent as she informs her parents. Although explaining the importance of not smoking and discussing the dietary needs for adequate fetal growth are important, because of the adolescent's potential for having a high-risk pregnancy, she will need a comprehensive prenatal program to minimize maternal and fetal complications.(CH 17 pg 676)

9. The nurse is assessing a 3-year-old African American child who is being seen in the clinic for the first time. The child's height and weight are at the 20th percentile on the commonly used growth chart from the National Center for Health Statistics (NCHS). When interpreting these data, the nurse should recognize which of the following? A. The data suggest the child requires nutritional intervention. B. The NCHS charts are accurate for U.S. African American children. C. A correction factor is used when the NCHS chart is used for nonwhite ethnic groups. D. No assessment can be made until several measurements are plotted over time.

B The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American children were included in the sample population. The 20th percentile for height and weight are not indicative of nutritional failure. No correction factor exists. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. Serial measurements are useful for longitudinal assessment of the child; single data points provide information about the child's current status.(CH 4 pg 110)

13. Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose test." The nurse is testing for which of the following? A. Deep tendon reflexes B. Cerebellar function C. Sensory discrimination D. Ability to follow directions

B The finger-to-nose test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although performing this test can demonstrate the child's ability to follow directions, it is used primarily for cerebellar function.(CH 4 pg 146)

6. The nurse is taking a health history on a child. At the beginning of the interview, a parent says, "I brought him here because he always has diarrhea." This should be recorded under which of the following headings? A. History B. Chief complaint C. Review of systems D. Nutritional assessment

B The mother has verbalized the specific reason for the child's visit to the health care provider. The chief complaint is the reason for which the child has been brought to the clinic, office, or hospital. History refers to information that relates to previous aspects of the child's health, not the current health. The review of systems is a specific review of each body system. It usually begins with a statement similar to asking the parent to describe how the child's general health has been. A nutritional assessment combines a nutrition history with a physical examination. (CH 4 pg 99)

2. Which of the following reflexes appear at about 7 to 9 months of age? A. Moro B. Parachute C. Neck righting D. Labyrinth righting

B The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months.(CH 10 pg 414)

1. A hallmark of cognitive development in the school-age child is in what Piaget describes as concrete operations. In this stage the child: A. Uses thought processes to experience events and actions B. Is unable to see things from another's point of view C. Has a limited perspective of how others' interpretations of a given event differ D. Makes judgments based on what he or she sees

A

2. A nurse looks over her assignment for the day that includes an infant, a preschool-age child, a third-grader, and a sophomore in high school. Which techniques take into consideration developmental stages when working with pediatric patients? A. Being aware that infants will become agitated due to stranger anxiety around age 4 months B. When a preschooler is getting blood drawn, giving a detailed explanation will be helpful C. Explaining and demonstrating what the blood pressure machine does to the third-grader before taking her blood pressure D. Using a single consistent approach with the adolescent will help allay anger and hostility

A

2. One indication that the toddler is ready to begin toilet training is: A. Child recognizes urge to let go and hold on and is able to communicate this sensation to the parent B. Child is able to stay dry all night C. Child demonstrates mastery of dressing and undresssing self D. Child asks parent to have wet or soiled diaper changed

A

3. The newest nurse on the Pediatric unit is concerned about maintaining a professional distance in her relationship with a patient and the patient's family. Which comment indicates that she needs more mentoring regarding her patient-nurse relationship? A. "I realize that caring for the child means I can visit them on my days off if they ask me." B. "When the mother asks if I will care for her daughter every day, I explain that the assignments change based on the needs of the unit." C. "When the mother asks me questions about my family, I answer politely, but I offer only pertinent information." D. "I engage in multidisciplinary rounds and listen to the family's concerns."

A

4. When assessing blood pressure in a child: A. Knowledge of normal mean is important: newborn, 65/41; 1 month to 2 years, 95/58; and 2 to 5 years, 101/57 B. Cuff size is the most important variable and should be measured using limb length C. The child is considered normotensive if the blood pressure is below the 95th percentile D. Check upper- and lower-extremity blood pressure to look for abnormalities such as aortic stenosis, which causes lower-extremity blood pressure to be higher than upper

A

5. A common cause of accidental death in children aged 1 to 19 years involves motor vehicle crashes. Evidence from test crashes indicates that the safest action to prevent accidental deaths in toddlers includes: A. Placing the child in a rear-facing weight-appropriate car restraint seat until age 24 months B. Allowing the child to ride in the front seat with a lap-shoulder seat restraint to avoid emotional outbursts C. Allowing the child to ride in a forward-facing booster restraint seat after 12 months of age D. Placing the child in the regular seat using the lap-shoulder belt as long as the child weighs at least 45 pounds

A

5. One of the key factors in addressing the health concerns and needs of the adolescent in a clinic or primary care office setting is to: A. Provide confidentiality B. Include the parent(s) in a discussion about the adolescent's sexual health C. Ask the adolescent if she or he is sexually active D. Discuss the negative effects of tobacco use

A

5. School-age children are prone to accidental injury primarily because of: A. Peer pressure and risk-taking behaviors B. Physical awkwardness and clumsiness C. Parents' lack of supervision D. Attempts to impress members of the opposite sex

A

5. The type of play in which infants engage is called: A. Solitary B. Parallel C. Associative D. Cooperative

A

14. The clinic is loaning a federally approved car seat to a 10-lb (4.5-kg) infant's family. The nurse should explain that the safest place to put the car seat is in the A. back seat facing forward. B. middle of the back seat facing rearward. C. front seat with airbags on passenger side. D. front seat if there is no air bag on the passenger side

B The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck in the event of an accident. The middle of the back seat is the safest position for the child. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat. (CH 10 pg 448)

5. Preschoolers' fears can best be dealt with by which of the following interventions? 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

A Actively involving preschoolers in finding methods to deal with frightening experiences 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. (CH 13 pg 537)

5. Which statement characterizes toddlers' eating behavior? A. Food fads are common. B. They have increased appetite. C. They have few food preferences. D. Their table manners are predictable.

A Appetite and food preferences are sporadic during the toddler years. The child may enjoy the same food several days in a row and then refuse to eat it. It is difficult to change the food fad. At approximately 18 months of age, toddlers have decreased nutritional needs. This is labeled physiologic anorexia. Toddlers have distinct food preferences that may not be consistent or predictable. At the toddler age, sitting at a table for a meal may be more disruptive than functional. (CH 12 pg 505)

1. Which of the following terms best describes a group of people who share a set of values, beliefs, practices, social relationships, laws, politics, economics, and norms of behavior? A. Race B. Culture C. Ethnicity D. Social group

B Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames the outlook and decisions of a group of people. Race is defined as a division of humankind possessing traits that are genetically transmissible. Ethnicity is the affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of a system of roles carried out in both primary and secondary groups. Socialization is the process by which individuals learn the roles that are expected of them.(CH 2 pg 39)

2. Which of the following is descriptive of toddlers' cognitive development at age 20 months? A. Realize that "out of sight" is not out of reach. B. Search for an object only if they see it hidden. C. Put objects into a container but cannot take them out. D. Understand the passage of time, such as "just a minute" and "in an hour."

A At this age, children are in the final sensorimotor stage. They 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 is able to put objects into a container but cannot take them out, this is indicative of tertiary circular reactions, which appear between the ages of 13 and 18 months. An embryonic sense of time exists; although children may behave appropriately to time-oriented phrases, their sense of timing is exaggerated. (CH 12 pg 492)

6. Bullying can be common during the school-age years. The nurse should recognize that 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 teased.

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. (CH 15 pg 577)

5. According to Erikson, infancy is concerned with acquiring a sense of which of the following? A. Trust B. Industry C. Initiative D. Autonomy

A During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years. (CH 10 pg 420)

9. The nurse is guiding parents in selecting a daycare facility for their child. Which of the following is especially important to consider when making the selection? A. Health practices of the facility B. Structured learning environment C. Socioeconomic status of the children D. Cultural similarities of the children

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 consistently used. A structured learning environment is not the highest priority for a child this age. The socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility's health care practices are more important. (CH 10 pg 435)

2. Physiologic measurements in children's pain assessment are A. not useful as the sole indicator for pain. B. the best indicator of pain in children of all ages. C. of most value when children also report having pain. D. essential to determine whether a child is telling the truth about pain.

A Physiologic manifestations of pain may vary considerably, so they do not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. Physiologic measurements are of limited value and must be viewed in the context of a pain rating scale, behavioral assessment, and parental report. When the child reports pain on an appropriate pain scale, the appropriate interventions should be used.(CH 5 pg 158)

5. What nursing intervention is most descriptive of atraumatic care of children? A. Preparing a child before any unfamiliar treatment or procedure B. Preparing a child for separation from parents during hospitalization C. Helping a child accept pain that is associated with a treatment or procedure D. Helping a child accept the loss of control associated with hospitalization

A Proper preparation of a child before any unfamiliar procedure is an essential component of atraumatic care. A major principle of atraumatic care is to minimize the separation from parents. Interventions are used to reduce and eliminate bodily injury and pain whenever possible. Children should be allowed choices and control whenever possible. (CH 1pg 8)

3. In terms of fine motor development, what should an infant of 7 months be able to do? A. Transfer objects from one hand to the other. B. Use the thumb and index finger in crude pincer grasp. C. Hold a crayon and make a mark on paper. D. Release cubes into a cup.

A The ability to transfer objects from one hand to another occurs at about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.(CH10 pg 417)

4. Which one of the following approaches would be best to use to ensure a receptive response from a toddler? A. Focus communication on the child and tell him or her how a procedure will feel. B. Call the toddler's name while picking up him or her. C. Call the toddler's name and say, "I am your nurse." D. Stand by the toddler, addressing him or her by name.

A Toddlers see things only in relation to themselves and from their point of view. A stranger picking up a child up in an unfamiliar environment is very frightening for the toddler. Toddlers will not know the meaning of "nurse." Unknown adults who call the toddler by name can frighten the child.(CH 4 pg 98)

6. The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests they consider administering a placebo instead of the usual pain medication. The decision should be based on knowledge of which of the following? A. This practice is unjustified and unethical. B. This practice is effective to determine whether a child's pain is real. C. The absence of a response to a placebo means the child's pain has an organic basis. D. A positive response to a placebo will not occur if the child's pain has an organic basis.

A Use of placebos without the patient's consent is unethical. Use of placebos does not provide information about the presence or severity of the pain. Individuals may have a positive response to a placebo despite a significant organic cause for their pain.(CH 5 pg 175)

2. Currently, the fastest-growing segment of the homeless population in the United States consists of which of the following? A. Families B. "Runaway" adolescents C. Migrant farm workers D. Individuals with mental disorders

A Homeless individuals lack the resources and community ties necessary to provide for their own adequate shelter. One of the most pressing problems in the United States is the rapidly increasing number of homeless families, which currently account for 50% of the nation's homeless. "Runaway" or throwaway adolescents are often victims of physical and social abuse. Although it is a significant issue, these adolescents do not represent the fastest-growing segment of the homeless population. Migrant farm workers are some of the most severely disadvantaged in the United States. They have a mobile existence that is detrimental for children. They do not constitute the fastest-growing segment of the homeless population. Individuals with mental disorders may be homeless. They do not constitute the fastest-growing segment of the homeless population.(CH 2 pg 35)

4. The father of a hospitalized child tells the nurse, "He can't have meat. We are Buddhist and vegetarians." What is the nurse's best intervention? A. Order the child a meatless tray as requested. B. Ask a Buddhist priest to visit the family. C. Explain that hospital patients are exempt from dietary rules. D. Help the parent understand that meat provides protein needed for healing.

A It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consult to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. It is not necessary to ask a Buddhist priest to visit. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided. (CH 2 pg 36)

14. The nurse is beginning to administer the Denver II to a small child when his mother asks, "Can you tell me again what this Denver II is?" The nurse's best response is which of the following? A. "It's a simple intelligence test for young children." B. "It tells us what a child can do at a particular age." C. "It's a test we give to measure a child's development." D. "It's an excellent way to see if a child's development is normal."

B The Denver II is a developmental screening tool that assesses the child's abilities at different ages. The Denver II is a screening tool for developmental milestones, not intelligence. Children are not expected to perform each item on the Denver II. Most children will perform tasks in a range. The Denver II is used to provide an indication of the child's developmental level.(CH 4 pg 148)

10. When taking a child's blood pressure, the nurse should select a cuff with a bladder width that is large enough to cover what percentage of the upper arm? A. 20% B. 40% C. 60% D. 80%

B The width of the cuff bladder ideally covers 40% of the arm circumference at the midpoint of the upper arm. Twenty percent is too small and may give falsely elevated blood pressure values. Sixty percent and 80% are too large and may give falsely low blood pressure values.(CH 4 pg 121)

4. Nonpharmacologic strategies for pain management A. may reduce pain perception. B. make pharmacologic strategies unnecessary. C. usually take too long to implement. D. trick children into believing they do not have pain.

A Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. It is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the nonpharmacologic techniques may mitigate the child's experience with mild pain, but the child will still know the discomfort was present.(CH 5 pg 163)

2. Which of the following immunization booster vaccines should be considered for a 13-year-old adolescent who has completed all recommended routine childhood vaccinations? Select all that apply. A. DTaP vaccine B. Tdap vaccine C. Meningococcal vaccine D. Pneumococcal vaccine E. Hepatitis B vaccine F. Hib vaccine

B, C

1. While interviewing parents who have just arrived in the health care clinic, the nurse begins the interview. Which statement below involves therapeutic communication techniques? Select all that apply. A. Allowing the parents to direct the conversation so they feel comfortable and in control B. Using broad, open-ended questions so that parents can feel open to discuss issues C. Redirecting by asking guided questions to keep the parents on task D. Careful listening, which relies on the use of clues and verbal leads to help move the conversation along E. Asking carefully worded, detailed questions to get accurate information

B, C, D

4. According to Jean Piaget, adolescent cognitive development is represented by the stage of formal operational thought that includes which of the following? Select all that apply. A. Believing that thoughts are all-powerful B. Thinking in abstract terms C. Thinking about hypotheses D. Using a future time perspective E. Thinking in the here and now

B, C, D

4. When teaching a 6-year-old child with sickle cell disease and his family about pain management, which of the following should the nurse discuss? Select all that apply. A. When pain medications are used, all pain will be eliminated. B. Nonpharmacologic methods of pain relief including heat, massage, physical therapy, humor, and distraction. C. It is helpful to use a "passport card" that includes information about the diagnosis, any previous complications, and the pain regimen. D. Only the physician can decide the best course of treatment, and the other health care providers follow that plan. E. Long-term medication use considers many factors.

B, C, D

4. Culture includes which of the following? Select all that apply. A. Cultural competence, which includes building skills in the health care provider, such as offering lists of common foods, health care beliefs, and important rituals B. Cultural humility, which requires that health care providers participate in a continual process of self-reflection and self-critique C. Recognizing the power of the health care provider role that views the patient and family as full members of the health care team D. A particular group with its values, beliefs, norms, patterns, and practices that are learned, shared, and transmitted from one generation to another E. A complex whole in which each part is interrelated, including beliefs, tradition, lifeways, and heritage

B, C, D, E

1. Because injuries are the most common cause of death and disability in children in the United States, which stage of development correctly determines the type of injury that may occur? Select all that apply. A. A newborn may roll over and fall off an elevated surface. B. The need to conform and gain acceptance from his peers may make a child accept a dare. C. Toddlers who can run and climb may be susceptible to burns, falls, and collisions with objects. D. A preschooler may ride her two-wheel bike in a reckless manner. E. A crawling infant may aspirate due to the tendency to place objects in his mouth.

B, C, E

1. Duvall's Developmental Stages of the Family include which of the following? Select all that apply. A. Stages an individual progresses through in their moral and spiritual development B.Stages families progress through in adulthood C. Stages that designate how parenting progresses as a child develops D. Stages that designate appropriate discipline related to developmental stages E. Stages that describe the journey a couple will take as their children mature

B, C, E

2. The National Children's Study is the largest prospective, long-term study of children's health and development in the United States. Which of these options are the goals of this study? Select all that apply. A. Ensure that every child is immunized at the appropriate age. B. Provide information for families to eradicate unhealthy diets, dental caries, and childhood obesity. C. Enlist the help of school lunch programs to reach the goal of vegetables and fruits as 30% of each lunch. D. Significantly reduce violence, substance abuse, and mental health disorders among the nation's children. E. Decrease tardiness and truancy and increase the high school graduation rate in each state over the next 5 years.

B, D

4. A 4-month-old infant is brought to the well-child clinic for immunizations. The mother indicates that the infant often strains to have a bowel movement, so she has been giving him honey and has stopped feeding him iron-fortified formula, based on her sister's recommendations. The nurse recognizes that the infant is at risk for the development of which of the following? Select all that apply. A. Obesity B. Iron deficiency anemia C. Rickets D. Infant botulism E. Cow's milk allergy

B, D

5. How can the nurse prepare a child for a painful procedure? Select all that apply. A. Be honest and use correct terms so that the child trusts the nurse. B. Involve the child in the use of distraction, such as using bubbles, music, or playing a game. C. Kindly ask parents to leave the room so they don't have to watch the painful procedure. D. Use positive self-talk such as "When I go home, I will feel better and be able to see my friends." E. Use guided imagery that involves recalling a previous pleasurable event.

B, D, E

6. Which of the following is most suggestive that a nurse has a nontherapeutic relationship with a patient or family? A. Staff members are concerned about the nurse's actions with the patient or family. B. Staff assignments allow the nurse to care for the same patient or family over an extended time. C. The nurse uses teaching skills to instruct the patient or family rather than doing everything for them. D. The nurse is able to withdraw emotionally when emotional overload occurs but still remain committed.

A The concern of other staff members may indicate that the nurse is exhibiting negative behaviors and may be involved in a nontherapeutic relationship. Consistent staff assignments are important to provide continuity of care and contribute to therapeutic relationships. Using teaching skills to instruct the patient or family rather than doing everything for them empowers the family and facilitates their caring for the child. In therapeutic relationships, the nurse must recognize and maintain professional boundaries. The ability to recognize when these are being eroded is essential. (CH 1 pg 9)

7. Which of the following is descriptive of nursing diagnoses? A. They provide the basis for the selection of nursing interventions. B. They should describe everything for which nursing is responsible. C. The cause of the problem must be identified before a nursing diagnosis can be made. D. The cause of the problem implies a cause-and-effect relationship in the nursing diagnosis.

A The nursing diagnosis is the clinical judgment about the client's response to actual or potential health problems. The outcome statement guides the necessary interventions. Nursing diagnoses do not describe all areas of nursing practice. An actual problem may not exist. There may be risk factors that predispose a child or family to dysfunctional health patterns. There may not be a direct cause-and-effect relationship expressed in the diagnostic statement.(CH 1 pg 14)

5. Which of the following statements is true concerning folk remedies? A. They may be used to reinforce the treatment plan. B. They are incompatible with modern medical regimens. C. They are a leading cause of death in some cultural groups. D. They are not a part of the culture in large, developed countries.

A Whenever folk remedies are compatible, they should be used to reinforce the treatment plan. This will assist in establishing a caring environment. Depending on the folk remedy, it may not be incompatible with modern medical regimens. Occasionally, a folk remedy can lead to death, but this varies with the remedy and its use. The roles that folk remedies have in large, developed countries vary depending on the remedies and the country's cultures. (CH 2 pg 40)

1. In relation to developmental milestones, the infant can be expected to roll over from back to abdomen at approximately: A. 2 months B. 4 months C. 6 months D. 8 months

C

2. An important milestone in the infant's life is the development of object permanence. This milestone is represented by which of these statements? A. The infant smiles at the mother when she talks to him. B. The infant repeatedly flexes and extends his arms and legs when the mother picks him up. C. The infant turns and looks for the mother when she walks out of his view. D. The infant cries when the mother hands him to a babysitter.

C

2. Family systems theory includes: A. Direct causality, meaning each change affects the whole family B. Family systems react to changes as they take place, not initiate it C. A balance between morphogenesis and morphostasis is necessary D. Theory is used primarily for family dysfunction and pathology

C

3. A mother brings her 3-year-old daughter to the well-child clinic and expresses concern that the child's behavior is worrisome and possibly requires therapy or medication at minimum. The mother further explains that the child constantly responds to the mother's simple requests with a "no" answer even though the activity has been a favorite in the recent past. Furthermore, the child has had an increase in the number of temper tantrums at bedtime and refuses to go to bed. The mother is afraid her daughter will hurt herself during a temper tantrum because she holds her breath until the mother picks her up and gives in to her request. The nurse's best response to the mother is that: A. The child probably would benefit from some counseling with a trained therapist B. The mother and father should evaluate their childrearing practices C. The child's behavior is normal for a toddler and may represent frustration with control of her emotions; further exploration of events surrounding temper tantrums and possible interventions should be explored D. The child's behavior is typical of toddlers, and the parents should just wait for the child to finish this phase, since this will end soon as well

C

3. An important nutritional supplement recommended to prevent rickets in infants who are exclusively breastfeeding is: A. Vitamin A B. Fluoride C. Vitamin D D. Folic acid

C

3. The nurse is explaining the strategy of consequences to a parent he is working with. Which response by the parent indicates more teaching is needed when he describes the types of consequences? A. Natural: Those that occur without any intervention B. Logical: Those that are directly related to the rule C. Transforming: Allowing the child to come to the conclusion on his or her own D. Unrelated: Those that are imposed deliberately

C

10. The school nurse is discussing dental health with some children in first grade. Which of the following should be included? A. Teach how to floss teeth properly. B. Recommend a toothbrush with hard nylon bristles. C. Emphasize the importance of brushing before bedtime. D. Recommend nonfluoridated toothpaste approved by the American Dental Association.

C Brushing before bedtime is especially important because there is more time overnight for interaction between bacteria and unremoved substrate on the tooth surfaces. Flossing is important, but most first graders do not have the manual dexterity to floss properly. Soft nylon bristles are recommended for school-age children. Fluoridated toothpastes are recommended. (CH 15 pg 597)

3. These general approaches can be helpful when performing a physical exam. Select all that apply. A. With toddlers restraint may be necessary, and requesting a parent's assistance is appropriate. B. When examining a preschooler, giving a choice of which parts to examine may be helpful in gaining the child's cooperation. C. With a school-age child, it is always best to have the parents present when examining. D. Giving explanations about body systems can make adolescents nervous due to their egocentricities. E. An infant physical exam is done head to toe, similarly to the adult.

A, B

1. Which of the following are the primary causes of mortality among adolescents in the United States? Select all that apply. A. Injuries B. Suicide C. Congenital anomalies D. Homicide E. Chronic illness

A, B, D

5. A family you are caring for on the Pediatric unit asks you about nutrition for their baby. What facts will you want to include in this nutritional information? Select all that apply. A. Breastfeeding provides micronutrients and immunologic properties. B. Eating preferences and attitudes related to food are established by family influences and culture. C. Most children establish lifelong eating habits by age 18 months. D. During adolescence, parental influence diminishes and adolescents make food choices related to peer acceptability and sociability. E. Due to the stress of returning to work, most mothers use this as a time to stop breastfeeding.

A, B, D

4. Toddlers are often known to be finicky eaters and may exhibit abnormal eating patterns that may concern parents. Which of the following actions for feeding toddlers should be suggested so adequate amounts of nutrients for growth and development are consumed? Select all that apply. A. Avoid placing large food portions on the toddler's plate B. Allow the child to graze on nutritious (not "junk" food) snacks during the day C. Insist that the child sit at the table until all persons have completed their meals D. Allow the child to make certain food choices (within reasonable limits)—for example, would you like a half peanut butter or ham sandwich? E. Provide meals at the same time of day as much as possible so the toddler has a sense of consistency F. Make the child eat all of the food provided, and provide disciplinary actions such as a "time-out" if the plate is not cleaned

A, B, D, E

1. The nurse caring for a preschool child understands which of the following developmental concepts? Select all that apply. A. Preschoolers have egocentric thought and believe that everyone thinks as they do. B. Play can be therapeutic and enlightening into a child's level of understanding. C. Explanations are helpful when using detail to allay the preschooler's stress. D. Preschoolers understand inferences and can relate to others' feelings with empathy. E. Preschoolers have magical thinking and believe their thoughts have power.

A, B, E

4. A school nurse in middle school (grades 6, 7, and 8) is preparing an outline for a sex education class. Which of these statements represent important concepts to be covered in discussing this topic with this age group? Select all that apply. A. Consider separating the boys and girls into same-sex groups with a leader of the same sex. B. Answer questions matter-of-factly and honestly and appropriate to the children's level of understanding. C. Use vernacular or slang terms to describe human physiologic functions. D. Avoid discussing sexually transmitted diseases in this age group. E. Discuss common myths and misconceptions associated with sex and the reproductive process. F. Avoid controversial topics such as birth control.

A, B, E

3. Which of the following hormones have the most impact on the development of puberty in females and males? Select all that apply. A. Follicle stimulating hormone (FSH) B. Insulin C. Luteinizing hormone (LH) D. Estrogen E. Testosterone

A, C

2. In terms of social development, the school-age child does which of the following? Select all that apply. A. Begins to explore the environment beyond the family B. Has an increased interest in persons of the opposite sex (gender) C. May actively participate in same-sex groups or clubs D. Strives to be different from those in the peer group E. Begins to form strong relationships with persons of the same sex (gender)

A, C, E

3. At the clinic appointment, a 4-year-old's mother wants to discuss several concerns. Which statements require more teaching by the nurse? Select all that apply. A. My husband feels that TV is okay as long as it is educational. B. I think it is okay for my son to play dress-up along with the girls. C. I told my son that his imaginary playmate moved away because it did not seem normal. D. My mother-in-law thinks I should be working around the house all the time, but I believe playing with my son is very important. E. My neighbor gave me some flash cards with letters and numbers for my son to use, but I said, "What's the rush? He's only 4."

A, C, E

5. Growth measurement is a key element in children of their health status. One measurement for height is linear growth measurement. What should the nurse do to perfect this technique? Select all that apply. A. Understand the difference in measurement for children who can stand alone and for those who must lie recumbent. B. Use a length board and footboard or a standiometer, which is the best technique, or use a tape measure. C. Two measurers are usually required for a recumbent child, although one measurer may be sufficient for a cooperative child. D. Reposition the child and repeat the procedure. Measure at least twice (ideally three times). Average the measurements for the final value. E. Demonstrate competency when measuring the growth of infants, children, and adolescents. Refresher sessions should be taken when a lack of standardization occurs.

A, D, E

5. At an appointment at the pediatrician's office, a patient's mother states, "My son gets rough with some of the neighborhood kids. I am worried that he is becoming a bully." Which statements by the mother need more teaching? Select all that apply. A. When my son becomes aggressive, I feel he needs to be punished. B. I think it is good for him to bond with his dad, so they often watch TV together. C. I am trying to get him to learn to say what he is upset about in words. D. Boys will be boys, so I think this can be considered a normal stage in development. E. I am thinking that a time-out would be a better strategy than spanking when my son shows this behavior.

C, E

1. When caring for their infant, a parent asks you, "Is Emily in a lot of pain? How would you know since she can't really tell you?" The best answer to this question is: A. "Infants don't feel pain as we do because their pain receptors are not fully developed yet." B. "The nurses give pain medication before she really feels the pain." C. "We assess her pain using an infant pain assessment tool and give the medicine as needed." D. "Although we try to give her medicine before she feels pain, we watch her very closely and use different techniques to help relieve the pain."

D

5. Ways to integrate spiritual practices into nursing care include: A. Explaining the religious practices you personally take part in B. Realizing that young children have little understanding regarding their spirituality C. Agreeing with children and their families when they explain their religious beliefs so they are not offended D. Becoming knowledgeable about the religious worldviews of cultural groups found in the patients you care for

D

7. The parent of a 10-week-old infant tells the nurse, "She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed." The most appropriate nursing intervention is which of the following? A. Reassure the parent that nothing is wrong. B. Explain how to better interpret infant cues. C. Evaluate for failure of the parent to bond with the infant. D. Reassure the parent that periods of "unexplained fussiness" are normal.

D A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent's concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.(CH 10 pg 426)

2. Which of the following is characteristic of the psychosocial development of school-age children? A. Peer approval is not yet a motivating power. B. A developing sense of initiative is very important. C. Motivation comes from extrinsic rather than intrinsic sources. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

D A sense of industry, or accomplishment, is achieved between the ages of 6 years and adolescence. Erikson labels this stage as industry versus inferiority. Interaction with peers is a source of satisfaction for school-age children. Initiative is the developmental task of the preschooler. Intrinsic motivation is associated with increased competence in mastering skills. (CH 15 pg 571)

7. Which of the following statements explains why it can be difficult to assess a child's dietary intake? A. No systematic assessment tool has been developed. B. Biochemical analysis for assessing nutrition is expensive. C. Families usually do not understand much about nutrition. D. Recall of food consumption is frequently unreliable.

D An individual's recall of food intake, especially amounts eaten, is frequently unreliable. Systematic tools such as the 24-hour recall and detailed dietary history questionnaires are available. Biochemical analysis is not necessary for assessing dietary intake. Family knowledge of nutrition is not required. Detailed questions can elicit the child's patterns of eating and food intake.(pg 105)

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

D Convertible car seats are necessary until the child is at least 18 kg (40 lb). Booster seats are required until the child is 36.2 kg (80 lb). Locking medicines in the bathroom cabinet will help prevent the child from accidentally ingesting medicines. Decreasing the temperature on the water heater can help prevent burns. Gates are appropriate to keep the toddler from falling down the stairs. (CH 12 pg 513)

1. Which of the following is the most consistent and commonly used indicator of pain in infants? A. Increased respirations B. Increased heart rate C. Thrashing of arms and legs D. Facial expression of discomfort

D Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not infants.(CH 5 pg 152)

10. A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given A. skim milk. B. whole cow's milk. C. commercial formula without iron. D. commercial iron-fortified formula.

D 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.(CH 10 pg 438)

3. Which of the following describes the cognitive abilities of school-age children? A. Have developed the ability to reason abstractly B. Become 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. Have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions based on that concept

D In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly until late adolescence. Scientific reasoning and formal logic are skills of adolescents. Progressing from making judgments based on what school-age children reason to making judgments based on what they see is not a developmental skill. (CH 15 pg 573)

5. An intravenous line is needed in a school-age child. The most appropriate action to provide analgesia during this procedure is to apply A. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure. B. a transdermal fentanyl (Duragesic) patch at the site of venipuncture. C. EMLA (eutectic mixture of local anesthetics) immediately before the procedure. D. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.

D LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60 minutes in advance.(CH 5 pg 177)

11. A school-age child with cancer is being prepared for a procedure. The child says, "I have had one of these. They hurt." The nurse's response should be based on knowledge that children A. often lie about experiencing pain. B. tolerate pain better than adults. C. become accustomed to painful procedures. D. commonly experience treatment-related moderate to severe pain when they have cancer.

D Pain is reported by approximately 84% of children with cancer. Of these, most report it as moderate to severe, and half report the pain as highly distressing. There are no data to support that children misrepresent pain experiences. Pain tolerance is a complex phenomenon that is not based on age. Children do not become accustomed to painful procedures.(CH 5 pg 1887)

4. A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which one of the following is the most appropriate recommendation? A. Punish the child. B. Explain to the child why the tantrum is wrong. C. Leave the child alone until the tantrum is over. D. Remain close by the child but ignore the behaviors.

D The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age group as the child becomes more independent and 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 presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over. (CH 12 pg 498)

1. In terms of fine motor development, what could a 3-year-old child be expected to do? A. Tie shoelaces. B. Use scissors or a pencil very well. C. Draw a person with seven to nine parts. D. Draw single-line shapes such as circles.

D Three-year-old children are able to draw single-line shapes such as circles. A 5-year-old child's fine motor skills include the ability to tie shoelaces, use scissors or a pencil, and draw a person with seven to nine parts. (CH 13 pg 523)

2. The health promotion interventions that have the greatest impact on injury prevention are which of the following? A. Utilization of auditory learning strategies for all families B. Including the nutritional counseling for the food pyramid C. Integrating Maslow's hierarchy of needs in the lesson D. Using a developmental approach to safety counseling

D Utilizing a developmental approach to safety counseling will ensure that the parents are taught risks associated with developmental age and increased risk factors for that population. Family members may have different learning styles, so the nurse should include several strategies in the health promotion teaching session. Although nutritional counseling is important, it is not an injury prevention health promotion priority for preventing injury. Maslow's hierarchy of needs is a theoretical model to assist in assuring all the needs of an individual are met, but it is not the theoretical model of choice in this scenario.(CH 1 pg 3)

1. Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, which of the following can gradually be achieved? A. Visual acuity of 20/20 B. Throwing a ball without falling C. Respirations becoming diaphragmatic D. Control of anal and urethral sphincters

D With complete myelination of the spinal column, voluntary control of elimination occurs. Control of anal and urethral sphincters is gradually achieved. Visual acuity is acceptable at 20/40. Throwing a ball without falling is achieved by 18 months of age. Respirations remain abdominal in this age-group. (CH 12 pg 489)

1. What do morbidity rates measure? A. Life span statistics B. Acute illness, chronic disease, or disability C. Cost-effective treatment for the general population D. Prevalence of a specific illness in a population

D Morbidity measures prevalence of a specific illness in a population over a specific period. Life span statistics are included in mortality data. Acute illness, chronic disease, and disability are factors that give morbidity statistics. Cost is not included in morbidity rates.(pg 6)

3. An adolescent asks the nurse what causes primary dysmenorrhea. The nurse's response should include which of the following? A. It is an inherited problem. B. Excessive estrogen production causes uterine pain. C. There is no physiologic cause; it is a psychologic reaction. D. One factor is the onset of ovulatory cycles.

D. The factor present in all instances of primary dysmenorrhea is the onset of ovulatory cycles. Primary dysmenorrhea is not known to be inherited. Excessive estrogen has not been implicated in the etiology. Primary dysmenorrhea has a physiologic cause. Women with dysmenorrhea have higher prostaglandin levels.(CH 17 pg 676)