1 Peds growth

According to developmental theories, which important event does the nurse understand is essential to the development of the toddler? 1. The child learns to feed self. 2. The child develops friendships. 3. The child learns to walk. 4. The child participates in being potty-trained.

4. Developmental theorists like Erickson and Freud believe that toilet training is the essential event that must be mastered by the toddler. The test taker must have knowledge of Freud and Erickson's developmental theories.

The school nurse is planning an educational program centered on abstinence for adolescents. Which of the following methods does the nurse recognize as the most effective way to present this program? 1. Use peer-led programs that emphasize the consequences of unprotected sexual contact. 2. Teach students methods to resist peer pressure. 3. Offer students the opportunity to care for a simulator infant for 1 week. 4. Offer statistics, pamphlets, and films discussing the consequences of unprotected sexual contact.

1. Adolescents are most concerned with what their peers think and feel. They are most receptive to information that comes from another adolescent. The test taker must understand the psychosocial development of an adolescent in order to choose the appropriate intervention. Adolescents focus on their relationships with peers and are much more influenced by peers than by multimedia in- formation or by information provided by an adult.

A 3-year-old female is hospitalized for an ASD repair. Her parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is: 1. "Your mommy and daddy will be back after your nap." 2. "Your mommy and daddy will be back at 6 p.m." 3. "Your mommy and daddy will be back later this evening." 4. "Your mommy and daddy will be back in 3 hours."

1. Preschoolers understand time in rela- tion to events. The age of the child is essential to answering this question. The test taker must have knowledge of a child's understanding of the concept of time. Answers 2, 3, and 4 can be eliminated because they provide choices for time measurement that would only be understandable to children school-age or older.

A female nurse caring for a 5-year-old boy is trying to encourage developmental growth. What can the nurse do to reinforce the child's intellectual initiative when he asks the nurse about his upcoming surgery? 1. Answer the child's questions about his upcoming surgery in simple terms. 2. Provide the child with a book that has vivid illustrations about his surgery. 3. Tell the child he should wait and ask the doctor his questions. 4. Tell the child that she will answer his questions at a later time.

1. The child is taking the initiative to ask questions, as all toddlers do, and the nurse should always answer those questions as appropriately and accurately as possible. The age of the child is essential to answering this question. The test taker must understand the cognitive level of the child in order to choose the appropriate intervention. Answers 3 and 4 can be eliminated because the nurse is avoiding the child's questions.

Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. "My child is able to stand but is not yet taking steps independently." 2. "My child has a vocabulary of approximately 15 words." 3. "My child is still thumb sucking." 4. "My child seems to be quite wary of strangers."

1. The child should be walking independently by 15 to 18 months. Because this toddler is 18 months and not walk- ing, a referral should be made for a developmental consult. The age of the child is essential to answering this question. The test taker must understand basic develop- mental milestones in order to choose the appropriate intervention.

The nurse is caring for a 12-month-old girl. The child's mother asks if the unit has any toys that her daughter can play with. The nurse goes to the toy area in search of a toy for the child. Which toy is the best choice for this child? 1. A doll. 2. A musical rattle. 3. A board book. 4. Colorful beads.

2. A musical rattle is the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation. The test taker must understand the developmental level of the child in order to choose the appropriate toy. The test taker must also understand safety issues for a child this age.

The nurse is caring for a 6-month-old in the ER. The physician orders the nurse to give the child a dose of Rocephin IM. The 1.5-mL dose arrives from the pharmacy. The nurse must do which of the following? 1. Administer the injection in the deltoid muscle. 2. Split the dose into two injections. 3. Administer the injection in the dorsogluteal muscle. 4. Administer the dose as a single injection to the vastus lateralis muscle.

2. A nurse should not deliver more than 1 mL per IM injection to a child of 6 months. The test taker must have knowledge of IM injections sites and acceptable volumes for children of varying ages.

A 17-year-old male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should: 1. Interview the adolescent using direct questions. 2. Gather information during a casual conversation. 3. Interview the adolescent only in the presence of his parents. 4. Gather information only from the parents.

2. Frequently adolescents will share more information when it is gathered during a casual conversation. The age of the child is essential to answering this question. Answers 3 and 4 contain the word "only." There are rare instances in nursing when the word "only" would apply. These answers can usually be eliminated.

A male infant is visiting the pediatrician for his 6-month well-child checkup. His mother tells the nurse she wants to advance the infant's diet. Which statement by the infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? 1. "I will continue to breastfeed my son and will give him rice cereal three times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 8 ounces of baby juice per day."

2. Infants should be started on vegetables prior to fruits. The sweetness of the fruits may inhibit them from taking vegetables. The test taker must have knowledge of the recommended nutrition for an infant.

A 2-year-old boy has been admitted to the hospital for anemia. His mother asks the nurse what foods to include in his diet to improve his nutritional status. Which of the following should the nurse recommend? 1. Increase the child's intake of whole cow's milk to 32 ounces a day. 2. Increase the child's intake of meats, eggs, and green vegetables. 3. Increase the child's intake of fruits, whole grains, and rice. 4. Increase the number of snacks the child eats during the day.

2. Meat, eggs, and green vegetables are excellent sources of iron. The test taker must have knowledge of the recommended nutrition for children. The test taker must also have knowledge of foods that are high in iron.

A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is: 1. "At 6 months his weight should be approximately three times his birth weight." 2. "Each child gains weight at his or her own pace." 3. "At 6 months his weight should be approximately twice his birth weight." 4. "At 6 months a child should weigh about 10 lb more than his or her birth weight."

3. Children should double their birth weight by 4 to 6 months of age. This is a specific physical developmental milestone that should be memorized.

A first-time mother brings in her 5-day-old baby for a well-child visit. The nurse weighs the infant and reports a weight of 7 lb 5 oz to the mother. The mother looks concerned and tells the nurse that her baby weighed 7 lb 10 oz when she was dis- charged 4 days ago. The nurse's best response to the mother is: 1. "I will let the doctor know, and he will talk with you about possible causes of your infant's weight loss." 2. "An initial weight loss of a few ounces is common among newborns, especially for breastfeeding mothers." 3. "I can tell you are a first-time mother. Don't worry; we will find out why she is losing weight." 4. "Maybe she isn't getting enough milk. How often are you breastfeeding her?"

2. Newborns can lose up to 10% of their birth weight without concern but should regain their birth weight by 2 weeks of age. The test taker can eliminate 3. This is a non-therapeutic response. Remembering that newborns can lose up to 10% of their birth weight will help you choose the right response.

A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you take that will most enhance his psychosocial development? 1. Fax the teen's teacher, and have her send in his homework. 2. Encourage the teen's friends to visit him in the hospital. 3. Encourage the teen's grandparents to visit frequently. 4. Tell the teen he is free to use his phone to call friends

2. Teens are most concerned about being like their peers. Having the teen's friends visit will help him feel he is still part of the school and social environment. The age of the child is essential to answering this question. The test taker must understand that peers are central to an adolescent's life.

A 5-year-old is at the pediatrician's office for his well-child checkup. The nurse will be administering three immunizations to the child. The nurse should expect which reaction from the child when she gives his immunizations? 1. The child will likely remain silent and still. 2. The child will likely cry and tell the nurse that it hurts. 3. The child will likely try to stall the nurse. 4. The child will likely remain still while telling the nurse that she is hurting him.

2. The common response of a 5-year-old is to cry and protest during an immunization. The age of the child is essential to answering this question. The test taker must understand the child's psychosocial development in order to choose the appropriate response.

The nurse caring for an 8-year-old boy is trying to encourage developmental growth. What activity can the nurse provide for the child to encourage his sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent in. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

2. The school-age child is focused on academic performance; therefore the child can achieve a sense of industry by completing his homework and staying on track with his classmates. The test taker must have knowledge of Erickson's stages of development. Answer 1 can be eliminated because it could be detrimental to children to allow them to choose medication times. Answers 3 and 4 can be eliminated because they are not activities that help the child achieve a sense of industry.

A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside her clubhouse that says "No boys allowed." The child's parents are concerned that she is excluding their neighbor's son, and they are upset. What should the school nurse tell the child's parents? 1. Her behavior is cause for concern and should be addressed. 2. Her behavior is common among school-age children. 3. Her feelings about boys will subside within the next year. 4. They should have their daughter speak with the school counselor.

2. This is common behavior. Girls of 9 and 10 generally prefer to have friends who are of the same gender. The age of the child is essential to answering this question. The test taker must understand the psychosocial development of the child in order to choose the appropriate behavior. Answer 3 can be eliminated because it is too absolute. There is no way to determine exactly how long the child will have these feelings about boys.

The nurse caring for a 4-year-old female in the ER is about to start a peripheral IV. The nurse's best method for explaining the procedure to the child is to: 1. Show the child a pamphlet with pictures showing the IV placement procedure. 2. Have the 5-year-old patient next door tell the 4-year-old about her experience with her IV placement. 3. Show the child the IV placement equipment, and demonstrate the procedure on a doll. 4. Tell the child that if she remains still, the procedure will be over quickly.

3. A 4-year-old child understands things in very concrete and simple terms. Therefore, medical play is an excellent method for helping her understand the procedure. The age of the child is essential to answering this question. The test taker must understand the developmental level of the child in order to choose the appropriate intervention. Most 4-year-old patients are unable to read, so choice 1 can be eliminated.

An 8-year-old is NPO while he awaits surgery for central line placement later in the afternoon. The nurse is trying to engage the child in some form of activity to distract him from thinking about his upcoming surgery. Which is the best method of distraction for a child of this age in this situation? 1. Encourage the child to use the telephone to call friends. 2. Encourage the child to watch television. 3. Encourage the child to play a board game. 4. Encourage the child to read the central line pamphlet he was given.

3. A board game is the optimal choice be-cause school-age children enjoy being engaged in an activity with others that will require some skill and challenge. The age of the child is essential to answering this question. The test taker must understand the cognitive developmental level of the child in order to choose the appropriate method of distraction.

A 3-year-old female is hospitalized for a femur fracture. As her nurse, what nursing action would help foster the child's sense of autonomy? 1. Allow the child to choose what time to take her oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe. 4. Allow the child to watch age-appropriate videos

3. Allowing toddlers to participate in actions of which they are capable is an excellent way to enhance their autonomy. The test taker must understand the meaning of the word "autonomy" in order to answer this question. The question also requires knowledge of Erickson's stages. The test taker also needs to consider safe nursing care. Answer 1 could be detrimental to the welfare of the child.

How can the nurse best facilitate the trust relationship between infant and parent while the infant is hospitalized? 1. The nurse should encourage the parents to remain at their child's bedside as much as possible. 2. The nurse should keep parents informed about all aspects of their child's condition. 3. The nurse should encourage the parents to hold their child as much as possible. 4. The nurse should encourage the parents to participate actively in their child's care.

3. Having parents hold their child while in the hospital is an excellent means of building the trust relationship. Infants are most secure when they are being held, patted, and spoken to. The test taker must understand Erickson's stages, including the individual tasks that are met during each stage.

In order to prevent separation anxiety in a hospitalized toddler, which of the following should the nurse do? 1. Assume the parental role when parents are not able to be at the bedside. 2. Encourage the parents to remain at the bedside always. 3. Establish a routine that is similar to that of the child's home. 4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

3. It is very important to try to maintain a child's home routine both when parents are present and when they have to leave the hospital. This will increase the child's sense of security and decrease anxiety. The test taker must have knowledge of the stages of separation anxiety. Answer 1 can be ruled out because the nurse should never assume a parental role with a child. Answer 4 can be eliminated because it is essential that children be provided with continuity of care.

The nurse is caring for a 7-year-old female on the school-age unit. Her mother is con- cerned that she may have some developmental delays. Which of the following statements would indicate to the nurse that the child is not developmentally on track for her age: 1. The child is able to follow a four-to-five-step command. 2. The child started wetting the bed on this admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister.

3. Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age. The test taker must also understand the stressors that affect children who are hospitalized and how they will react to those stressors based on their developmental level.

A 7-year-old female is being admitted to the hospital for a diagnosis of acute lympho- cytic leukemia. The nurse wants to gather information from the child regarding her feelings about her diagnosis. Which nursing action is most appropriate to gain infor- mation about how the child is feeling? 1. The nurse should actively attempt to make friends with the child before asking her about her feelings. 2. The nurse should ask the child's parents what feelings she has expressed in regard to her diagnosis. 3. The nurse should provide the child with some paper to draw a picture of how she is feeling. 4. The nurse should ask the child direct questions about how she is feeling.

3. Often children will include much more detail of their feelings in drawings. They will often express things in pictures they are unable to verbalize. The age of the child is essential to answering this question. The test taker must also have knowledge of psychosocial development of the school-age child.

The nurse is instructing a new breastfeeding mother in the need to provide her pre- mature infant with an adequate source of iron in her diet. Which one of the following statements reflects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby's diet when she is 9 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet."

3. Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months. Full-term infants have iron stores that last approximately 4 to 6 months. The test taker must have knowledge of the recommended nutrition for an infant.

The mother of 11-year-old fraternal twins tells the nurse at their well-child checkup that she is concerned because her daughter has gained more weight and height than her twin brother. The mother is concerned that there is something wrong with her son. The nurse's best response is: 1. "I understand your concern. I will talk with the physician, and we can draw some lab work." 2. "I understand your concern. Has your son been ill lately?" 3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." 4. "It is normal for you to be concerned, but I am sure your son will catch up with

3. This is the appropriate response. The nurse understands that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood. This is a specific physical developmental milestone that should be memorized.

The mother of a child 2 years 6 months has arranged a play date with the neighbor and her 3-year-old daughter. During the play date the two mothers should expect that the children will do which of the following? 1. The children will share and trade their toys while playing. 2. The children will play with one another with little or no conflict. 3. The children will play alongside one another but not actively with one another. 4. The children will play with one or two items, ignoring most of the other toys.

3. Toddlers engage in parallel play. They often play alongside another child but they rarely engage in activities with the other child. The age of the child is essential to answering this question. The test taker must understand the develop- mental level of the child in order to choose the appropriate form of play.

The parents of a 2-year-old boy are concerned about his behavior. Since the child's admission to the hospital 2 days ago he has been crying much more than usual and is inconsolable much of the time. The nurse's best response to the child's parents is: 1. The child is in the detachment phase of separation anxiety, which is normal for children during hospitalization. 2. The child is in the despair stage of separation anxiety, which is normal for children during hospitalization. 3. The child is in the bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. The child is in the protest stage of separation anxiety, which is normal for children during hospitalization.

4. During the protest stage of separation anxiety, children are often inconsolable, and they often cry more than they do when they are at home. These children also frequently ask to go home. The test taker must have knowledge of the stages of separation anxiety.

An ER nurse is assessing a 12-month-old female. Which statement accurately describes the best method for assessing this child? 1. The nurse should assess the child on the examining table. 2. The nurse should assess the child in a head-to-toe sequence. 3. The nurse should have the child's mother assist in holding her down. 4. The nurse should assess the child while she is in her mother's lap.

4. Infants are most secure when in proximity to the parent. The parent's lap is an excellent place to assess the child. Health-care professionals must use developmentally appropriate methods to approach children. The test taker must have knowledge of a child's psychosocial development. Answers 1 and 2 can be eliminated because these methods of assessment would be used on an older child.

A 5-year-old girl has been brought to the ER for suspected child abuse. What approach should the nurse use to gather information from the child? 1. The nurse should promise the child that her parents will not know what she tells the nurse. 2. The nurse should promise the child that she will not have to see the suspected abuser again. 3. The nurse should use correct anatomical terms to discuss body parts. 4. The nurse should tell the child that the abuse is not her fault and that she is a good person.

4. Many young children believe abuse or illness is their fault, and they should be reminded they are not to blame. Many children of this age believe they have acquired a disease or have been abused because they are bad people. Children of this age often believe an injury or abuse is their fault. They sometimes feel they are being punished for being bad. The safety and security of the child is paramount in this situation. The child needs to know she is now safe and she did not cause the abuse. Answers 1 and 2 can be eliminated be- cause of the word "promise." The nurse needs to build a trusting relationship with the child and should never make a promise that cannot be kept.

An 11-year-old male is being evaluated in the ER for an inguinal hernia. Which statement accurately describes how the nurse should approach him for his physical assessment? 1. The nurse should ask the child's parents to remain in the room during the physical exam. 2. The nurse should auscultate the child's heart, lungs, and abdomen first. 3. The nurse should explain to the child that the physical exam will not hurt. 4. The nurse should explain to the child what the nurse will be doing in basic understandable terms.

4. School-age children are capable of understanding basic functions of the body and should be taught about their diagnosis in simple, basic terms. Healthcare professionals must approach children using developmentally appropriate methods. The test taker must have knowledge of a child's psychosocial development. Answers 1 and 2 can be eliminated because they are methods of assessment used for younger children.