EAQ Ch 3 Dev & Genetic Influences on Child Health Promotion

The nurse is assessing a 17-year-old girl with primary amenorrhea. The nurse reports to the primary health care provider that the patient is short in stature. Which instructions does the nurse expect from the primary health care provider? 1 Evaluate for Turner syndrome. 2 Evaluate for fragile X syndrome. 3 Evaluate for Down syndrome. 4 Evaluate for neurofibromatosis.

1 Turner syndrome is a genetic disorder caused by the absence of one of the X chromosomes in females. Genetic evaluation must be done to detect the birth defects. It helps to properly evaluate the disease condition. Reduction in the chromosomes affects hormonal levels and the growth pattern. Turner syndrome causes primary amenorrhea and short stature in females. Therefore, the 17-year-old girl with primary amenorrhea and short stature must be evaluated for Turner syndrome. Fragile X syndrome causes hyperactivity and autistic behavior in the preschooler. Down syndrome is associated with the delay in the physical growth of children due to a chromosomal abnormality. Neurofibromatosis is a genetic disorder that affects the growth of nerve cells. It causes changes in skin texture and leads to the deformation of bones.

The nurse is assessing four children in a pediatric health care setting. Which child's condition is caused by a deformation-related congenital anomaly? 1 Child A: 2 years old; the child's foot is turned inward, the bottom of the foot faces sideways 2 Child B: 3 y/o; one arm missing at birth 3 Child C: 2 y/o; absence of a few teeth and presence of a few conical-shaped teeth 4 Child D: 3 y/o; presence of abnormal upper lip and palate on both sides of the roof of the mouth

1 (I put 2) Congenital anomalies are often classified as deformations, disruptions, dysplasias, or malformations. Club foot is a congenital deformation. A child with club foot has an inward turning of the foot and the bottom of the foot faces the side. A missing arm at birth indicates congenital amputation, which is a disruption, not a deformation. Abnormalities of teeth, sweat glands, and hair are due to dysplasia but are not associated with deformation. An abnormal upper lip and palate indicates cleft lip, which is a malformation, not a deformation.

According to Piaget, at what stage of development do children typically solve problems through trial and error? Sensorimotor stage Preoperational stage Formal operational stage Concrete operational stage

1 (I put 2) During the sensorimotor stage, infants and young toddlers develop a sense of cause and effect. Relational problem solving is characteristic of the preoperational stage. Adolescents, in the formal operations stage, can test hypotheses. Children in the concrete operations stage solve problems in a tangible, systematic fashion.

Phenylketonuria (PKU) is a multifactorial condition resulting from the absence of an enzyme that metabolizes the amino acid phenylalanine. When are the effects of the condition most often evident in infants with PKU? (p. 51) 1 After the infant ingests milk 2 After the infant is exposed to a virus 3 After the infant's first bowel movement 4 After the infant experiences dehydration

1 Effects of phenylketonuria (PKU) are often expressed in infants after sufficient ingestion of phenylalanine-containing substances, such as milk. The effects of PKU are not associated with exposure to a virus, the infant's first bowel movement, or dehydration.

1. 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

The nurse is observing a child who appears to be daydreaming while seated in a chair in the clinic waiting for her scheduled appointment with her mother. This behavior is noted as being an example of pretend play. dramatic play. unoccupied behavior. skill play.

3 This type of behavior pattern represents a child who is focusing on something of interest and is considered a normal response. Pretend or dramatic play would be more symbolic and representative of an action. Skill play would involve the child demonstrating some action or motion.

The nurse is discussing the behaviors based on the developmental changes in children with the parents of a 2-year-old child. Based on Erikson's psychosocial stages of development, what advice does the nurse give the parents? 1 "Always keep the child close to you." 2 "Allow your child to make decisions." 3 "Let your child play on a slide and run around in the park." 4 "Encourage a competitive spirit in the child."

3 (I put 2) According to Erikson's psychosocial stages of development, 2-year-old children start displaying increased ability to control their bodies, themselves, and also their environment. The child wants to do things independently. The nurse should thus ask the parents to allow the child to do activities like running around, walking, and so on, by themselves. An infant (0-1 year) should always be kept close to the parents. This would inculcate the feeling of trust in the child. Two-year-old children are not mature enough to make their own decisions. Thus this advice would be inappropriate. At an age of 2 years the child does not understand about cooperation and competency. Thus it would be inappropriate for the nurse to give such advice to the parents.

The nurse finds that a preschooler has hyperactivity and autistic-like behaviors. What would be the nurse's best intervention? 1 Administer the Denver II screening test. 2 Ask the mother if she drank when she was pregnant. 3 Recommend diagnostic genetic testing for fragile X syndrome. 4 Document the findings and instruct the parents to monitor the behavior.

3 (I put 4) Hyperactivity and autistic-like behaviors in a preschooler may indicate fragile X syndrome. Fragile X syndrome is characterized by the presence of fragile, weak sites with expanded triplet repeats on both autosomes and the X chromosome; therefore the best nursing intervention is to recommend diagnostic genetic testing. Administering the Denver II test assesses the child's ability to do age-appropriate developmental tasks and would not be appropriate. The child's symptoms are not indicative of fetal alcohol syndrome. Fetal alcohol syndrome causes severe birth defects and cognitive impairment. This child's behaviors are not normal and should be addressed immediately.

*Which statement helps explain the growth and development of children? (p. 39 Developmental Pace) 1 Development proceeds at a predictable rate. 2 Rates of growth are consistent among children. 3 The sequence of developmental milestones is predictable. 4 At times of rapid growth there is also acceleration of development.

3 (guessed 4) There is a fixed, precise order to development. There are periods of both accelerated and decelerated growth and development, so the rates are not consistent. Each child develops at his or her own rate. Physical growth and development proceed at differing rates. Although development has a fixed, precise order, it does not progress at the same rate or pace. When a spurt occurs in one area, minimal advances may take place in other areas.

Which should the nurse do to prevent separation anxiety in a hospitalized toddler?

Establish a routine similar to that of the child's home

A 3 y/o admitted to the hospital with croup has the following VS: HR 90, RR 44, BP 100/52, temp 98.8F. Which vital sign is not expected? 1. BP is elevated 2. Temp is elevated 3. RR is elevated 4. HR is elevated

3. A normal RR for a child 3-6 y/o is 20-30 breaths/min 1. Normal SPB is 78-111 and DBP is 42-70 2. Normal temp is 96.6 F to 100F 4. Normal HR for a child from 3-6 years is 75-120

What statement accurately describes the best method for assessing a 12 month old? 1. On the examining table 2. Head-to-toe sequence 3. Have the child's parent assist in holding her down 4. Assess the child while she is in her parent's lap

4

Which genetics term refers to abnormal formation of organs or body parts resulting from an abnormal developmental process? (p. 51) 1 Syndrome 2 Teratogen 3 Aberration 4 Malformation

4 A malformation is abnormal formation of organs or body parts resulting from an abnormal developmental process. A syndrome is a recognized pattern or anomaly resulting from a single specific cause. A teratogen is an agent that causes birth defects when present in the prenatal environment. An aberration is any variation from the usual or expected, such as in the number or structure of chromosomes.

An 8 day old was admitted to the hospital with vomiting and dehydration. The newborn's HR is 170, RR 44, BP 85/52, and temp 99F. What is the nurse's best response to the parents who ask if the vital signs are normal? 1. The BP is elevated 2. The temp is elevated 3. The RR is elevated 4. The HR is elevated

4 A normal HR for a child from birth-1 month is 90-160.

The parent of a 12-month-old says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much mess." The most appropriate response by the nurse is "It's important not to give in to this kind of temper tantrum at this age." "Maybe you need to try a different type of spoon, one designed for children." "It's important to let him make a mess. Just don't worry about it so much." "He is at the age when he should begin to feed himself. Let's think of ways to make the mess more tolerable."

4 At 12 months, children should be self-feeding. Because they eat primarily finger foods, providing some concrete strategies for the parent as to how to minimize the mess would be helpful. The child is developmentally ready for self-feeding, and his behavior reflects his desire to be autonomous. Most infants begin self-feeding with finger foods, so the use of a spoon is generally not required, limiting the "mess." "It's important to let him make a mess. Just don't worry about it so much." minimizes the parents' concerns about the mess created by self-feeding, blocks communication, and misses a teaching-learning opportunity.

Which attribute of temperament is descriptive of the child's ability to be sidetracked by an external stimulus? (p. 43 Box 3-2) 1 Activity 2 Rhythmicity 3 Adaptability 4 Distractibility

4 Temperament is the mode of thinking, behaving, or reacting to stimuli. It describes behavioral tendencies, regardless of good or bad. Distractibility is the attribute of temperament that describes the attentive behavior of an individual that can be diverted by an external stimulus. Activity, rhythmicity, and adaptability do not describe the behavior caused by external stimuli. Activity refers to the level of motion in which a child indulges during physical activity. Rhythmicity describes the regularity in the activities of daily life. Adaptability describes the nature of an individual in adjusting to the environment.

The parent of a 1-year-old child is worried because the child is not able to speak words and uses hand gestures. The mother informs the nurse that the child is able to say only three words: ma, bye, and go. What does the nurse interpret from this? 1 The child has normal language development. 2 The child has impaired cognitive development. 3 The child should be referred to an audiologist. 4 The child should be referred to speech therapist.

1 A child within the age of 30 months (2.5 years) uses few words and relies on hand gestures for communication. Thus, the child has normal language development. An inability to speak many words and use of hand gestures does not indicate that the child has impaired cognitive development. As the child is able to communicate through hand gestures, the child does not have a hearing impairment, so the child does not need to be referred to an audiologist. The child's language skills are appropriate for the age, so the child does not need to be referred to a speech therapist.

A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group? The amount of medicine is less. The amount of medicine did not change, only its appearance. Pouring medicine makes the medicine hot. The glass changed shape to accommodate the medicine.

1 A preschool child does not have the ability to understand the concept of conservation. This concept is not developed until school age. Understanding conservation occurs between 7 to 10 years of age, when a child begins to realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed. Children are able to deal with a number of different aspects of a situation simultaneously. This is not an expected response by a child. A preschool child will not typically believe the glass changed shape to accommodate the medicine but rather that the amount of medicine is less in the short, wide glass.

The nurse is assessing the height of a newborn. Where does the nurse expect to find the approximate midpoint of the head-to-toe measurement in this neonate? 1 The umbilicus 2 The pubic symphysis 3 The tip of the xiphoid process 4 The upper one third of the thigh

1 At birth the midpoint of the head-to-toe measurement of the child is approximately around the umbilicus. As the age progresses, the midpoint descends from the umbilicus to the pubic symphysis. The tip of the xiphoid process is much higher than the midpoint of the head-to-toe measurement in a neonate. The upper one third of the thigh is much lower than the midpoint of the head-to-toe measurement in a neonate.

The nurse is assessing the growth and development of four children in a health care setting. Which child has abnormal findings at 1 year of age? (p. 41) 1 Child A 2 Child B 3 Child C 4 Child D

1 Birth weight of infants generally triples by the end of the first year. An infant's height generally increases by approximately 50% of the birth height by the end of the first year. Child A, with a birth weight of 3.1 kg and birth height of 47.8 cm, should weigh 9.3 kg and be be 75.7 cm tall at the end of the first year. Therefore, the body weight of 7.1 kg and height of 70 cm in child A are abnormal findings. The weights and heights of children B, C, and D are normal.

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as concrete operations. preoperational. school-age rhetoric. formal operations.

1 Black-and-white reasoning involves a situation in which only two alternatives are considered, when in fact there are additional options. Preoperational thinking is concrete and tangible. During the school-age years, children deal with thoughts and learn through observation. They do not have the ability to do abstract reasoning and learn best with illustration. Thought at this time is dominated by what the school-age child can see, hear, or otherwise experience. School-age rhetoric simply refers to the type of ideas that arise out of the years children attend school. Formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years.

The nurse working at a day care center observes that three toddlers are sitting beside each other and are playing independently with their own dolls. The nurse finds that these children are neither interacting nor being influenced by each other. What does the nurse conclude from the behavior of the children? (p. 48) 1 The children are demonstrating a form of parallel play. 2 The children are trying to adjust to each other. 3 The children are playing alone as they have no siblings. 4 The children are showing impaired social interaction.

1 Parallel play is a characteristic feature of toddlers, such as when children play independently with similar toys and are not influenced by each other. Though they sit beside each other, they do not play together. The nurse cannot draw the conclusion that the children are trying to adjust to each other without having more information. The nurse also cannot infer that these children are only children without having more information. Without proper assessment and without interacting with the child, the nurse cannot conclude that the child has impaired social interaction. Toddlers tend to play alone. They start getting involved in group play during early childhood.

Based on Piaget's theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life? If an object is hidden, that does not mean that it is gone. He or she cannot be fooled by changing shapes. Parents are not perfect. Most procedures can be reversed.

1 Part of learning permanence is learning that although an object is no longer visible, it still exists. At 1 year of age, a child may not be able to understand that an object that changes shape is still the same object. Understanding conservation occurs between ages 7 to 11 years. At 1 year of age, a child is unable to determine or understand that parents make mistakes. At 1 year of age, a child does not understand the idea of reversed trial and error.

Which assessment for self-esteem includes the evaluation of cognitive and social skills? (p. 47) 1 Competence 2 Moral worth 3 Sense of control 4 Worthiness of love

1 Self-esteem is how worthy one feels about oneself and among social groups. The assessment for competence helps in the evaluation of cognitive and social skills. Moral worth, sense of control, and worthiness of love and acceptance do not help in assessing the ability of cognitive and social skills. Moral worth is indicative of how children feel about their actions. A sense of control is how much power children have over their own actions and abilities. If a child feels worthy of love, then the child feels trustworthy for love among family members and peers.

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 15 words 3.. My child is still sucking his thumb 4. My child seems to be quite wary of strangers

1 The child should be walking independently by 15-18 months. Because this toddler is 18 months and not walking, a referral should be made for a developmental consult. 2. Vocab of an 18 month old should be about 10 words or more 3. Thumb sucking is still common at this age and may be at its peak at this age 4. It is very common for a child of 18 months to exhibit stranger anxiety

The nurse is studying Freud's theory of psychosocial development. Which behavior of the hungry child in a class indicates that the id personality is the predominant personality over the ego and superego? (p. 44) 1 The child would immediately leave the class and have food. 2 The child would ask the permission of the teacher and then have food. 3 The child would wait for the teacher to ask the child to eat food. 4 The child would not have food unless the child goes back to the home.

1 The id obeys the pleasure principle of immediate gratification of needs. In this situation, the child is hungry. If the id personality is predominant, then the child would immediately go and have food without asking the teacher's permission. The ego functions as a controlling of self and finds realistic means of gratification of the need. If the ego predominates, then the child would ask the teacher for permission and then have food. The superego functions as an ideal and prevents the individual from expressing instincts. Therefore, waiting for the teacher to ask the child to eat food and not having food unless the child goes back home are behaviors suggesting a superego personality.

According to Erikson, infancy is concerned with acquiring a sense of trust. industry. initiative. separation.

1 The task of infancy is the development of trust. If the infant is not successful with this task, then mistrust develops. Industry versus inferiority is the developmental task of school-age children. Initiative versus guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage, as described by Piaget.

*A child is depressed after losing a game in a chess competition. The child refuses to speak to the child who won. The child's parent says to the child, "You can win the game in the next competition." The child feels guilty. What does the nurse interpret from the child's behavior? (p. 47) 1 The child's behavior indicates poor self-esteem. 2 The child's behavior indicates good self-worth. 3 The child's behavior shows there are trust issues. 4 The child's behavior indicates fear of punishment.

1 (guessed 2) The child's behavior indicates poor self-esteem. In this stage, the child is worried about the failure and is very conscious about the performance. The child's behavior does not indicate a concept of good self-worth. Losing the chess competition is not indicative of trust issues, nor does the child show fear of punishment.

Following the assessment of a 3-year-old child, the nurse tells the parents that they will have to make efforts to manage the child, because their child has a slow-to-warm-up temperament. Based on what findings has the nurse made this assessment? Select all that apply. (p. 43) 1 The child has a moody nature. 2 The child has irregular habits. 3 The child is extremely active. 4 The child frequently has temper tantrums. 5 The child has decreased adaptability.

1 & 5 (I put 1, 4, & 5) Moody nature and inability to adapt well to a new environment are characteristics indicative of a slow-to-warm-up temperament. Unlike difficult children, these children do not have irregular habits. Such children are usually very inactive. On the other hand, difficult children are hyperactive. These children are silent and do not usually show aggressive behavior such as temper tantrums.

During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. The nurse, drawing on knowledge of developmental levels, suggests the most appropriate toys. What are they? Select all that apply. (p. 50) 1 Push-pull toys 2 Toys with black-white patterns 3 Pop-up toys such as Jack-in-the-box 4 Soft toys that can be put in the mouth 5 Toys that pop apart and fit back together

1, 3, 5 (I put 1 & 3) Both gross and fine motor skills are becoming more developed at this age, and these children enjoy toys that can help refine these skills. Children at this age enjoy more colorful toys rather than black-and-white ones. Children at this age are less interested in placing toys in the mouth and more interested in toys that can be manipulated.

During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. Based on the nurse's knowledge of developmental levels, the most appropriate toys to suggest are Select all that apply. push-pull toys. toys with black-white patterns. pop-up toy such as Jack-in-the-box. soft toys that can be put in the mouth. toys that pop apart and go back together.

1, 3, 5 (I put 1, 3, 4, 5) Both gross and fine motor skills are becoming more developed and children at this age enjoy toys that can help refine these skills. Children at this age enjoy more colorful toys. Children at this age are less interested in placing toys in the mouth and more interested in toys that can be manipulated.

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

3

Which toy is the best choice for a 12-month-old? 1. Baby doll 2. Music rattle 3. Board book 4. Colorful beads

2

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. Based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to feed lunch. allow the toddler to start making choices about what to wear. allow the toddler to pull a talking-duck toy. turn on a TV show with bright colors and loud songs.

2 A toddler is developing autonomy and is able to start making some choices about what he or she can wear. A toddler would not want the mother to feed him or her. The child is at the stage of autonomy versus shame and doubt, as defined by Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys the child can control will help achieve this stage. A toddler might easily become overstimulated by images from TV and loud sounds. Toddlers are more interested in manipulating and learning from objects in the environment.

In terms of genetic presentations, if a disease pattern exists without known correlation of symptoms, this would be characterized as a syndrome. association. sequence. mutation.

2 An association represents unrelated symptoms that are not identified by a single event or occurrence. A syndrome represents symptoms that are associated with a single defining event. A sequence represents numerous anomalies that are a consequence of a single defining event. A mutation represents an alteration in a genetic sequence that can lead to problems or symptoms.

Which age group of children have cognitive skills characterized by formal operations? (p. 46) 1 Toddlers 2 Adolescents 3 Early childhood 4 Middle childhood

2 Development of cognitive skills is much similar to that of physical growth and development. Adolescents are mastering the concepts of deductive and abstract reasoning, according to Piaget. Toddlers and children in early childhood have the ability to have preoperational thoughts; this is egocentric. Middle childhood is characterized by concrete operations.

The nurse, caring for a toddler in the activity room, notices that the toddler is playing with trains alongside another toddler. In what type of play is this toddler engaging? (p. 48) 1 Solitary 2 Parallel 3 Onlooker 4 Associative

2 In parallel play, children play independently with similar toys alongside one another. In solitary play, a child plays alone with different toys than those used by other children in the same area. In onlooker play, a child watches what other children are doing but makes no attempt to join in the play. In associative play, children play together and engage in similar or even identical activities but there is no organization, division of labor, leadership assignment, or mutual goal.

What is the social character of a child involved in parallel play? (p. 48) 1 The child tends to play alone with toys and games. 2 The child plays independently alongside other children. 3 The child watches other children, but is not involved in the play. 4 The child plays with other children engaged in a similar activity.

2 Parallel play involves performing individual tasks among peers, which is most commonly seen in toddlers. Tasks like creating crafts by a group of children are an example of parallel play. Playing alone, watching others, and playing with other children are not the characteristic features of parallel play. Playing with toys alone in a play area is called solitary play. If a child watches other children but does not become involved in the play, it is referred to as onlooker play. Playing with other children engaged in a similar activity is observed during associative play.

An infant weighed 7 pounds at the time of birth. If the growth and development of the infant is normal, how much does the height increase after one month? (p. 41 table 3-1) 1 0.5 inch 2 1 inch 3 1.5 inches 4 2 inches

2 Physical growth is the most prominent feature observed in children and infants. The normal weight of a newborn is 7 to 7.5 pounds. The growth and development of the infant is indicated as normal if the height increases by 1 inch (2.5 cm) per month. This is observed in the first 6 months of the child's life.

Which statement helps explain the growth and development of children? Development proceeds at a predictable rate. The sequence of developmental milestones is predictable. Rates of growth are consistent among children. At times of rapid growth, there is also acceleration of development.

2 There is a fixed, precise order to development. There are periods of both accelerated and decelerated growth and development. Each child develops at his or her own rate. Physical growth and development proceed at differing rates.

The nurse offers candy to a child. The child does not accept the candy and says, "If I take this, my mom will scold me." According to Kohlberg's theory of moral development, which level does this child's response indicate? 1 Conventional level 2 Preconventional level 3 Autonomous level 4 Postconventional level

2 (I put 1) In the preconventional level of moral development, a child decides whether to do or not to do an action based on the consequence of the action. In this situation, the child fears punishment and thus refuses the nurse's offer. In the conventional level, the child demonstrates behavior that pleases others and is considered good. In the postconventional or the autonomous level, an individual's behavior is defined in terms of what the individual thinks is fair and the standards of behavior set by society.

At what age would a child demonstrate the ability to understand the concept of compromise as related to social play interactions? 2 years of age 5 to 6 of age It depends on the child's ability to reason and therefore may vary considerably It is a learned concept and is typically present by 10 years of age.

2 (I put 3) Typically, when a child reaches 5 to 6 years of age, they have an understanding of compromise or arbitration based on their respective past experiences. This concept is not well understood at an earlier age such as 2 years of age. Although each child is an individual and is influenced by their environment, the concept of compromise is usually seen by the age of 5 to 6 years of age. Through continued interaction with peers, the concept of compromise is integrated. This should be present well before 10 years of age.

A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child's development is on target? The child has not gained weight for 3 months. The child can throw a large ball but not a small ball. The child's arms are the most rapidly growing part of the child's body. The child can pull herself or himself to her or his feet before the child is able to sit steadily.

2 (I put 4) Development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large objects before small ones. Not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child's development may not be on target. In children, the legs are normally the most rapidly growing part of the body; if this is not the case, the child's development may not be on target. A child whose development is on target can sit steadily before pulling herself or himself up to her or his feet.

While reviewing the laboratory reports of a 12-month-old infant, the nurse finds that the infant has elevated levels of phenylalanine in the blood. Which recommendation does the nurse give to the mother to ensure the infant's safety? 1 "You should not give your child a high-protein diet." 2 "You should not feed your child whole cow's milk." 3 "You should mix aspartame in the infant's foods." 4 "You should avoid feeding commercially available formula to the infant."

2 (I put 4) Elevated levels of phenylalanine in the blood indicate phenylketonuria. Environmental factors such as milk trigger and increase the risk of phenylketonuria. An infant with phenylketonuria requires a high-protein diet. The artificial sweeter aspartame contains high amounts of phenylalanine. Therefore, the mother should not add aspartame to the infant's diet. Commercially available formulas do not increase the risk of phenylketouria. Therefore, the mother can feed the infant formula.

Parents are often confused by the terms growth and development and use the terms interchangeably. Based on the nurse's knowledge of growth and development, the most appropriate explanation of development is a child grows taller all through early childhood. a child learns to throw a ball overhand. a child's weight triples during the first year. a child's brain increases in size until school age.

2 (I put 4) Development is the mental and cognitive attainment of skills as noted by the ability of a child to learn to throw a ball overhand. The other options refer to growth which is the increase in physical size both height and weight.

Which statements provides the best description of parallel play? Select all that apply. Two children playing checkers together. One child playing with his truck while another child plays with a car while seated on the floor. Three children playing each playing with a deck of cards but performing different actions with the respective deck of cards. Two children playing with dolls together while a third child walks by with a doll stroller and asks if she could play with them.

2, 3 Parallel play represents children who are playing with similar toys but are not directly engaged in playing with them together. Their actions may be similar but they are not identical and there is no verbal/direct interaction during the course of play. Two children playing checkers together are interacting as are the two children playing with dolls while a third child interacts with them.

Which stressors are common in hospitalized toddlers? SATA. 1. Social isolation 2. Interrupted routine 3. Sleep disturbances 4. Self-concept disturbances 5. Fear of being hurt

2, 3, 5

Following an assessment, the nurse finds that the child has a difficult temperament. Which assessment finding would have led the nurse to conclude this? Select all that apply. 1 The child reacts negatively to new stimuli. 2 The child is highly active and very irritable. 3 The child adapts slowly to new routines. 4 The child behaves in predictable ways. 5 The child adapts slowly to established routines.

2, 3, 5 (I put 1, 2, 3) Temperament is the manner of thinking, behaving, or reacting characteristic of an individual. A child's temperament can be categorized in one of three ways based on characteristics displayed by the child. The difficult child is highly active and irritable. Such a child adapts slowly to new routines and situations. The difficult child is unpredictable in behavior. The difficult child does not react negatively to new stimuli. The difficult child adapts well to repetitive routines. Slow-to-warm-up children react negatively to new stimuli. They also adapt slower to repetitive routines with repeated contact.

What is one of the most common causes of injury and death for a 9 month old infant? 1. poisoning 2. child abuse 3. aspiration 4. dog bites

3

Upon reviewing a patient's laboratory reports, the nurse confirms pregnancy. The nurse also finds that the patient is using isotretinoin (Accutane) for acne. Which information does the nurse provide to the patient? (p. 52) 1 "You should apply isotretinoin (Accutane) as usual." 2 "You should apply isotretinoin (Accutane) only once a day." 3 "You should stop taking isotretinoin (Accutane) medication." 4 "You should stop isotretinoin (Accutane) after the first trimester."

3 Isotretinoin (Accutane) is a teratogen and can result in harmful effects on the fetus. Therefore, the nurse should instruct the patient to stop taking isotretinoin (Accutane) medication. The patient should not apply isotretinoin (Accutane) as usual or once per day. Isotretinoin (Accutane) can cause potential harm to the fetus during pregnancy, mainly in the first trimester.

A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory? Erikson Fowler Kohlberg Freud

3 Kohlberg developed the theory of moral development sequence for children. It includes how children acquire moral reasoning and is based on cognitive developmental theory. Erikson developed the theory of psychosocial development. Fowler developed the theory of spiritual development. Freud developed the theory of psychosexual development.

Which behavioral pattern would be a cause for concern to a nurse for in a pediatric male patient, 8 years of age, who is presenting to the clinic with his parents for a well-child visit? Child is quiet playing with his iPad while his parents answer questions posed by the nurse. Parents are laughing and joking with their son regarding an earlier event that occurred that day. Parents are telling their son that he is going to get fat if he continues to keep eating pretzels before dinner. Child asks to borrow the nurse's stethoscope to see how it works.

3 Labeling behavior applying a "fat" notation to a concept even in the context of nutritional knowledge may lead to alterations in body image at a young age. The child playing with his iPad and/or asking for the nurses' stethoscope are age appropriate behaviors. The interaction of parent and child laughing and joking about an earlier event in the day indicate acceptance.

During a home visit, the nurse observes that a 4-year-old child cheats while playing and wants to change the rules for winning. What does the nurse conclude from the child's activity? 1 The child is very hyperactive. 2 The child is a difficult child. 3 It is age-associated behavior. 4 The child has trust issues.

3 Preschoolers hate to lose at games, so they try to cheat or change the rules of the game in order to win. In addition, they demand opportunities to change their opportunities for winning. It is a normal age-associated behavior. It does not indicate that the child is hyperactive. Such children should not be labeled as difficult children because difficult children are highly active, irritable, and irregular in their habits. This activity does not indicate that this child has trust issues.

Parents of a 4-month-old infant bring the infant to the clinic for a well-baby checkup. Which instruction should the nurse include at this time about injury prevention? "Never shake baby powder directly on the infant because it can be aspirated into the lungs." "Do not permit the child to chew paint from window ledges, because the child might absorb too much lead." "When the child learns to roll over, you must offer supervision whenever the child is on a surface from which the child might fall." "Keep doors of appliances closed at all times."

3 Rolling over from the abdomen to the back occurs between 4 and 7 months of age. This statement is the appropriate anticipatory guidance for this age related to the prevention of injuries. "Never shake baby powder directly on the infant because it can be aspirated into the lungs" is appropriate guidance for a first-month well-baby checkup related to injury prevention. Information on lead, and lead sources, should be included at the 9-month visit when the child is beginning to crawl and pull himself or herself to a standing position. Guidance regarding appliances and keeping doors of appliances closed should be included at the 9-month visit when the child is beginning to crawl and pull himself or herself to a standing position.

The school nurse finds that a preschooler seems uninterested in basketball and more interested in games such as London Bridge. What could be the reason behind the child's interest? (p. 48) 1 The preschooler does not like physically active games. 2 The preschooler does not like playing with others. 3 The preschooler does not like competitive games. 4 The preschooler likes to play imitative games.

3 Some preschoolers do not like to play competitive games such as basketball because they hate to lose. To win a game, they may cheat or try to change the rules. Some preschoolers like to engage in physically active games and like to play with others. Preschoolers do not engage in imitative play; rather they engage in formal games.

The nurse is assessing a 4-year-old child in a health care facility. The child asks another female patient with a distended abdomen, "When is your baby coming out?" Of what is this behavior indicative? (p. 46) 1 Conservation 2 Intuitive reasoning 3 Transductive reasoning 4 Object permanence

3 The child asks the woman having a distended abdomen, "When is your baby coming out?" This indicates that the child has a notion that all women who have large abdomens bear children. This reasoning is referred to as transductive reasoning. Conservation refers to the idea that factors such as volume, weight, and number remain the same, even though outward appearances are changed. Intuitive reasoning refers to concepts which have no basis or inference. These concepts are generated by the child. Object permanence means that a child is aware that an object exists even when it is not visible.

The nurse is caring for a 10-year-old boy. What does the nurse recognize as most characteristic of the concrete operations stage of cognitive development? (p. 46) 1 Intuitive reasoning 2 Thought becoming more abstract 3 Thought becoming less self-centered 4 The inability to put one's self in the place of another

3 Thought becomes less self-centered by the time a child reaches the age of 10. Children at this age can consider points of view other than their own. Thought does not become more abstract until a child is 11 to 15 years of age. Reasoning at the intuitive level occurs in 2- to 7-year-old children. At this age, they do have the ability to put oneself in the place of another.

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning? 4 months 6 months 10 months 14 months

3 (I picked 4) At 10 months of age, infants say sounds with meaning. Consonants, such as n, k, g, p, and b, are made by an infant at 4 months of age. Babbling resembling one-syllable sounds occurs at 6 months of age. Age 14 months is late for the development of sounds with meaning. Between the age of 1 and 2 years, the number of words should increase from approximately 4 words to 300 words.

The nurse is explaining about the behavioral interventions that have to be adopted while caring for a 2-year old-child. Based on Erikson's stages of development, which intervention suggested by the nurse is the most appropriate? 1 The child should be encouraged to solve problems alone. 2 The child should be encouraged to work together with peers. 3 The child should never be punished in front of peers. 4 The child should never be allowed to play independently.

3 (I put 1) According to Erikson's stages of development, the child is in the stage of autonomy versus shame and doubt. A child at this age may feel small and conscious when scolded in front of other children. The parent should never react negatively to the child in front of others. The child is not mature enough to solve problems alone or work together with peers. These activities should be encouraged when the child is more than 3 years of age. Children in this phase enjoy doing things by themselves. Thus, solitary play should be encouraged. .

What does the nurse interpret when a child failed an item in Denver II? 1 It is an acceptable score. 2 It indicates delayed development. 3 It is a caution indicator. 4 It indicates advanced development.

3 (I put 2) The Denver II is an assessment tool used for diagnosing children with cognitive impairments. The nurse interprets the score based on the results obtained during the assessment. A score of caution indicates that the child either failed the task or refused to perform the task by the age line or between the 75h and 90th percentiles. This interpretation does not indicate that development is acceptable, delayed, or advanced. The development is acceptable when the item is passed, failed, or refused by the age line between the 25th and 75th percentiles. Delayed development indicates a complete failure of items to the left of the age line. Advanced development indicates complete passing of items to the right of the age line.

A 2 y/o admitted to the hospital 2 days ago has been crying and is inconsolable much of the time. The nurse's best response to the child's parents who are concerned about this behavior that the child is in: 1. Detachment phase of separation anxiety 2. Despair stage of separation anxiety 3. Bargaining stage of separation anxiety 4. Protest stage of separation anxiety

4 During the protest stage of separation anxiety, children are often inconsolable and often cry more than they do when they are at home. These children also frequently ask to go home. 1. Detachment phase -> children are usually fairly cheerful and often lack a preference for their parents 2. Despair phase -> children usually have a loss of appetite, altered sleep patterns, and lack of much interest in play 3. The bargaining stage is not a stage of separation anxiety/

A 12-year-old child is performing extracurricular activities in school. The child stays after school and tries to grab the teacher's attention. The child participates in every event at school and tries to win approval. According to the Kohlberg theory, what is the probable reason for the child's behavior? (p. 46) 1 Social-contract orientation 2 Law-and-order orientation 3 Naive instrumental orientation 4 Good-boy, nice-girl orientation

4 In this stage, the child obeys the rules, performs one's duty, maintains the social order, and shows respect for authority. The child does all these things to earn approval for being nice. This stage is observed in the child aged 6 to 12 years. In children between the ages of 12 to 18 years, the child's social-contract orientation is observed. In this stage, the child recognizes the social laws and tries to make possible changes in the law in terms of societal needs and rational considerations. In the 6 to 12 years age group, law-and-order orientation is observed. In this stage, the child tries to follow laws. Children between the ages of 3 to 6 years old fall into the naive-instrumental orientation stage. This is when the child's behavior is motivated by a selfish desire to obtain rewards and benefits.

Following an assessment of a 3-year-old child, the nurse finds that the child likes being destructive, but is afraid of punishment. What is the likely reason for the child's behavior according to Kohlberg's moral judgment theory? (p. 46) 1 Social-contract orientation 2 Law-and-order orientation 3 Naive instrumental orientation 4 Punishment and obedience orientation

4 Kohlberg's moral judgment theory is based on cognitive developmental theory. According to this theory, at this age, the child is in the stage of punishment and obedience orientation, and follows the rules due to the fear of punishment. At this age, punishment and obedience orientation is found in the child. To avoid punishment, the child obeys rules without question. The child judges whether an action is good or bad on the basis of punishment. Social-contract orientation occurs in the child at the age of 12 to 18 years. During this stage, the child behaves like a more responsible person and tries to develop good social relationships. Law-and-order orientation occurs in the child at the age of 6 to 12 years. In this stage, the child tries to follow laws. Naive instrumental orientation occurs in the child at the age of 3 to 6 years. In this stage, the child's behavior is motivated by a selfish desire to obtain rewards and benefits.

The nurse is teaching a group of nursing students about the process of neurologic maturation in infants. Which statement made by the nurse is most appropriate? (p. 42) 1 "The need for sleep decreases as the child gets older." 2 "The basal metabolic rate is slightly higher in boys than girls." 3 "A growth plate unites diaphysis by columns of metaphysis." 4 "This provides the foundation for behavioral development."

4 Neurologic development indicates the development of the brain and the nervous system. The rate of increase in the number of neurons starts from 15 to 20 weeks of age and extends up to 1 year. Maturation of the neurologic system leads to language, learning, and behavioral development. Even though infants require less sleep as they get older, this is not related to neurologic development. The child's basal metabolic rate and fusion of the growth plates are not the characteristic features of neurologic development in infants either. Decrease in sleep time indicates sleep and rest processes on aging. The differences in the basal metabolic rate in different genders indicate the metabolic status. The role of the growth plate in uniting diaphysis is a process of ossification.

What are the first parts of speech to be demonstrated by children? (p. 46) 1 Adjectives and nouns 2 Adjectives and adverbs 3 Sentences of 3 to 5 words 4 Nouns, sometimes verbs, and combination words

4 Nouns, sometimes verbs, and combination words are the first parts of speech to appear. Responses are usually structurally incomplete during the toddler period, although the meaning is clear. Adjectives and adverbs come after nouns and verbs.

What is the therapeutic value of play? 1 It helps children to learn the effect of their behavior on others. 2 It helps the child to establish positive social relationships. 3 It creates opportunity to express ideas and experiment. 4 It expresses emotions and releases improper impulses.

4 Play is therapeutic for children of all age groups. Play helps children to express their feelings and relieve stress. This helps them in mastering difficult tasks. Play does not help children to learn the effect of behavior in others, develop positive social relationships, or express or try out different ideas. Learning the impact of behavior on others is the ultimate goal of self-awareness. Establishing social relationships is the ultimate goal of socialization. Creating opportunities to try new ideas is the realm of creativity.

What does the nurse recognize as a characteristic of the psychosocial development of school-age children? (p. 45) 1 Peer approval is not a motivating power. 2 Developing a sense of initiative is very important. 3 Motivation comes from extrinsic rather than intrinsic sources. 4 Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

4 School-age children are eager to develop skills and participate in activities. Not all children are able to perform all tasks well, and the child must be prepared to accept some feelings of inferiority. Peer group formation is one of the major characteristics of this age group. A developing sense of initiative is characteristic of preschoolers. School-age children gain satisfaction from successful independent behaviors.

Which characteristic best describes the fine motor skills of a 5-month-old infant? Transfers objects from one hand to another Crude pincer grasp Able to build a tower of two cubes Able to grasp an object voluntarily

4 The ability to grasp objects voluntarily is an appropriate fine motor skill for a 5-month-old infant. Transferring objects from one hand to another is an appropriate fine motor skill for a 7-month-old. A crude pincer grasp is an appropriate fine motor skill for an 8- to 9-month-old. The ability to build a tower of two cubes is an appropriate fine motor skill for a 15-month-old.

A 5-year-old boy asks the parent, "How do girls pee?" The mother is very anxious about the child's behavior and consults with the nurse. Which response made by the nurse relieves the parent's anxiety? (p. 44) 1 The child has symptoms of a hormonal disorder. 2 The child's behavior indicates the anal stage. 3 The child requires some psychologic treatment. 4 The child's behavior indicates the phallic stage.

4 The child's behavior indicates that the child is in the phallic stage of development. According to Freud's psychosexual development theory, human behavior is energized by psychodynamic forces. This theory describes human psychologic sensual pleasure. At this age, the child's genitalia become an interesting and sensitive area of the body. The child can recognize differences between the sexes. Therefore, the nurse should tell the parent that this is normal behavior. Asking questions is not a symptom of a hormonal disorder. In the anal stage, the sphincter muscles develop and children are able to maintain control over bowel elimination. It is an age-associated behavior and does not indicate that the child requires psychologic treatment.

The nurse instructed a nursing student about temperamental attributes of childhood behavior. The nurse is evaluating student comprehension of the material. Which statement by the student indicates the need for further teaching? 1 "The slow-to-warm-up child usually reacts negatively to new stimuli." 2 "Easygoing children are regular and predictable in their habits." 3 "The slow-to-warm-up child responds to routine with passive resistance." 4 "The difficult child tends to adapt quickly to new routines."

4 The easygoing child, the difficult child, and the slow-to-warm up child are common categories based on the overall pattern of temperamental attributes. Temperament is the manner of thinking, behaving, or the reacting characteristic of an individual. One of the characteristic features is that the difficult child usually reacts slowly to new routines, people, and situations. The slow-to-warm-up child often has a negative approach to new stimuli, but responds with only mild but passive resistance to novelty or changes in routine. The easygoing child can adapt positively and easily to new stimuli. Easygoing children are regular and predictable in their habits. The difficult child is highly active and irritable. The difficult child adapts slowly to a new routine and situation because he or she does better with established routines and structure.

Following an assessment, the nurse finds that the child has poor gross motor skills. Which instruction should the nurse give to the parents for improving the muscle coordination in the child? 1 Encourage the child to draw some pictures. 2 Encourage the child to play with building blocks. 3 Encourage the child to participate in onlooker play. 4 Encourage the child to play with toys that require pulling.

4 The nurse should instruct the parents to encourage the child to play with toys that require pulling. It helps to develop muscles and facilitates muscle coordination. Drawing pictures, playing with building blocks, and being an onlooker to games do not help with improving muscle coordination of the child. Drawing pictures is helpful for developing fine motor skills of the child. Playing with building blocks helps the child to learn about shapes and sizes. Being an onlooker to games does not produce any muscle-related activity, and it is not helpful for improving the muscle coordination of the child.

What is the basal energy requirement of a newborn in kcal/kg of body weight? 1 102 2 104 3 106 4 108

4 (I put 1) The rate of metabolism indicates the basal energy requirement of an individual. It differs based on the weight of an individual. The average basal energy requirement of a newborn is 108 kcal per kilogram of body weight and changes as the child ages.

In which age group do children begin to direct their focus away from the family group to engage in a wide range of interaction among peers? (p. 39, 43) 1 Infancy period 2 Early childhood 3 Later childhood 4 Middle childhood

4 (I put 3) Middle childhood is generally referred to as school age. This is when the child's world is centered among peers. Individuals in the middle childhood age group rapidly advance in physical, mental, and social development. Infancy is characterized by motor and cognitive development and trust and mutuality with the mother. Early childhood, or toddlerhood, is characterized by intense activity and discovery. Later childhood, or adolescence, marks the onset of puberty and is an early indication of entry into the adult world.

A parent of a 6-year-old child is worried because the child is depressed and sad. The parent informs the nurse that the child is being teased by peers for not performing a task well when playing together. What does the nurse suggest to the child's mother to help the child perform well in the tasks? 1 "Encourage the child to perform the tasks by giving immediate assistance." 2 "Advise the child to play indoor games with you instead of playing with peers." 3 "Praise the child afterwards by not emphasizing the child's mistake." 4 "Share your pleasure with the child after successful completion of the tasks."

4 (I put 3) The nurse should provide guidelines to the parents by which they can help their child to master a task. The parents must share their pleasure with the child if the child is able to complete a task successfully. It gives motivation, encourages the child, and enhances self-esteem. The parents should not help the child immediately by giving assistance to complete a task. Children learn by trial and error. Physical activity and interaction with peers is essential for proper growth and development. The parents should encourage the child to play outdoor games. The parents must not ignore the mistakes of the child and should encourage the child to learn from mistakes.

*A nurse examining a toddler is discussing with the mother psychosocial development according to Erikson's theories. In light of the nurse's knowledge of Erikson, what is the most age-appropriate activity to suggest to the mother at this stage? (p. 44) 1 Feeding lunch 2 Allowing the toddler to pull a talking duck toy 3 Turning on a TV show with bright colors and loud songs 4 Allowing the toddler to start making choices about what to wear

4 (guessed 1) A toddler is developing autonomy and is able to start making some choices about what he or she can wear. A toddler who is beginning to focus on doing things for himself would not want the mother to feed him. The child is at the stage of autonomy versus shame and doubt according to Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys that the child can control will help the child reach this stage. Toddlers might easily become overstimulated by images from TV and loud sounds and they are more interested in manipulating and learning from objects in the environment.

According to Sigmund Freud, in which age period do children usually undergo maturation of the reproductive system and develop sex hormones? (p. 44) 1 1-3 years 2 3-6 years 3 6-12 years 4 12-18 years

4 Freud's theory of psychosexual development emphasizes that sexual instincts are important in personality development. It also emphasizes that the genital stage is the final stage observed in people who belong to the age group of 12 to 18 years. This age group indicates the onset of puberty and the development of the genitalia and related hormones. Children in the age group of 1 to 3 years are associated with the development of the sphincter muscles. Children who fall into the age group of 3 to 6 years develop the ability of differentiation between sexes. Children in the age group of 6 to 12 years make use of their physical and psychic energy in attaining knowledge and in vigorous play.

The nurse is teaching about developmental motor milestones to a group of mothers in the obstetric unit. Arrange the order in which a normally developing child would be able to perform the activities with increasing age. (p. 38) 1. The child would be able to sit. 2. The child would be able to stand. 3. The child would be able to crawl on four limbs. 4. The child would be able to turn the head from side to side. 5. The child would be able to raise the back in prone position.

4, 5, 1, 3, 2 Motor development always occurs in a cephalocaudal direction. In a normally developing child, the control of head movements occurs first. The child is able to turn the head from side to side. Once this motor milestone is achieved, the child then develops the ability to control the trunk. Therefore, the child is able to raise the back in the prone position. Once the child is able to stabilize the trunk, the child starts developing the ability to sit, initially with support, then without support. Gradually the child starts developing the ability of using the lower limbs as well. The child starts crawling using the upper and lower limbs. Once the child has gained control over lower limb movements, the child starts attempting to stand and walk.

Child 2 1/2 years is having a playdate with a 2 3/4 year old. During the play date, the two mothers should expect that the children will do which of the following?

Play alongside one another but not actively with one another (parallel play)