EXAM 1 (CH 1, 2, 4, 5, 10, 12, 13, 15, 17, 22, 23)

nonopioids pain medications

acetominophen NSAID ( ibubrophen, naproxen, indomethacin, diclofenac, celecoxib, ketorolac, choline magnesium trisalicylate)

The troubled adolescent thinking about suicide should be immediately referred for acute intervention when

the adolescent has a specific plan

The nurse can expect an infant whose birth weight was 7 pounds to weigh ______ lbs by 12 months of age? A. 14 pounds B. 21 pounds C. 28 pounds D. 32 pounds

B. 21 pounds

overweight

BMI above 85%

Six areas included in the neurologic examination

Behavior Sensory cerebellar functioning Motor functioning Reflexes Cranial nerves

Consanguineous

Blood relationships (p 49-51, 56-59, 63)

What is the process of physical growth in boys and girls from early school-age to age 12? By age 10 boys are heavier and taller than girls. By age 12 girls are taller and heavier than boys. Boys are shorter than girls during early school-age but are the same weight. Girls are heavier than boys during early school-age but are the same height.

By age 12 girls are taller and heavier than boys. By age 12, girls are taller and heavier than boys the same age.

A 12-month-old infant would be likely to have: A. 2 teeth B. 4 teeth C. 6 teeth D. 12 teeth

C. 6 teeth

In guiding parents who are choosing a daycare center, the nurse should stress the state licensure represents a program that maintains: A. optimal care B. health features C. minimum requirements D. safety features

C. minimum requirements

school age years

Children at this stage require explanations and the reasons why procedures are being done to them Children in these stage have a heightened concern about body integrity being overly sensitive to any activity thatConstitutes a threat to it

adolescence

Children in that these stage are interviewed first before they are parents

infancy

Children in this stage primarily use and respond to nonverbal communication

Match the age with the critical milestone in language development.

Cooing with a reciprocal smile 1-3 months Babbling is common. 3-4 months Repeating sounds to self 4-6 months Increase interest in sounds 6-8 months

Complete maturity of the kidneys occurs: A. at birth B. by 6 months C. by 1 year D. by 24 months

D. by 24 months

FLACC Pain Assessment Tool

F- facial expression L - leg movement A - Activity C - Cry C - Consolability

Family of origin

Family unit into which a person is born (p 49-51, 56-59, 63)

Which parental practice encourages motor vehicle safety for a school-aged child? Checking brake lights Speak quietly while conversing with the driver Fastening seat belt for every ride Leaving extra time to reach destination

Fastening seat belt for every ride The child seeing the parents consistently wear their seatbelts helps to encourage motor vehicle safety.

early childhood

Focus Communication on the child; experiences of others hold no interest to children in this stage Children in at this stage interpret words literally and are unable to separate fact from fantasy

anthropometry

an essential paramenter of nutritional status; the measurement of heirght, weight, head circumference, proportions, skinfold thickness, and arm circumference

psychological distress

anxiety fear anger dissappointment sadness guilt shame

Puberty is considered delayed in males if which physical changes do not occur by age 14? Growth of testes Gynecomastia Penis enlargement Axillary hair growth Scrotum color darkening

Growth of testes Puberty is considered delayed in males if testicular enlargement does not occur by age 14.

Landau

Hold infant in horizontal prone suspension. > Infant completely extends head, trunk, and extremities (a la Superman). Relevance: Breaks up flexor dominance; facilitates prone extension. Onset: 3-4 mths_____Integration: 12-24 mths

Arm circumference

Indirect measurement of muscle mass

family function

Interactions of the family members especially focusing on the quality of relations and interactions

Fear of punishment is the hallmark of which of Kohlberg's stages of moral development? Level of premorality Level of conventional morality Level of postconventional morality Level of self-accepted moral principles

Level of premorality Children at this level have no real understanding of right and wrong. Children will do what they are told to do rather than what is right. The child will demonstrate acceptable behavior because of a fear of punishment.

Which physical changes are experienced by girls during the adolescent years? Select all that apply. Menarche Pubic hair growth Breast development Formation of ovaries Decrease in adipose tissue

Menarche Menarche is a physical change experienced by girls during the adolescent years. Pubic hair growth Pubic hair growth is a physical change experienced by girls during the adolescent years. Breast development Breast development is a physical change experienced by girls during the adolescent years.

What is NOT considered a complementary and alternative medicine therapy?

Multivitamin

According to Holland-Hall and Burnstein, which developmental change in the brain allows for the adolescent's ability to think critically and solve problems? Demyelization Increased brain size Neuron maturation Decreased cortex growth

Neuron maturation Neuron maturation in the brain allows for critical thinking and problem solving.

A nurse is measuring the height and weight of a 4-year-old child during the well-child visit. The child's parents comment that they are concerned that the child's growth seems to have slowed down since the child was a toddler. The nurse knows that this is because of which factors? The child may be neglected at home. The child likely has a growth disorder. Normal growth slows down in this age group. The child isn't taking in enough calories for their age.

Normal growth slows down in this age group. It is normal for children to have slowed patterns of growth between age 2 and the onset of puberty. Rapid growth tends to occur during infancy/toddlerhood and puberty.

According to Piaget's cognitive theory, which concept is demonstrated by an infant looking for a pacifier that has fallen out of the crib? Object permanence Operational thought Preoperational thought Concrete operational thought

Object permanence This scenario reflects the development of object permanence, which is the awareness that objects continue to exist even when they disappear from sight. Object permanence develops in the sensorimotor period, when reflexive behavior is used to adapt to the environment and the child has an egocentric view of the world.

Why should the nurse auscultate the abdomen before palpation during an abdominal assessment? Palpation changes bowel sounds. Palpation will be painful for the patient. Palpation takes less time than auscultation. Auscultation can reveal more abnormalities than palpation.

Palpation changes bowel sounds. The nurse would auscultate before palpation, because palpation can cause a shift in intestinal contents and alter bowel sounds.

Decreased eating at mealtime, poor test scores, and refusal to talk about school may be signs that a child is experiencing which school-age problem? Peer influence School refusal Impulse control Peer victimization

Peer victimization Decreased eating at mealtime, poor test scores, and refusal to talk about school are signs of peer victimization or bullying.

The nurse is preparing to administer an oral narcotic to a pediatric patient. The nurse performed the six rights when removing the drug from the storage container, again when preparing the drug, and then asked a colleague to perform a final check. The colleague confirmed the six rights. What is the nurse's next step? Administer the drug. Perform the six rights at the bedside. Review the drug administration with the patient. Confirm the drug dosage with the unit nurse manager.

Perform the six rights at the bedside. The nurse should always perform the six rights at the bedside, prior to administering the medication. This is true even if a colleague performed an additional check.

A school-age child asks the school nurse about sexual development, which indicates that the child is in which Freudian stage of development? Anal stage . Latency stage Genital stage Phallic or Oedipal/Electra stage

Phallic or Oedipal/Electra stage During this stage the genitals become the focus of sexual curiosity, the superego (conscience) develops, and feelings of guilt emerge. Children at this stage are school age and often ask many questions.

The nurse is preparing to insert an IV catheter in a pediatric patient. What actions should the nurse take when applying eutectic mixture of local anesthetics (EMLA) cream? Select all that apply. Remove gloves to ensure accurate application. Apply over a surface area twice the size of the chosen site. Place on the skin site and cover with a transparent dressing. Leave in place for a minimum of 1 hour prior to catheter insertion. Rub the medication into the skin and cover with an occlusive dressing.

Place on the skin site and cover with a transparent dressing. The EMLA cream should be placed on the skin and covered with an occlusive, transparent dressing to allow absorption time and prevent the medication from being removed. Leave in place for a minimum of 1 hour prior to catheter insertion. The EMLA cream should be left in place for at least 1 hour but should be removed within 4 hours after placement.

Which milestones associated with fine/gross motor control are achieved by the adolescent? Select all that apply. Driving a car Jumping in place Playing an agility sport Texting on a smart phone Playing a complex musical instrument

Playing an agility sport Developing more coordinated muscle control to play agility sports is a milestone associated with motor control achievement of the adolescent. Texting on a smart phone Developing more coordinated muscle control to text on a phone is a milestone associated with motor control achievement of the adolescent. Playing a complex musical instrument Developing more coordinated muscle control to play a complex musical instrument is a milestone associated with motor control achievement of the adolescent. Driving a car Developing more coordinated muscle control to drive a car is a milestone associated with motor control achievement of the adolescent.

Behavior modification

Practice based on the belief that behavior, if rewarded will be eliminated (p 49-51, 56-59, 63)

parenting styles

authoritarian, permissive, and authoritative

Examination of the abdomen is performed correctly by the nurse in what order? a. Inspection, palpation, and auscultation. b. Inspection, auscultation, and palpation. c. Palpation, auscultation, and inspection. d. Auscultation, inspection, and palpation.

b. Inspection, auscultation, and palpation.

If 5-year-old Brian develops thrombocytopenia, the nurse knows to avoid which one of the following medications for pain? a. Acetaminophen. b. NSAID's. c. Morphine d. Codeine.

b. NSAID's.

The nurse says to 15-year-old Monique, "Tell me about your cough." This is an example of which type of communication? a. Direct. b. Open ended. c. Reflective. d. Closed.

b. Open ended.

Which one of the following is an expected finding in the child's eye examination? a. Opaque red reflex of the eye. b. Ophthalmoscopic examination revealing that veins are darker and about one-fourth larger than the arteries. c. Strabismus in the 12-month-old infant. d. A 5-year-old who reads the Snellen chart at the 20/40 level.

b. Ophthalmoscopic examination revealing that veins are darker and about one-fourth larger than the arteries.

Which of the following terms describes a physiologic state in which abrupt cessation of an opioid results in a withdrawal syndrome? a. Tolerance. b. Physical dependence. c. Addiction. d Pseudo-addiction.

b. Physical dependence.

Which of these is not usually a factor in the development of a pediatric pressure ulcer? a. Shear b. Skin moisturizer c. Moisture d. Chemical factors e. Friction

b. Skin moisturizer

Head circumference is: a. measured in all children up to the age of 24 months. b. equal to chest circumference at about 1 to 2 years of age. c. about 8 to 9 cm smaller than chest circumference during childhood. d. measured slightly below the eyebrows and pinna of the ears.

b. equal to chest circumference at about 1 to 2 years of age

The caregivers of an 11-year-old child report that the child is worried about upcoming tests and is not sleeping well. The nurse tells the parents to watch for which signs of stress? Bed-wetting Malocclusion Watching three hours of TV Screaming during the night

Screaming during the night Sleep terrors, or screaming during sleep, can be brought on by stress. The child should not be awakened or comforted and will not remember the episode in the morning.

Freud suggested parts of the body assume psychological significance as the focus of which type of energy? Sexual energy Sensorimotor energy Preoperational energy Formal operational energy

Sexual energy Freud suggested that the body assumes psychological significance as the focus of sexual energy.

Which activity shows the school-age child has normal gross motor skill development? Tying shoelaces Drawing a picture Walking backwards Skipping on sidewalk

Skipping on sidewalk Skipping is an activity that shows normal gross motor skill development of the school-age child.

Which of the following statements about pattern of growth during adolescence is true? a. knowing the correct sequence of the growth pattern is useful only when assessing abnormal growth patterns versus normal growth patterns b. girls usually begin puberty and reach maturity about 2 years earlier than boys do c. girls and boys experience an increase of muscle mass that begins during early puberty and lasts throughout adolescence d. girls and boys experience an increase in linear growth that begins for both during midpuberty

b. girls usually begin puberty and reach maturity about 2 years earlier than boys do

Routine nutrition screening for all adolescents should include: a. a complete laboratory evaluation b. questions about meal patterns and consumption of foods c. a complete physical examination d. a complete family history

b. questions about meal patterns and consumption of foods

Intimate relationships are not necessarily characterized by: a. concern for each other's well-being. b. sharing of sexual intimacy c. a willingness to disclose private, sensitive topics d. sharing of common interests and activities

b. sharing of sexual intimacy

which of the following dysfunctional speech patterns is a normal characteristic of the language development of a preschooler? a. lisp b. stuttering c. nystagmus d. echolalia

b. stuttering

voluntary control of elimination

Spincter control by age 18-24 months

A child lives in an overcrowded apartment. Which is the nurse's main concern? The child's privacy Comfort level for the family Access to food and clean water Spread of communicable disease

Spread of communicable disease Living in close quarters can increase the spread of communicable disease and the likelihood of illness.

Which toy is appropriate to encourage cognitive development in the toddler? Card game Board game Stacking cups One-hundred-piece puzzle

Stacking cups Stacking cups would encourage cognitive development. Cups are also safe and durable. This would be an appropriate toy.

children who are identified as having a difficult or easily distracted temperment

benefit from pactice sessions before an event

Infant mortality decreased significantly in the 1990s for which of the following? a) Low birth weight b) congenital heart defects c) HIV infection d) SIDS

c) HIV infection

Mental health problems in children: a) affect 1/20 adolescents b) make the children less likely to drop out of school than those w/other disabilities c) include ADHD d) are more common in children living in large urban centers

c) include ADHD

After a child reaches the age of 1 year, the leading cause of death is from: a) HIV b) congenital anomolies c) unintentional injuries d) heart disease

c) unintentional injuries

Which one of the following has been shown to have calming and pain-relieving effects when used with invasive procedures in neonates? a. Allowing parent to hold neonate during procedure. b. Allowing neonate quiet time in the bassinet before the procedure. c. Administering concentrated sucrose with or without nutritive sucking before the procedure. d. Using relaxation techniques during the procedure.

c. Administering concentrated sucrose with or without nutritive sucking before the procedure.

Which of the following reactions to surgery is most typical of an adolescent's reaction of fear of bodily injury? a. Concern about the pain b. Concern about the procedure itself c. Concern about the scar d. Understanding explanations literally

c. Concern about the scar

Which of the following is not a correct definition of the term "family" as it is viewed today? a. The family is what the patient considers it to be b. The family may be related or unrelated c. The family is always related by legal ties or genetic relationships, and members live in the same household d. The family members share a sense of belonging to their own family

c. The family is always related by legal ties or genetic relationships, and members live in the same household (p 46-47)

When caring for the child in isolation, the nurse should: a. spend as little time as possible in the room. b. teach the parents to care for the child to decrease the risk for spreading infection. c. let the child see the nurse's face before donning the mask. d. perform all of the above.

c. let the child see the nurse's face before donning the mask. pt/fam must receive info about reason behind isolation and risk to fam if isolation not followed anticipatory preparation; allow to dress up in gown/mask/gloves

EBP

The collection, interpretation, and integration of valid, important, and applicable patient-reported, clinician-observed, and research-derived evidence concept - analizing and translating published clinical research into the everyday practice of nursing

One difference between toddlers and school-age children in their reactions to hospitalization is that most school-age children: a. experience more separation anxiety. b. show less fright or overt resistance to pain. c. may react more to separation from school friends. d. may throw temper tantrums

c. may react more to separation from school friends. preschoolers more secure, can tolerate brief separation and more inclined to dvp trust in other adults (illness may cause regression) less obvious signs of separation anxiety in school age: crying quietly waiting for parents, difficulty sleeping, refusal to eat, continually asking when parents will return, break toys, hitting other kids

Noncompliant families: a. share typical characteristics. b. have less education than compliant families. c. often have complex medical regimens. d. often have an increased loss of control.

c. often have complex medical regimens. satisfaction with physical setting, relationship with HCP, simple treatment improve compliance measure by clinical judgment, self reporting, direct observation, monitoring appointments/therapeutic response/pill counts, and chemical assays

Health concerns consistent with middle adolescence include: a. school performance b. emotional health issues c. physical appearance d. future career or employment

c. physical appearance

To practice cultural humility with children and their families, the nurse should: a. disregard one's own cultural values. b. identify behavior that is abnormal. c. recognize characteristic behaviors of certain cultures. d. rely on one's own feelings and experiences for guidance.

c. recognize characteristic behaviors of certain cultures.

What is one way adolescents receive inappropriate or incorrect information regarding sex and sexuality? The internet Outdated books Health teacher Talking to parents

The internet The internet, social media in particular, is a way an adolescent can receive inappropriate or inaccurate information on sex. The information on social media also may not reflect the morals and values held by the household.

The nurse has to administer amoxicillin to the pediatric patient who weighs 40 lbs. The dose required is 60 mg/kg/day BID. Calculate the mg/dose the patient will receive mg/dose BID.

The nurse has to administer amoxicillin to the pediatric patient who weighs 40 lbs. The dose required is 60 mg/kg/day BID. Calculate the mg/dose the patient will receive mg/dose BID.

When using epidural analgesia to manage pain, the nurse knows that: a. analgesia results from the drug's effect on the brain. b. respiratory depression is fast to develop, usually 1 to 2 hours of administration. c. the epidural spaces at the lumbar and caudal level are used most often. d. securing the catheter with an occlusive dressing does little to prevent infection.

c. the epidural spaces at the lumbar and caudal level are used most often.

obtain informed consent

capable of giving consent person must receive the info needed to make an intelligent decision person must act voluntarily

True or false: Roles are learned through the socialization process

True (p 51-52)

Which is a common physical growth pattern seen in infancy during the first to second month? Upper limbs and head grow faster. Lower limbs and GI tract develop faster. Cardiovascular system and lower limbs develop faster. Respiratory and immune systems develop at a rapid pace

Upper limbs and head grow faster. A faster growth of the upper limbs and head is a common pattern seen in the first two months of life. Head circumference measurements are taken at each health provider visit to ensure the infant is showing normal growth patterns.

vernix caseosa

Waxy or "cheesy" white substance found coating the skin of newborn humans

Cindy, age 16, reports that she has been sexually abused by her uncle. The nurse knows that the adolescent who has been a victim of sexual abuse: a. should be informed about the steps in the reporting process before information is disclosed to local authorities b. is more likely to become a runaway c. is more likely to remain in school and form ties with less-threatening families d. will usually attempt suicide within 1 month of reporting the incident

a. should be informed about the steps in the reporting process before information is disclosed to local authorities

middle childhood is also referred to as the middle years, the school years, or the school age years. what ages does this period represent

ages 6-12 years old

A mother states that her baby has a rash directly over the umbilical area. As a triage nurse completing a problem-based history, which is an important question to ask? "At how many weeks gestation was the baby born?" "Have you tried any treatments at home to help with the rash?" "Is there a family history of melanoma or other skin disease?" "Has the baby ever been diagnosed with any skin conditions, such as eczema?"

"Have you tried any treatments at home to help with the rash?" The nurse would ask parents about any treatments they have tried at home to improve the child's condition as part of the problem-based history.

Which instructions by the nurse would be appropriate for the school-age child who is active in sports? "As long as it isn't hot, you can play." "Rest often and drink plenty of water." "If you are sweating, then take a break." "Stop playing sports when you feel tired."

"Rest often and drink plenty of water." Resting and staying hydrated are important to prevent dehydration and would be appropriate instruction for the school-age child who is active in sports.

What are the benefits of an adequate intake of dietary fiber?

-decrease constipation -decrease body weight -prevent type II diabetes

2 components of cognitive development for attachemtns

1. ability to descriminate the mother from other individuals 2. achievement of object permanence

growth rate until 5 months

1.5 lb per month

early adolescence

11-14 physical changes of puberty and emotional responses to them

What are the toddler years?

12-36 months

preconceptual phase

2-4 yo

The nurse has an order to administer 250 mg cephalexin p.o. every 12 hours to a pediatric patient who weighs 25 lbs. The pediatric dose limit is 45 mg/kg/day BID. The patient can receive mg/day.

513 The nurse will have to convert the weight to kilograms (25 lbs/2.2 = 11.4 kg). The next step is the multiplication of the weight times the dose (11.4 kg*45 mg/kg/day = 513 mg/day). The patient can receive up to 513 mg of cephalexin p.o. each day.

A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration solution (ORS). The nurse should recommend that the child's diet be advanced to what kind of diet? a. Regular diet b. Clear liquids c. High carbohydrate diet d. BRAT (bananas, rice, applesauce, and toast or tea) diet

ANS: A It is appropriate to advance to a regular diet after ORS has been used to rehydrate the child. Clear liquids are not appropriate for hydration or afterward. A high carbohydrate diet may contribute to loose stools because of the low electrolyte content and high osmolality. The BRAT diet has little nutritional value and is high in carbohydrates.

A male school-age student asks the school nurse, "How much with my height increase in a year?" The nurse should give which response? a. "Your height will increase on average 1 inch a year." b. "Your height will increase on average 2 inches a year." c. "Your height will increase on average 3 inches a year." d. "Your height will increase on average 4 inches a year."

ANS: B Between the ages of 6 and 12 years, children grow an average of 5 cm (2 inches) per year.

To prevent spread of illnesses from one patient to another after procedures, the most important strategy the nurse can use is to: a. follow disease-specific infection control guidelines. b. wear vinyl gloves. c. avoid wearing nail polish. d. wash the hands routinely after each patient contact.

d. wash the hands routinely after each patient contact.

The school nurse is teaching female school-age children about the average age of puberty. What is the average age of puberty for girls? a. 10 years b. 11 years c. 12 years d. 13 years

ANS: C The average age of puberty is 12 years in girls.

behavioral interventions to prevent and treat pain

distraction relaxation guided imagery hypnosis cognitive-behaviral therapy massage heat cold transcutaneous nerve stimulation some techniques have combined targets of action

2-4 yo speech

egocentric - repeating words and sounds for the pleasure of hearing oneself and is not intended to communicate socialized sppech - for communication abut self

Authoritarian

establishes rules, regulatiojns, and standards of conduct for children that are to be followed without question

Communication through transition objects such as dolls or stuffed animals delays the child's response to verbalCommunication offered by the nurse

false

rectal temperature

gold standard for the precise diagnosis contraindicated fpr infants younger than 1 month old, as well as children with recent rectal surgery, diarrhea, anorectal lesions, under chemotherapy 1 " for children and 1/2" for infants

race

groups people by their outward, physical appearance

ethnicity

groups people by their shared common characteristics or traditions

by the end of middle childhood children should be able to assume personal responsibility for self care in the areas of

hygiene, nutrition, excersise, recreation, sleep and safety

Malignan hyperthermia simptoms

hypercarbia( increased end tidal carbon dioxide) elevated temperature tachycardia tachypnea acidosis muscle rigidity hyperkalemia rhabdomiosis treat 100% oxygen; IV dantrolene sodium

The nurse says to Tina I am concerned about how the medicine treatmentsAre going becauseI want you to feel better

i messaging

Axilary temperature

inconsistent and insensetive for children under 1 month old used as screening tool for fever in young, clinically stable infants and children

ecologic framework

individuals adapt in response to changes in their surroundign environments

What is the primary developmental task of the toddler period using Erikson's theory?

learn to give up dependence for independence

what period beings toward the end of middle childhood and ends at age 13

preadolescences

principles of atraumatic care

prevent or minimize the child's separation from the family promote a sense of control prevent or minimize the bodily injury and pain

consanguineous

related by blood

physical distress

sleeplessness disturbances from sensory stomuli

What is true about stress in toddlers?

small amounts of stress help toddlers develop effective coping skills.

Flaws in corporal punishment:

teaches violence may physically harm the child children become accustomed to it and may need more severe punishment each time interferes with effective parent-child interaction may affect moral reasoning

fifth stage of sesorimotor phase

tertiary circular reaction applies combined knowledge to new situations, experimentation 19-24 months domestic mimicry

family centered care

to care of the parents as well as kids empower parents to care of the child, expecially siblings formal and informal support advocate for the family

major cause of death in small childrens

traumatic injuries if not injuries, than cancer

Children are alert to their surroundings and attach meaning to gestures

true

The most important digestive system changes completed during toddler period is?

voluntary control of sphincters

cranial nerves

1. Olfactory 2. Optic 3. Oculomotor 4. Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Vestibulocochlear 9. Glossopharyngeal 10. Vagus 11. Accessory 12. Hypoglossal

major cause of illness in kids

1. respiratory 2 GI -vomiting, diarrhea

Discipline

A system of rules governing conduct (p 49-51, 56-59, 63)

The infant's posterior fontanel closes by: A. 6-8 weeks B. 3-6 months C. 12-18 months D. 9-12 months

A. 6-8 weeks

The purpose of nonnutritive sucking is to: A. satisfy the basic sucking urge B. take in food C. collect food and propel it into the esophagus D. Provide an efficient way to process fluids

A. satisfy the basic sucking urge

Open family

Accepting of new ideas, resources, and opportunities (p 49-51, 56-59, 63)

If the infant weighs 8 kg at 5 months, about how many kg was his or her probable birth weight? A. 7.0 B. 6.0 C. 4.0 D. 15.0

C. 4.0

Function

Family interaction (p 49-51, 56-59, 63)

orthostatic hypotension

Often manifests as dizziness or syncope

Indirect history taking

Patient or parent completes questionnaire

Information overload

Receives too much information

BMI

Requires child's weight and height in order to determine

binocularity

The ability to use both eyes together; develops by 6 weeks

Identify the gross motor capability of the toddler. Select all that apply. Riding a bicycle Ascending the stairs Jumping over objects Hop on one foot Throwing a ball overhand

Throwing a ball overhand Throwing a ball overhand is a gross motor skill capability of the toddler. Ascending the stairs Learning to climb is a gross motor milestone of the toddler.

Match the stage of development according to Erikson with the corresponding age group.

Trust vs. mistrust Infancy Autonomy vs. shame Toddlerhood Initiative vs. guilt Preschool age Industry vs. inferiority School age

The major determinant of neonatal death in technologically developed countries is: a) birth weight b) short gestation c) long gestation d) HIV infection

a) birth weight

On palpation of 3-year-old Jennifer's apical impulse, where would the nurse expect to place the fingers? a. At the left midclavicular line and fourth intercostal space. b. Second left intercostal space, close to the sternum. c. Fifth left intercostal space, close to the sternum. d. Fifth right intercostal space, left midclavicular line.

a. At the left midclavicular line and fourth intercostal space.

Which one of the following is not part of the past history to be included in a pediatric health history? a. Symptom analysis. b. Allergies. c. Birth history. d. Current medications.

a. Symptom analysis.

The best intervention for the treatment of hyperthermia in a 4-year-old child is to administer: a. a tepid sponge bath. b. acetaminophen. c. an alcohol sponge bath. d. aspirin.

a. a tepid sponge bath. - water 1 degree less than temp cooling blankets/matresses, cool compress frequently asssess temp

The hormone in the female that causes growth and development of the vagina, uterus, fallopian tubes, and breasts is: a. estrogen b. progesterone c. follicle-stimulating hormone (FSH) d. luteinizing hormone (LH)

a. estrogen

Labyrinth righting

an infant in the rome or supine position is able to raise his or her head

seven year old any was cause taking a playmates toy. which o the following is an important understanding of this behavior

at this age ands sense of property rights is limited and he took the item simply because he was attracted to it

The numeric rating scale: a. consists of six cultural specific photographs of faces. b. uses a straight line. c. uses descriptive words. d. is harder to use but more reliable than other methods.

b. uses a straight line.

Which one of the following findings should the nurse recognize as normal when measuring the vital signs of a 5-year-old child? a. Femoral pulses graded at 1+. b. Oral temperature of 100.9 F. c. Blood pressure <90th percentile d. absent femoral pulses

c. Blood pressure <90th percentile

The Functional Disability Inventory (FDI): a. is used to evaluate depression in children with chronic pain. b. is used to evaluate the influence of acute pain on physical functioning. c. is used to assess the child's ability to perform everyday physical activities. d. has both child and parent versions.

c. is used to assess the child's ability to perform everyday physical activities.

magical thinking, according to piaget is a belief that: a. events have cause and effect b. god is an imaginary friend c. thoughts are all powerful d. if the skin is broken, the child's insides will come out

c. thoughts are all powerful

When administering medications to a child through a gastric tube, the nurse should: a. use oily medications to ease passage through the tube. b. mix the medication with the enteral formula. c. use a syringe with the plunger in place to administer the drug. d. flush the tube well between each medication administration.

d. flush the tube well between each medication administration.

telephone triage

involves assessing symptoms and forming clinical judgement for further medical care

neurologic reflexes during infancy

labyrinth righting neck righting body righting otolith righting landau parachute

major health problem with kids

obesity

acute pain

short-term, self-limiting, often predictable trajectory; stops after injury heals

24 month old's characteristic of motor development

the toddler's activities begin to produce purposeful results.

establishing a setting for communication

appropriate introduction assurance of privacy and confidentiality

The first pubescent change in boys is: a. appearance of pubic hair b. testicular enlargement with thinning, reddening, and increased looseness of the scrotum c penile enlargement d. temporary breast enlargement and tenderness

b. testicular enlargement with thinning, reddening, and increased looseness of the scrotum

The parent of a four-year old child is concerned because the child has lost several teeth. What response by the nurse is most appropriate? "Only provide milk at bedtime, not juice." "Your child should be checked for malnutrition." "It is normal at this age for your child to begin losing deciduous teeth." "You should focus on flossing your child's teeth more so they will not fall out."

"It is normal at this age for your child to begin losing deciduous teeth." Children may begin to lose deciduous teeth around four to five years of age. This is a normal occurrence, and the deciduous teeth should be replaced by permanent teeth.

For a problem-oriented history, a nurse would chart which statement as a chief complaint? "My mom died from cancer." "I smoke about three cigarettes every day." "My tummy has been hurting since last night." "I haven't been sick since I saw you last year."

"My tummy has been hurting since last night." The patient's report of abdominal pain since the previous night is the chief complaint.

Characteristics of Piaget's Preoperational Phase

-dependence on perception in problem solving -egocentric use of language -ability to manipulate objects in relation to one another in a logical manner

handling tantrums

-offer options - ensure consistent reply - praising the child for ositive behavior -

middle adolescence

15-17 transitioning from adult caregiver to peer -dominant orientation

What is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Childhood diseases d. Congenital disorders

ANS: A Injuries are the most common cause of death in children ages 1 through 4 years. It is the highest rate of death from injuries of any childhood age group except adolescence. Congenital disorders are the second leading cause of death in this age group. Infectious and childhood diseases are less common causes of death in this age group.

The nurse is teaching parents about avoiding accidental burns with their toddler. What water heater setting should the nurse recommend to the parents? a. 120° F b. 130° F c. 140° F d. 150° F

ANS: A The water heater should be set to limit household water temperatures to less than 49° C (120° F). At this temperature, it takes 10 minutes for exposure to the water to cause a full-thickness burn. Conversely, water temperatures of 54° C (130° F), the usual setting of most water heaters, expose household members to the risk of full-thickness burns within 30 seconds.

What are the goals of organized athletics for preadolescent children? (Select all that apply.) a. Physical fitness b. Basic motor skills c. A positive self-image d. Commitment to winning

ANS: A, B, C The goals of organized athletics for preadolescent children include physical fitness, basic motor skills, and a positive self-image. The commitment is to the values of teamwork, fair play, and sportsmanship, not to winning.

The nurse is planning play activities for a 2-month-old hospitalized infant to stimulate the auditory sense. Which activities should the nurse implement? (Select all that apply.) a. Talk to the infant. b. Play a music box. c. Place a squeaky doll in the crib. d. Give the infant a small-handled clear rattle.

ANS: A, B, D Auditory stimulation appropriate for a 2-month-old infant includes talking to the infant, playing a music box, and giving the infant a small-handled clear rattle. Placing a squeaky doll in the crib is appropriate for an infant 6 months of age or older.

What are characteristics of middle adolescence (15-17 years) with regard to relationships with peers? (Select all that apply.) a. Behavioral standards set by peer group b. Acceptance of peers extremely important c. Seeks peer affiliations to counter instability d. Exploration of ability to attract opposite sex e. Peer group recedes in importance in favor of individual friendship

ANS: A, B, D Characteristics of middle adolescence relationships with peers include behavioral standards set by the peer group, acceptance of peers is extremely important, and exploration of the ability to attract opposite sex. Seeking peer affiliations to counter instability is a characteristic of early adolescence relationships with peers. Peer groups receding in importance in favor of individual friendships is characteristic of late adolescence relationships with peers.

The parents of a 5-year-old child ask the nurse how they can minimize misbehavior. Which responses should the nurse give? (Select all that apply.) a. Set clear and reasonable goals. b. Praise your child for desirable behavior. c. Don't call attention to unacceptable behavior. d. Teach desirable behavior through your own example. e. Don't provide an opportunity for your child to have any control.

ANS: A, B, D To minimize misbehavior, parents should (1) set clear and reasonable rules and expect the same behavior regardless of the circumstances, (2) praise children for desirable behavior with attention and verbal approval, and (3) teach desirable behavior through their own example. Parents should call attention to unacceptable behavior as soon as it begins and provide children with opportunities for power and control.

The nurse determines that a child's intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action? a. Stop the infusion and apply ice. b. End the infusion and notify the practitioner. c. Slow the infusion rate and notify the practitioner. d. Discontinue the infusion and apply warm compresses.

ANS: B A vesicant causes cellular damage when even minute amounts escape into the tissue. The intravenous infusion is immediately stopped, the extremity is elevated, the practitioner is notified, and the treatment protocol is initiated. The applying of heat or ice depends on the fluid that has extravasated. The catheter is left in place until it is no longer needed.

The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine whether she is sexually active? a. Ask her, "Are you sexually active?" b. Ask her, "Are you having sex with anyone?" c. Ask her, "Are you having sex with a boyfriend?" d. Ask both the girl and her parent if she is sexually active.

ANS: B Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information for the nurse to provide necessary care. The word "anyone" is preferred to using gender-specific terms such as "boyfriend" or "girlfriend." Using gender-neutral terms is inclusive and conveys acceptance to the adolescent. Questioning about sexual activity should occur when the adolescent is alone.

At which age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. A 3-month-old infant can recognize familiar faces. At age 4 months, infants can enjoy social interactions.

children f divorce cope better with their feelings of baandonment when there is continuing conflict between parents

false

By the age of 3, the toddler generally:

has sense of maleness and femaleness

What is the best technique to use when toilet training a toddler?

limit sessions to 5-8 minutes of practice

What consideration is important for the nurse when changing dressings and applying topical medication to a child's abdomen and leg burns? a. Apply topical medication with clean hands. b. Wash hands and forearms before and after dressing change. c. If dressings have adhered to the wound, soak in hot water before removal. d. Apply dressing so that movement is limited during the healing process.

ANS: B Frequent hand and forearm washing is the single most important element of the infection-control program. Topical medications should be applied with a tongue blade or gloved hand. Dressings that have adhered to the wound can be removed with tepid water or normal saline. Dressings are applied with sufficient tension to remain in place but not so tightly as to impair circulation or limit motion.

What type of dehydration occurs when the electrolyte deficit exceeds the water deficit? a. Isotonic dehydration b. Hypotonic dehydration c. Hypertonic dehydration d. Hyperosmotic dehydration

ANS: B Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion. Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Hyperosmotic dehydration is another term for hypertonic dehydration.

What is descriptive of the social development of school-age children? a. Identification with peers is minimum. b. Children frequently have "best friends." c. Boys and girls play equally with each other. d. Peer approval is not yet an influence for the child to conform.

ANS: B Identification with peers is a strong influence in children's gaining independence from parents. Interaction among peers leads to the formation of close friendships with same-sex peers—"best friends." Daily relationships with age mates in the school setting provide important social interactions for school-age children. During the later school years, groups are composed predominantly of children of the same sex. Conforming to the rules of the peer group provides children with a sense of security and relieves them of the responsibility of making decisions.

The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large and one is too small. The best nursing action is which? a. Use the small cuff. b. Use the large cuff. c. Use either cuff using the palpation method. d. Wait to take the blood pressure until a proper cuff can be located.

ANS: B If blood pressure measurement is indicated and the appropriate size cuff is not available, the next larger size is used. The nurse recognizes that this may be a falsely low blood pressure. Using the small cuff will give an incorrectly high reading. The palpation method will not improve the inaccuracy inherent in the cuff.

Which family theory is described as a series of tasks for the family throughout its life span? a. Exchange theory b. Developmental theory c. Structural-functional theory d. Symbolic interactional theory

ANS: B In developmental systems theory, the family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Exchange theory assumes that humans, families, and groups seek rewarding statuses so that rewards are maximized while costs are minimized. Structural-functional theory states that the family performs at least one societal function while also meeting family needs. Symbolic interactional theory describes the family as a unit of interacting persons with each occupying a position within the family.

The Asian parent of a child being seen in the clinic avoids eye contact with the nurse. What is the best explanation for this considering cultural differences? a. The parent feels inferior to the nurse. b. The parent is showing respect for the nurse. c. The parent is embarrassed to seek health care. d. The parent feels responsible for her child's illness.

ANS: B In some ethnic groups, eye contact is avoided. In the Vietnamese culture, an individual may not look directly into the nurse's eyes as a sign of respect. The nurse providing culturally competent care would recognize that the other answers listed are not why the parent avoids eye contact with the nurse.

The parent of a 4-year-old boy tells the nurse that the child believes "monsters and bogeymen" are in his bedroom at night. What is the nurse's best suggestion for coping with this problem? a. Let the child sleep with his parents. b. Keep a night light on in the child's bedroom. c. Help the child understand that these fears are illogical. d. Tell the child that monsters and bogeymen do not exist.

ANS: B Involve the child in problem solving. A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with his parents will not get rid of the fears. A 4-year-old child is in the preconceptual stage and cannot understand logical thought.

Studies show that toddlers up to 24 months are the safest in a car when they are?

placed in a car seat facing the rear in the back seat.

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." What is the nurse's best interpretation of this comment? a. Sign of stress b. Common at this age c. Suggestive of maladaptation d. Suggestive of excessive discipline at home

ANS: B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age react to stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease? a. Teaching how to irrigate the colostomy b. Protecting the skin around the colostomy c. Discussing the implications of a colostomy during puberty d. Using simple, straightforward language to prepare the child

ANS: B Protection of the peristomal skin is a major priority. Well-fitting appliances and skin protectants are used. Teaching how to irrigate a colostomy is not necessary because colostomies are not irrigated in infants. The colostomy is usually reversed within 6 months to 1 year. The parents, not the infant, need to be prepared for the surgery.

After the family, which has the greatest influence on providing continuity between generations? a. Race b. School c. Social class d. Government

ANS: B Schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize race as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the family's economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the most significant influence on continuity besides family.

affinal

related through marriage

Piaget's theory of cognitive development depicts the toddler as a child who?

repeatedly explores the same object each time it appears in a new place

Burn injuries in the toddler age group are most often the result of?

scald burn from hot liquids

Accidental poisoning in toddlers can be best prevented by?

storing poisonous substances in a locked cabinet.

Physiologic anorexia in toddlers is characterized by?

strong taste preferences -extreme changes in appetite from day to day -heightened awareness of social aspects of meal

A bone marrow biopsy will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. How should the nurse respond? a. Holding your child is unsafe. b. Holding may help your child relax. c. Hospital policy prohibits this interaction. d. Holding your child is unnecessary given the child's age.

ANS: B The mother's preference for assisting, observing, or waiting outside the room should be assessed, as well as the child's preference for parental presence. The child's choice should be respected. This will most likely help the child through the procedure. If the mother and child agree, then the mother is welcome to stay. Her familiarity with the procedure should be assessed and potential safety risks identified (mother may sit in chair). Hospital policies should be reviewed to ensure that they incorporate family-centered care.

Guidelines for intramuscular administration of medication in school-age children include what standard? a. Inject medication as rapidly as possible. b. Insert needle quickly, using a dartlike motion. c. Have the child stand if at all possible and if the child is cooperative. d. Penetrate the skin immediately after cleansing the site while the skin is moist.

ANS: B The needle should be inserted quickly in a dartlike motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before the skin is penetrated. Place the child in a lying or sitting position.

When caring for a child with an intravenous (IV) infusion, what is an appropriate nursing action? a. Change the insertion site every 24 hours. b. Check the insertion site frequently for signs of infiltration. c. Use a macrodropper to facilitate reaching the prescribed flow rate. d. Avoid restraining the child to prevent undue emotional stress.

ANS: B The nursing responsibility for IV therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently, at least every 1 to 2 hours, to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. This exposes the child to significant trauma. A minidropper (60 drops/ml) is the recommended IV tubing in pediatric patients. Intravenous sites should be protected. This may require soft restraints on the child.

The nurse is assessing a toddler's visual acuity. Which visual acuity is considered acceptable during the toddler years? a. 20/20 b. 20/40 c. 20/50 d. 20/60

ANS: B Visual acuity of 20/40 is considered acceptable during the toddler years.

The school nurse recognizes that children respond to stress by using which tactics? (Select all that apply.) a. Passivity b. Delinquency c. Daydreaming d. Delaying tactics e. Becoming outgoing

ANS: B, C, D Children respond to stress by using coping mechanisms that include internalizing symptoms such as withdrawal, delaying tactics, and daydreaming, along with externalizing symptoms such as aggression and delinquency.

A parent asks the nurse, "When will I know my child is ready for toilet training?" The nurse should include what in the response? (Select all that apply.) a. The child should be able to stay dry for 1 hour. b. The child should be able to sit, walk, and squat. c. The child should have regular bowel movements. d. The child should express a willingness to please.

ANS: B, C, D Signs of toilet training readiness include physical and psychological readiness. The ability to sit, walk, and squat and having regular bowel movements are physical readiness signs. Expressing a willingness to please is a sign of psychological readiness. The child should be able to stay dry for 2 hours, not 1.

Which actions by the nurse demonstrate clinical reasoning? (Select all that apply.) a. Basing decisions on intuition b. Considering alternative action c. Using formal and informal thinking to gather data d. Giving deliberate thought to a patient's problem e. Developing an outcome focused on optimum patient care

ANS: B, C, D, E Clinical reasoning is a cognitive process that uses formal and informal thinking to gather and analyze patient data, evaluate the significance of the information, and consider alternative actions. Clinical reasoning is a complex developmental process based on rational and deliberate thought and developing an outcome focused on optimum patient care. Clinical reasoning is based on the scientific method of inquiry; it is not based solely on intuition.

What strategies should the nurse implement to assist in feeding a sick child? (Select all that apply.) a. Serve large portions. b. Make mealtimes pleasant. c. Avoid foods that are highly seasoned. d. Provide finger foods for young children. e. Ensure a variety of foods, textures, and colors.

ANS: B, C, D, E To assist in feeding a sick child mealtimes should be pleasant; highly seasoned foods should be avoided; finger foods should be provided for young children; and a variety of foods, textures, and colors should be ensured. Small portions, not large, should be served.

The nurse is performing an otoscopic examination on a child. Which are normal findings the nurse should expect? (Select all that apply.) a. Ashen gray areas b. A well-defined light reflex c. A small, round, concave spot near the center of the drum d. The tympanic membrane is a nontransparent grayish color e. A whitish line extending from the umbo upward to the margin of the membrane

ANS: B, C, E Normal findings include the light reflex and bony landmarks. The light reflex is a fairly well-defined, cone-shaped reflection that normally points away from the face. The bony landmarks of the eardrum are formed by the umbo, or tip of the malleus. It appears as a small, round, opaque, concave spot near the center of the eardrum. The manubrium (long process or handle) of the malleus appears to be a whitish line extending from the umbo upward to the margin of the membrane. The tympanic membrane should be light pearly pink or gray and translucent, not nontransparent. Ashen gray areas indicate signs of scarring from a previous perforation.

What developmental achievements are demonstrated by a 4-year-old child? (Select all that apply.) a. Cares for self totally b. Throws a ball overhead c. Has a vocabulary of 1500 words d. Can skip and hop on alternate feet e. Tends to be selfish and impatient f. Commonly has an imaginary playmate

ANS: B, C, E, F Developmental achievements for a 4-year-old child include throwing a ball overhead, having a vocabulary of 1500 words, tending to be selfish and impatient, and perhaps having an imaginary playmate. Caring for oneself totally and skipping and hopping on alternate feet are achievements normally seen in the 5-year-old age group.

The school nurse teaches adolescents that the detrimental long-term effects of tanning are what? (Select all that apply.) a. Vitamin D deficiency b. Premature aging of the skin c. Exacerbates acne outbreaks d. Increased risk for skin cancer e. Possible phototoxic reactions

ANS: B, D, E Adolescents should be educated regarding the detrimental effects of sunlight on the skin. Long-term effects include premature aging of the skin; increased risk for skin cancer; and, in susceptible individuals, phototoxic reactions. Exposure to levels of sunlight cause an increase in vitamin D production. Tanning can often reduce outbreaks of acne.

The school nurse is teaching bicycle safety to a group of school-age children. What should the nurse include in the session? (Select all that apply.) a. Ride double file when possible. b. Watch for and yield to pedestrians. c. Only ride double with someone your own size. d. Ride bicycles with traffic away from parked cars. e. Keep both hands on the handlebars except when signaling.

ANS: B, D, E Bicycle safety includes watching for and yielding to pedestrians, riding bicycles with traffic away from parked cars, and keeping both hands on handlebars except when signaling. It is best to ride single file, not double file, and never to ride double on a bicycle.

Characteristics of bullies include what? (Select all that apply.) a. Female b. Depressed c. Good peer relationships d. Poor academic performance e. Exposed to domestic violence

ANS: B, D, E Children who are bullies are likely to be male, depressed, have poor academic performance, be exposed to domestic violence, have poor peer relationships, and have poor communication with their parents.

The nurse is performing an assessment on a 12-month-old infant. Which fine or gross motor developmental skill demonstrates the proximodistal acquisition of skills? a. Standing b. Sitting without assistance c. Fully developed pincer grasp d. Taking a few steps holding onto something

ANS: C Acquisition of fine and gross motor skills occurs in an orderly center-to-periphery (proximodistal) or head-to-toe (cephalocaudal) sequence. A fully developed pincer grasp is an example of the proximodistal development because infants use a palmar grasp before developing the finer pincer grasp. Standing, sitting without assistance, and taking a few steps are examples of a cephalocaudal development sequence.

The parents of 9-year-old twin children tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and bird nests." The nurse should recognize that this is which? a. Indicative of giftedness b. Indicative of typical twin behavior c. Characteristic of cognitive development at this age d. Characteristic of psychosocial development at this age

ANS: C Classification skills involve the ability to group objects according to the attributes they have in common. School-age children can place things in a sensible and logical order, group and sort, and hold a concept in their mind while they make decisions based on that concept. Individuals who are not twins engage in classification at this age. Psychosocial behavior at this age is described according to Erikson's stage of industry versus inferiority.

The school nurse recognizes that pubertal delay in boys is considered if no enlargement of the testes or scrotal changes have occurred by what age? a. 11 1/2 to 12 years b. 12 1/2 to 13 years c. 13 1/2 to 14 years d. 14 1/2 to 15 years

ANS: C Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes by ages 13 1/2 to 14 years or if genital growth is not complete 4 years after the testicles begin to enlarge.

What is a characteristic of a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Use of holophrases c. Increasing level of understanding d. Approximately one third of speech understandable

ANS: C During the second year of life, the understanding and understanding of speech increase to a level far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. An 18-month-old child has a vocabulary of approximately 10 words. At this age, the child does not use the one-word sentences that are characteristic of 1-year-old children. The child has a very limited vocabulary of single words that are comprehensible.

The school nurse understands that children are impacted by divorce. Which has the most impact on the positive outcome of a divorce? a. Age of the child b. Gender of the child c. Family characteristics d. Ongoing family conflict

ANS: C Family characteristics are more crucial to the child's well-being during a divorce than specific child characteristics, such as age or sex. High levels of ongoing family conflict are related to problems of social development, emotional stability, and cognitive skills for the child.

At a well-child visit, parents ask the nurse how to know if a daycare facility is a good choice for their infant. Which observation should the nurse stress as especially important to consider when making the selection? a. Developmentally appropriate toys b. Nutritious snacks served to the children c. Handwashing by providers after diaper changes d. Certified caregivers for each of the age groups at the facility

ANS: C Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when handwashing and other hygienic measures are not consistently used. Developmentally appropriate toys are important, but hygiene and the prevention of disease transmission take precedence. An infant should not have snacks. This is a concern for an older child. Certified caregivers for each age group may be an indicator of a high-quality facility, but parental observation of good hygiene is a better predictor of care.

A 5-year-old child returns from the pediatric intensive care unit after abdominal surgery. The orders state to monitor vital signs every 2 hours. On assessment, the nurse observes that the child's heart rate is 20 beats/min less than it was preoperatively. What should be the nurse's next action? a. Follow the orders and check in 2 hours. b. Ask the parents if this is the child's usual heart rate. c. Recheck the pulse and blood pressure in 15 minutes. d. Notify the surgeon that the child is probably going into shock.

ANS: C In a 5-year-old child, this is a significant change in vital signs. The nurse should assess the child to see if his condition mirrors a drop in heart rate. The assessment and vital signs should be redone in 15 minutes to determine whether the child's condition is stable. When a disparity in vital signs or other assessment data is observed, the nurse should reassess sooner. Most parents will not know their child's heart rate. It is important to determine how the child is recovering from surgery. The nurse should collect additional information before notifying the surgeon. This includes blood pressure, respiratory rate, and pain status.

The nurse is assessing the Tanner stage in an adolescent female. The nurse recognizes that the stages are based on which? a. The stages of vaginal changes b. The progression of menstrual cycles to regularity c. Breast size and the shape and distribution of pubic hair d. The development of fat deposits around the hips and buttocks

ANS: C In females, the Tanner stages describe pubertal development based on breast size and the shape and distribution of pubic hair. The stages of vaginal changes, progression of menstrual cycles to regularity, and the development of fat deposits occur during puberty but are not used for the Tanner stages.

During an otoscopic examination on an infant, in which direction is the pinna pulled? a. Up and back b. Up and forward c. Down and back d. Down and forward

ANS: C In infants and toddlers, the ear canal is curved upward. To visualize the ear canal, it is necessary to pull the pinna down and back to the 6 to 9 o'clock range to straighten the canal. In children older than age 3 years and adults, the canal curves downward and forward. The pinna is pulled up and back to the 10 o'clock position. Up and forward and down and forward are positions that do not facilitate visualization of the ear canal.

A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? a. The parent is trying to feed the child only what the child likes most. b. Hispanics believe the "evil eye" enters when a person gets cold. c. The parent is trying to restore normal balance through appropriate "hot" remedies. d. Hispanics believe an innate energy called chi is strengthened by eating soup.

ANS: C In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are "cold" conditions and are treated with "hot" foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy.

Prevention of burn injury is important anticipatory guidance. In the infant and toddler period, which mode is the most common cause of burn? a. Matches b. Electrical cords c. Hot liquids in the kitchen d. Microwave-heated foods

ANS: C Infants and toddlers are most commonly injured by hot liquids in the kitchen and bathroom. This often occurs as a result of inadequate supervision of this curious and energetic age group. Matches and lighters are seen as toys by young children and should be kept out of reach. Older toddlers and preschool children are at risk of chewing on electrical cords and placing objects in outlets. Microwave-heated fluids and foods can become superheated, resulting in oral burns.

An appropriate method for administering oral medications that are bitter to an infant or small child should be to mix them with which? a. Bottle of formula or milk b. Any food the child is going to eat c. One teaspoon of something sweet-tasting such as jam d. Carbonated beverage, which is then poured over crushed ice

ANS: C Mix the drug with a small amount (about 1 tsp) of sweet-tasting substance. This will make the medication more palatable to the child. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Medication should not be mixed with essential foods and milk. The child may associate the altered taste with the food and refuse to eat this food in the future.

By which age should the nurse expect that an infant will be able to pull to a standing position? a. 5 to 6 months b. 7 to 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs.

The nurse is planning to administer a nonopioid for pain relief to a child. Which timing should the nurse plan so the nonopioid takes effect? a. 15 minutes until maximum effect b. 30 minutes until maximum effect c. 1 hour until maximum effect d. 1 1/2 hours until maximum effect

ANS: C Nonsteroidal antiinflammatory drugs (NSAIDs) can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency. Most NSAIDs take about 1 hour for effect, so timing is crucial.

The nurse manager is compiling a report for a hospital committee on the quality of nursing-sensitive indicators for a nursing unit. Which does the nurse manager include in the report? a. The average age of the nurses on the unit b. The salary ranges for the nurses on the unit c. The education and certification of the nurses on the unit d. The number of nurses who have applied but were not hired for the unit

ANS: C Nursing-sensitive indicators reflect the structure, process, and outcomes of nursing care. For example, the number of nursing staff, the skill level of the nursing staff, and the education and certification of nursing staff indicate the structure of nursing care. The average age of the nurses, salary range, and number of nurses who have applied but were not hired for the unit are not nursing-sensitive indicators.

A parent taking a preschool child to school on the first day asks the nurse, "What do I do if my child wants me to stay?" What is an appropriate response by the nurse? a. "It is better if you do not stay." b. "It is best to stay and participate in the activities." c. "It is OK to stay part of the first day, but be inconspicuous." d. "It would be better to have a good friend take your child to class the first day."

ANS: C On the first day of preschool, in some instances, it is helpful for parents to remain for at least part of the first day until the child is comfortable. If parents stay, they should be available to the child but inconspicuous. It would not be appropriate not to stay, to have someone else take the child to school, or to stay and participate in activities.

A 6-year-old child needs to drink 1 L of GoLYTELY in preparation for a computed tomography scan of the abdomen. To encourage the child to drink, what should the nurse do? a. Give him a large cup with ice so it tastes better. b. Restrict him to his room until he drinks the GoLYTELY. c. Use little cups and make a game to reward him for each cup he drinks. d. Tell him that if he does not finish drinking by a set time, the practitioner will be angry.

ANS: C One liter of GoLYTELY is difficult for many children to drink. By using small cups, the child will find the amount less overwhelming. Then a game can be made in which some type of reward (sticker, reading another page of a book) is given for each cup. A large cup of ice would make it more difficult because the child would see it as too much and ice adds additional fluid to be consumed. Negative reinforcement may work if the child wishes to be out of his room. A practitioner may or may not be angry if he does not finish drinking by a set time; this is a threat that may or may not be true. If the child is having difficulty drinking, this would most likely not be effective.

Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face b. Buttocks c. Oral mucosa d. Palms and soles

ANS: C Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark-skinned individuals unless they are in the mouth or conjunctiva.

The nurse is teaching a class on nutrition to a group of parents of 10- and 11-year-old children. What statement by one of the parents indicates a correct understanding of the teaching? a. "My child does not need to eat a variety of foods, just his favorite food groups." b. "My child can add salt and sugar to foods to make them taste better." c. "I will serve foods that are low in saturated fat and cholesterol." d. "I will continue to serve red meat three times per week for extra iron."

ANS: C School-age children should be eating foods that are low in saturated fat and cholesterol to prevent long-term consequences. The child's diet should include a variety of foods, include moderate amounts of extra salt and sugar, emphasize consumption of lean protein (chicken and pork), and limit red meat.

During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action? a. Recheck head control at next visit. b. Teach the parents appropriate exercises. c. Schedule the child for further evaluation. d. Refer the child for further evaluation if the anterior fontanel is still open.

ANS: C Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Head control is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated.

In boys, what is the initial indication of puberty? a. Voice changes b. Growth of pubic hair c. Testicular enlargement d. Increased size of penis

ANS: C Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 1/2 and 14 years during Tanner stage 2. Voice change occurs between Tanner stages 3 and 4. Fine pubic hair may occur at the base of the penis; darker hair occurs during Tanner stage 3. The penis enlarges during Tanner stage 3.

At which age does an infant start to recognize familiar faces and objects, such as his or her own hand? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is beginning to develop hand-eye coordination.

Which is the single most important factor to consider when communicating with children? a. Presence of the child's parent b. Child's physical condition c. Child's developmental level d. Child's nonverbal behaviors

ANS: C The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Nonverbal behaviors vary in importance based on the child's developmental level and physical condition. Although the child's physical condition is a consideration, developmental level is much more important. The presence of parents is important when communicating with young children but may be detrimental when speaking with adolescents.

The nurse is planning care for a hospitalized preschool-aged child. Which should the nurse plan to ensure atraumatic care? a. Limit explanation of procedures because the child is preschool aged. b. Ask that all family members leave the room when performing procedures. c. Allow the child to choose the type of juice to drink with the administration of oral medications. d. Explain that EMLA cream cannot be used for the morning lab draw because there is not time for it to be effective.

ANS: C The overriding goal in providing atraumatic care is first, do no harm. Allowing the child a choice of juice to drink when taking oral medications provides the child with a sense of control. The preschool child should be prepared before procedures, so limiting explanations of procedures would increase anxiety. The family should be allowed to stay with the child during procedures, minimizing stress. Lidocaine/prilocaine (EMLA) cream is a topical local anesthetic. The nurse should plan to use the prescribed cream in time for morning laboratory draws to minimize pain.

The nurse is teaching parents about the types of behaviors children exhibit when living with chronic violence. Which statement made by the parents indicates further teaching is needed? a. "We should watch for aggressive play." b. "Our child may show lasting symptoms of stress." c. "We know that our child will show caring behaviors." d. "Our child may have difficulty concentrating in school."

ANS: C The statement that the child will show caring behaviors needs further teaching. Children living with chronic violence may exhibit behaviors such as difficulty concentrating in school, memory impairment, aggressive play, uncaring behaviors, and lasting symptoms of stress.

The nurse is explaining about the developmental sequence in children's capacity to conserve matter to a group of parents. What type of matter is last in the sequence for a child to develop? a. Mass b. Length c. Volume d. Numbers

ANS: C There is a developmental sequence in children's capacity to conserve matter. Children usually grasp conservation of numbers (ages 5 to 6 years) before conservation of substance. Conservation of liquids, mass, and length usually is accomplished at about ages 6 to 7 years, conservation of weight sometime later (ages 9 to 10 years), and conservation of volume or displacement last (ages 9 to 12 years).

An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which situation? a. Water excess b. Sodium excess c. Water depletion d. Potassium excess

ANS: C These clinical manifestations indicate water depletion or dehydration. Edema and weight gain occur with water excess or overhydration. Sodium or potassium excess would not cause these symptoms.

When checking the intravenous (IV) site on a child, the nurse should take which action? a. Look at the site. b. Ask the child if the site "hurts." c. Look at the site while palpating the area. d. Take all the tape off, assess the site, and redress.

ANS: C To appropriately check the intravenous (IV) site, the nurse should look at the site and palpate the area. The other options would not be adequate assessments of the site.

Frequent urine tests for specific gravity are required on a 6-month-old infant. What method is the most appropriate way to collect small amounts of urine for these tests? a. Apply a urine collection bag to the perineal area. b. Tape a small medicine cup inside of the diaper. c. Aspirate urine from cotton balls inside the diaper with a syringe without a needle. d. Use a syringe without a needle to aspirate urine from a superabsorbent disposable diaper.

ANS: C To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. Diapers with superabsorbent gels absorb the urine; if these are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. It is not feasible to tape a small medicine cup to the inside of the diaper; the urine will spill from the cup.

What is the major cause of death for children older than 1 year in the United States? a. Heart disease b. Childhood cancer c. Unintentional injuries d. Congenital anomalies

ANS: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. The leading cause of death for those younger than 1 year is congenital anomalies, and childhood cancers and heart disease cause a significantly lower percentage of deaths in children older than 1 year of age.

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen. How should the nurse respond to the parents? a. Febrile seizures can result. b. Antipyretics may cause malignant hyperthermia. c. Antipyretics are of no value in treating hyperthermia. d. Liver damage may occur in critically ill children.

ANS: C Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead. Antipyretics do not cause seizures. Malignant hyperthermia is a genetic myopathy that is triggered by anesthetic agents. Antipyretic agents do not have this effect. Acetaminophen can result in liver damage if too much is given or if the liver is already compromised. Other antipyretics are available, but they are of no value in hyperthermia.

True or false: All families have strengths and vulnerablilities

true

True or false: Each family has its own standards for interaction within and outside the family

true

What explains physiologically the edema formation that occurs with burns? a. Vasoconstriction b. Reduced capillary permeability c. Increased capillary permeability d. Diminished hydrostatic pressure within capillaries

ANS: C With a major burn, capillary permeability increases, allowing plasma proteins, fluids, and electrolytes to be lost into the interstitial space, causing edema. Maximum edema in a small wound occurs about 8 to 12 hours after injury. In larger injuries, the maximum edema may not occur until 18 to 24 hours later. Vasodilation occurs, causing an increase in hydrostatic pressure.

The nurse is providing anticipatory guidance to parents of a 6-month-old on preventing an accidental poisoning injury. Which should the nurse include in the teaching? (Select all that apply.) a. Place plants on the floor. b. Place medications in a cupboard. c. Discard used containers of poisonous substances. d. Keep cosmetic and personal products out of the child's reach. e. Make sure that paint for furniture or toys does not contain lead.

ANS: C, D, E Anticipatory guidance for a 7-month-old infant to prevent a suffocation injury takes into account that the infant will become more active and eventually crawl, cruise, and walk. Used containers of poisonous substances should be discarded, cosmetic and personal products should be kept out of the child's reach, and paint for furniture or toys should be lead free. Plants should be hung out of reach or placed on a high shelf. Medications should be locked, not just placed in a cupboard.

What are characteristics of early adolescence (11-14 years) with regard to identity? (Select all that apply.) a. Mature sexual identity b. Increase in self-esteem c. Trying out of various roles d. Conformity to group norms e. Preoccupied with rapid body changes

ANS: C, D, E Characteristics of early adolescence identity include trying out of various roles, conformity to group norms, and preoccupation with rapid body changes. Mature sexual identity and increase in self-esteem are characteristics of late adolescent identity.

Which are components of the FLACC scale? (Select all that apply.) a. Color b. Capillary refill time c. Leg position d. Facial expression e. Activity

ANS: C, D, E Facial expression, consolability, cry, activity, and leg position are components of the FLACC scale. Color is a component of the Apgar scoring system. Capillary refill time is a physiologic measure that is not a component of the FLACC scale.

The nurse is assessing breath sounds on a child. Which are expected auscultated breath sounds? (Select all that apply.) a. Wheezes b. Crackles c. Vesicular d. Bronchial e. Bronchovesicular

ANS: C, D, E Normal breath sounds are classified as vesicular, bronchovesicular, or bronchial. Wheezes or crackles are abnormal or adventitious sounds.

What child behavior indicates to the nurse that temper tantrums have become a problem? (Select all that apply.) a. The child is 2 to 3 years old b. Tantrums occur at bedtime c. Tantrums occur past 5 years of age d. Tantrums last longer than 15 minutes e. Tantrums occur more than five times a day

ANS: C, D, E Temper tantrums are common during the toddler years and essentially represent normal developmental behaviors. However, temper tantrums can be signs of serious problems. Temper tantrums that occur past 5 years of age, last longer than 15 minutes, or occur more than five times a day are considered abnormal and may indicate a serious problem. A popular time for a tantrum is before bedtime.

Which are effective auscultation techniques? (Select all that apply.) a. Ask the child to breathe shallowly. b. Apply light pressure on the chest piece. c. Use a symmetric and orderly approach. d. Place the stethoscope over one layer of clothing. e. Warm the stethoscope before placing it on the skin.

ANS: C, E Effective auscultation techniques include using a symmetric approach and warming the stethoscope before placing it on the skin. Breath sounds are best heard if the child inspires deeply, not shallowly. Firm, not light, pressure should be used on the chest piece. The stethoscope should be placed on the skin, not over clothing.

The nurse is teaching parents about safety for their "latchkey" children. What should the nurse include in the teaching session? (Select all that apply.) a. Teach the child first-aid procedures. b. Keep the key in an easy place to find. c. Teach the child weather-related safety. d. Teach the child to open the door for delivery people. e. Emphasize fire safety rules and conduct practice fire drills.

ANS: C, E Safety for "latchkey" children includes teaching the child first-aid procedures, teaching the child weather-related safety, and emphasizing fire safety rules and conducting practice fire drills. Teach the child not to display keys and to always lock doors. The child should be taught to not open the door to anyone, even delivery people.

The nurse is conducting an assessment of fine motor development in a 3-year-old child. Which is the expected drawing skill for this age? a. Can draw a complete stick figure b. Holds the instrument with the fist c. Can copy a triangle and diamond d. Can copy a circle and imitate a cross

ANS: D A 3-year-old child copies a circle and imitates a cross and vertical and horizontal lines. He or she holds the writing instrument with the fingers rather than the fist. A 3-year-old is not able to draw a complete stick figure but draws a circle, later adds facial features, and by age 5 or 6 years can draw several parts (head, arms, legs, body, and facial features). Copying a triangle and diamond are mastered sometime between ages 5 and 6 years.

The presence of which pair of factors is a good predictor of a fluid deficit of at least 5% in an infant? a. Weight loss and decreased heart rate b. Capillary refill of less than 2 seconds and no tears c. Increased skin elasticity and sunken anterior fontanel d. Dry mucous membranes and generally ill appearance

ANS: D A good predictor of a fluid deficit of at least 5% is any two four factors: capillary refill of more than 2 seconds, absent tears, dry mucous membranes, and ill general appearance. Weight loss is associated with fluid deficit, but the degree needs to be quantified. Heart rate is usually elevated. Skin elasticity is decreased, not increased. The anterior fontanel is depressed.

The nurse is preparing a pamphlet for parents of adolescents about guidance during the adolescent years. What suggestion should the nurse include in the pamphlet? a. Provide criticism when mistakes are made or when views are different. b. Use comparisons with older siblings or extended family to promote good outcomes. c. Begin to disengage from school functions to allow the adolescent to gain independence. d. Provide clear, reasonable limits and define consequences when rules are broken.

ANS: D An anticipatory guideline to include when teaching parents of adolescents is to provide clear, reasonable limits and have clear consequences when rules are broken. Parents should avoid criticism when mistakes are made and should allow opportunities for the teen to voice different views and opinions. Parents should try to avoid comparing the teen with a sibling or extended family member. Parents should try to be more engaged in the teen's school functions to show support and unconditional love.

What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy? a. Neurogenic shock b. Cardiogenic shock c. Hypovolemic shock d. Anaphylactic shock

ANS: D Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Neurogenic shock results from loss of neuronal control, such as the interruption of neuronal transmission after a spinal cord injury. Cardiogenic shock is decreased cardiac output. Hypovolemic shock is a reduction in the size of the vascular compartment, decreasing blood pressure, and low central venous pressure.

A child is admitted with extensive burns. The nurse notes burns on the child's lips and singed nasal hairs. The nurse should suspect what condition in the child? a. A chemical burn b. A hot-water scald c. An electrical burn d. An inhalation injury

ANS: D Evidence of an inhalation injury includes burns of the face and lips, singed nasal hairs, and laryngeal edema. Clinical manifestations may be delayed for up to 24 hours. Chemical burns, electrical burns, and burns associated with hot-water scalds would not produce singed nasal hair.

The school nurse recognizes that pubertal delay in girls is considered if breast development has not occurred by which age? a. 10 years b. 11 years c. 12 years d. 13 years

ANS: D Girls may be considered to have pubertal delay if breast development has not occurred by age 13 years or if menarche has not occurred within 2 to 2 1/2 years of the onset of breast development.

adolescents have feelings of anxiety, may withdraw from family and friends, and may have a disturbed concept of sexuality

true

divorce constitutes a major disruption for children of all ages, and all all children suffer stress second only to the stress producted by the death of a parent

true

A 3-year-old child was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning a response? a. It is best to wait until the child asks about it. b. The best time to tell the child is between the ages of 7 and 10 years. c. It is not necessary to tell a child who was adopted so young. d. Telling the child is an important aspect of their parental responsibilities.

ANS: D It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child's identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to prevent third parties from telling the children before the parents have had the opportunity.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is what? a. A sign the child is spoiled b. An attempt to exert unhealthy control c. Regression, which is common at this age d. Ritualism, an expected behavior at this age

ANS: D The child is exhibiting the ritualism, which is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of structure and comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate the child has unreasonable expectations but rather is part of normal development. Ritualism is not regression, which is a retreat from a present pattern of functioning.

The nurse is explaining the preconventional stage of moral development to a group of nursing students. What characterizes this stage? a. Children in this stage focus on following the rules. b. Children in this stage live up to social expectations and roles. c. Children in this stage have a concrete sense of justice and fairness. d. Children in this stage have little, if any, concern for why something is wrong.

ANS: D Young children's development of moral judgment is at the most basic level in the preconventional stage. They have little, if any, concern for why something is wrong. Following the rules, living up to social expectations, and having a concrete sense of justice and fairness are characteristics in the conventional stage.

Which problem behaviors can occur when leaving a child home alone after school? Select all that apply. Alcohol use Binge eating Creating messy art Drug experimentation Preparing snacks and meals

Alcohol use Drinking alcohol is a problem behavior that can result from leaving a child home alone after school. During this time the child needs guidance and direction, especially for doing chores and homework. Binge eating Inappropriate eating habits are a problem behavior that can result from leaving a child home alone after school. The lack of direction and supervision allows children to experiment with unwanted behaviors. Drug experimentation Drug use is a problem behavior that can result from leaving a child home alone after school. During this time the child needs guidance and supervision, especially for doing chores and homework.

A patient tells the school nurse that he is scared because he saw a classmate with a gun in his backpack. After hearing this, which action should the nurse take? Ask if the gun was a toy. Talk with the child about his fear. Call the child's parents immediately. Alert police and initiate the emergency protocol for the school.

Alert police and initiate the emergency protocol for the school. The nurse would alert the police and follow the school's emergency protocol for violent threats to protect the students and staff.

Which action by the nurse would be most appropriate when preparing the preschool child for a medical procedure? Telling the child he or she will get a sticker if he or she does not cry at all Explaining the entire sequence of the procedure to the child Avoiding giving the medical procedure equipment silly names Allow the child to practice the procedure on a stuffed bear

Allow the child to practice the procedure on a stuffed bear Allowing the child to practice the procedure on a stuffed bear can be therapeutic for the child and is the most appropriate action.

What anticipatory guidance can the nurse give parents of a toddler to support the toddler's need for increasing autonomy? Take the food away if the toddler spills it. Continue feeding the toddler during mealtime. Give the toddler finger foods to decrease messes. Allow the toddler to practice feeding with a spoon

Allow the toddler to practice feeding with a spoon. Allowing the toddler to practice feeding with a spoon will help increase autonomy at mealtimes.

Based on the developmental level of a 7-year-old child, what should the nurse do before administering an IM medication to enhance cooperation? Demonstrate the injection using puppets. The nurse should give a sticker or lollipop as a reward. Ask the child which arm he or she would prefer for the injection. Provide a detailed explanation about the mode of action of the medication.

Ask the child which arm he or she would prefer for the injection. A school-aged child, such as a 7-year-old child, should be offered as many choices as possible to help feel in control.

The nurse assesses the 14-year-old patient for suicide risk after the parents reported the patient was cutting. Which intervention is the priority action by the nurse? Discuss positive coping strategies. Assess the patient for a suicide plan. Refer the family to counseling services. Explain the infection risk from cutting.

Assess the patient for a suicide plan. A person with a plan to commit suicide is at high risk for actually committing suicide. This must be assessed before other interventions are performed, and until the cause of the cutting can be properly addressed.

Which series of activities best reflects the motor development of an infant from 1 month of age to 4 months? Select all that apply. At 4 months, the rooting reflex disappears. At 1 month, the child will hold a fist tightly clenched. At 3 months the child will be able to crawl a minimal distance. At 3 months the child will be able to lift the head 90 degrees from a prone position. At 4 months the child can hold the head steadily erect in a sitting position.

At 4 months, the rooting reflex disappears. There are several primitive reflexes that disappear after the first year of life. The Moro reflex and the rooting reflex will disappear by 4 months of age. Correct At 1 month, the child will hold a fist tightly clenched. At one month the child will keep the hand clenched and this will start to change by 2 months of age. At 3 months the child will be able to lift the head 90 degrees from a prone position. The muscle strength in the baby's head by 3 months of age will allow for lifting to 90 degrees in a prone position. Correct At 4 months the child can hold the head steadily erect in a sitting position. At four months a child has motor development sufficient enough to hold the head erect in the sitting position.

of the following strategies, the one used most often to help new parents like jennifer's adjust to the parenting role is: A. parenting classes B. anticipatory guidance C. first aid courses D. cadiopulmonary resuscitation course

B. anticipatory guidance

The school administrators are trying to help an adolescent who constantly gets in trouble for fighting. Which of the following are risk factors for adolescent use of violence? Select all that apply. Being raised by an abusive parent Doing chores after school every day Playing video games involving shooting Supervised gun use at the shooting range Watching television with family each night

Being raised by an abusive parent Physical violence in the home leads to an increased acceptability of violence and desensitization in the adolescent. Playing video games involving shooting Playing a violent video game with friends is associated with violent behaviors.

The development of gender identity is reported to begin: A. after the first year B. during the phallic stage C. in utero D. at puberty

C. in utero

The _______ is the most immature of all the gastro organs throughout infancy A. large intestine B. pylorus C. liver D. lower esophageal sphincter

C. liver

Which of the following play activities would be least appropriate to suggest to parents for their 3-month-old infant? A. provide bright objects B. use rattles C. place in an infant walker D. place infant on the floor to crawl and roll

C. place in an infant walker

Which factor affecting growth and development is defined as the sum of beliefs and values shared and transmitted from generation to generation? Social Family Culture Physiological Psychological

Culture Culture is defined as the sum of beliefs and values shared and transmitted from generation to generation.

Studies have shown that excessive fruit juice consumption in infants and small children increases the risk for: A. hypervitaminosis B. flourosis C. rickets D. growth problems

D. growth problems

A recent survey of breastfeeding mothers identified causes for the mother stopping breastfeeding before 6 months. Which of the following was not a cause for stopping breastfeeding? A. concern about infant weight gain B. difficulties with lactation C. effort to pump and maintain milk supply D. infant refusing to nurse

D. infant refusing to nurse

All of the following digestive processes are deficient in an infant until about 3 months except: A. amylase B. lipase C. saliva D. trypsin

D. trypsin

In order to prevent rickets, the mother who is exclusively breastfeeding should consider the administration of: A. iron B. calcium C. vitamin E D. vitamin D

D. vitamin D

The nurse is caring for a child who is experiencing an acute asthma attack. What approach should the nurse use to administer a bronchodilator? Encourage the child to continue to breathe rapidly. Supply the medication using a metered-dose inhaler. Use a spacer to aid the child in inhalation of the dose. Deliver the nebulized medication with supplemental oxygen.

Deliver the nebulized medication with supplemental oxygen. Using oxygen with the nebulizer allows both the medication and oxygen to be delivered to the lungs. The delivery of oxygen is independent of the nebulized medication because oxygen transfer occurs in the alveoli and nebulized medication will not travel into the alveoli.

Which pedestrian safety recommendations are common to enforce in children who ride bikes, inline skates, and skateboards? Select all that apply. Do not listen to music Do not ride when sunlight is dim Wear appropriate head protection When in the street, stop at stop signs Ensure the equipment is the appropriate size and for the appropriate age

Do not listen to music Children should avoid using audio headphones while riding any moving recreational equipment, because headsets can diminish hearing capabilities. Children may not hear an approaching vehicle. Correct Do not ride when sunlight is dim Children should be taught to avoid riding at dusk or in the dark, as they cannot see well. Correct Wear appropriate head protection Wearing a helmet is a priority safety recommendation that is common to biking, inline skating, and skateboarding. Moreover, child helmet laws exist in all states.

The nurse is assessing a patient who reports shortness of breath, wheezing, and chest tightness. Which assessment technique(s) will help the nurse assess the severity of the patient's condition? Select all that apply. Palpation Inspection Percussion Auscultation

Inspection Inspection is used to visualize the amount of respiratory distress the patient is having. For example, the nurse must determine whether the patient is using accessory muscles to assist with breathing. Auscultation Because auscultation is used to listen to the flow of air through lungs, it can be helpful in determining whether the patient is wheezing and whether airflow is normal; thus it will help the nurse assess the severity of the patient's condition.

The parents of a toddler are worried that the child is not eating at meal times. Which suggestions should the nurse make to promote healthy eating for the child? Offer three meals and two snacks per day. Offer the child a routine menu of nutritious food each day. Offer a treat, such as a cupcake, with meals to encourage a healthy appetite. Serve a large breakfast with a high protein content to increase the child's metabolism

Offer three meals and two snacks per day. This will help the child build a regular appetite. Setting meal times will train the toddler to eat at regular times, and limited snacks will help ensure an appetite at those times.

A parent of a four-year-old child is frustrated at the child's new habit of acting out and hitting other children. The nurse should recommend which actions to address this behavior? Select all that apply. Taking away something the child loves as punishment Offering hugs and physical encouragement when positive behavior is experienced Explaining that if the child hits other children, he/she will be punished with a spanking Explaining to the child that he/she will not be able to play with other children when the behavior occurs

Offering hugs and physical encouragement when positive behavior is experienced A time-in is often effective at enforcing positive behavior. Frequent, brief, nonverbal, physical contact should be provided when the child is acting appropriately. Explaining to the child that he/she will not be able to play with other children when the behavior occurs A time-out is often effective in addressing child impulse control. The child should be removed from the situation for a short period and offered an explanation for the punishment.

Which cognitive developmental changes are expected in the school-age child? Select all that apply. Organizing toys by size Starting a new leaf collection Telling jokes to make others laugh Understanding the idea of volume and mass Believing their magic wand makes the sun set

Organizing toys by size Placing toys in order from smallest to largest is part of classification and is an expected cognitive developmental change in the school-age child. Starting a new leaf collection Collecting items is part of classification and is an expected cognitive developmental change in the school-age child. Telling jokes to make others laugh Understanding humor is an expected cognitive developmental change in the school-age child. Understanding the idea of volume and mass Understanding conservation is an expected cognitive developmental change in the school-age child.

Which statement reflects a child's ability to develop autonomy according to Erikson? The child learns to do chores. The child is able to pour milk from a cup. The child speaks in an appropriate tone of voice. The child no longer cries when taken from the mother.

The child is able to pour milk from a cup. Erikson suggested that, for a toddler, one important developmental task is to acquire a sense of autonomy rather than a sense of shame and doubt

The nurse would expect to observe which behaviors in an infant with an insecure parental attachment? The infant is content when being fed by the parent. The infant stops crying when they see their parent. The infant is more easily comforted by a babysitter than the parent. The infant calms down after being picked up by the parent.

The infant is more easily comforted by a babysitter than the parent. Insecure parental attachment might be demonstrated by an inability or less ability of the parent to comfort the infant, compared to other caretakers who have been more consistent in providing stable caring.

Children 12 years of age and older who are victims of homicide tend to be killed by: a) firearms b) family members c) stabbing d) poor safety devices on firearms

a) firearms

Knock- knee a accompanied by short statue in an nine -year-old child

abnormal

Which one of the following patient outcomes is individualized for Sara? a) Sara will receive her immunizations on time b) Sara will demonstrate adherence to the nurse's recommendations c) Marisa Gutierrez will verbalize the need to keep small objects away from Sara to avoid aspiration d) Sara's brothers will verbalize the need to stop playing with small objects

c) Marisa Gutierrez will verbalize the need to keep small objects away from Sara to avoid aspiration

When is a screening hemoglobin or hematocrit recommended for adolescents? a. at the first health provider encounter with an adolescent b. at the end of pubertal development c. at both of the above visits d. at neither of the above visits

c. at both of the above visits

Treatment of tolerance to opioid therapy includes: a. discontinuing the drug. b. decreasing the dose. c. increasing the dose. d. increasing the duration between doses.

c. increasing the dose.

which one of the following sources of stress is typical of a 3y/o? a. insecurity b. masturbation c. jealousy d. sexuality

c. jealousy

To avoid multiple needle punctures for chemotherapy administration and blood draws, the _________ __________ provides access for such procedures

central line used for short term PICC lines for short to moderate length therapy tunneled catheters and implanted infusion ports are for long-term access

rapprochement

child moves away and returns for reassrance

fasting recommendations to reduce the risk of pulmonary aspiration

clear liquid - >2 hr breast milk 4 hr infant formula 6 hr nonhuman milk 6 hr light meal 6 hr

The current trend toward EBP practice involves: a) questioning whether a better approach exists b) analyzing published clinical research c) increased emphasis on measurable outcomes d) a, b, and c are correct

d) a, b, and c are correct

Which of the following accounts for the most deaths in infants <1 year of age? a) pneumonia/influenza b) infection specific to the perinatal period c)accidental injuries d) congenital anomalies

d) congenital anomalies

Which one of the following is not considered to be a major stressor of hospitalization in the young child? a. Separation b. Loss of control c. Bodily injury d. School absence

d. School absence also pain

communal family

emerges from disenchantment with most contemporary life choices

Family Assessment

family composition homemand community environment occupation and education of family members cultursal and religious traditions family function and relationships - family interactions and roles; power, decision making and problem solving, communication, expression of feelings and individuality genetic and chronic diseases in child's familuy members

vastus lateralis IM

location - find great trochanter and knee joints divide vertical distance into 1/3s; inject into middle 1/3 needle insertion and size - perpendicular to knee or perpendicular to thigh or slightly angled toward anterior thigh 22-25 gauge (5/8-1") advantages - large developed muscle tolerate larger quantities ( 0.5 in infant to 2.0 ml in child); easily accesible disadvantages thrombosis of femoral artery; sciatic nerve damage, more painful than deltoid or gluteal

step-parenting

power conflicts occur along with complexity of forming new life-styles and interaction patterns

in relation to body image school age children

seldom express concerns about their bodes to their families

psychosocial development preschooler

sense of initiative energetic learners dont understand aceeptable/non acceptable oedipal stage magical thinking still do not understand time ( in 2 months, tuesday) dramatic play - dress up, farm, housekeeping, med kits...

What predisposes toddlers to frequent infections?

short straight internal ear canal and enlarged lymph tissue

Which report by a parent would indicate normal social development of the 2-year-old patient? "He doesn't care at all when I leave him." "He only talks to himself, and not to me." "I never really know what he is saying to me." "He will play next to another child and watch the child, but won't interact with the child."

"He will play next to another child and watch the child, but won't interact with the child." Playing beside other children, or parallel play, indicates normal social development of the toddler.

The nurse is teaching parents about pain management for their child with irritable bowel syndrome. Which statement, made by the parents, indicates the need for further teaching? "I read him a story and rub his back when he's hurting." "I know he's hurting when he stops talking, playing, and laughing." "The provider's phone number is posted on our kitchen refrigerator." "I give him pain medicine every hour on the hour so a schedule is not necessary."

"I give him pain medicine every hour on the hour so a schedule is not necessary." The child's pain can vary and should be assessed using a specific pain assessment tool. The nurse will provide a schedule to the parents and guidance on administering the child's medication.

Match the route of temperature measurement to the most appropriate age

10 years Oral 4 years Axillary 3 months Temporal

height increase

2.5 cm a month

radial pulse

2yo

A preschooler who was 37 inches/94 cm tall on his or her third birthday would be expected to measure ____ inches/cm on his or her fifth birthday. 41 inches/104 cm 43 inches/109 cm 45 inches/114 cm 47 inches/119 cm

43 inches/109 cm Height increases approximately 3 inches/7.62 cm per year during the preschool years. Therefore, the child would be expected to grow by 6 inches (3 x 2), or 15.24 cm (7.62 x 2), to a height of 43 inches, or 109 cm.

Which statement corresponds to Freud's puberty stage of psychosexual development? A child who places an object in his or her mouth A child who tries to control body functions A child who experiences personal and family turmoil A child who begins to develop a conscience and feelings of guilt

A child who experiences personal and family turmoil The puberty stage of psychosexual development is a time when the child is stimulated by increasing hormone levels; sexual energy wells up in full force, resulting in personal and family turmoil.

A 6-month-old infant is brought to the clinic and after assessing the child's head circumference, the nurse notes that the head circumference for this baby has gone from the 50th percentile to 10th percentile since the 2-month visit. What might this indicate? A delay in skull growth A below-normal intelligence Disturbances in nutrition intake A problem with brain development Issues with physical development

A delay in skull growth Frequent head growth measurements can provide information on the growth of an infant's skull. Suture closure may occur at inappropriate times and therefore affect skull growth. Disturbances in nutrition intake A lack of proper nutrition can impede growth and development in children including head growth. This can indicate failure to thrive in an infant. Correct A problem with brain development Since the skull grows to accommodate the developing brain, head circumference measurements can provide information on brain development.

Which of the following is a characteristic of the somatic swallow reflex? A. the mandible does not thrust forward B. the tongue remains in front of the central incisors C. the tongue is concave and inclined against the palate D. it is efficient for fluids but not for solids

A. the mandible does not thrust forward

What information should be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large push-pull toys for kinetic stimulation. b. Place a cradle gym across the crib to help develop fine motor skills. c. Provide the child with finger paints to enhance fine motor skills. d. Provide a stick horse to develop gross motor coordination.

ANS: A A 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for this age child include large push-pull toys for kinetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse

What condition is often associated with severe diarrhea? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

ANS: A Metabolic acidosis results from the increased absorption of short-chain fatty acids produced in the colon. There is an increase in lactic acid from tissue hypoxia secondary to hypovolemia. Bicarbonate is lost through the stool. Ketosis results from fat metabolism when glycogen stores are depleted. Metabolic alkalosis and respiratory alkalosis do not occur from severe diarrhea.

The nurse is planning care for a hospitalized toddler. What is the rationale for planning to continue the toddler's rituals while hospitalized? a. To provide security b. To prevent regression c. To prevent dependency d. To decrease negativism

ANS: A Ritualism, the need to maintain sameness and reliability, provides a sense of security and comfort. It will not prevent regression or dependency or decrease negativism.

What is the reason pedestrian motor vehicle injuries increase in the preschool age? (Select all that apply.) a. Riding tricycles b. Running after balls c. Playing in the street d. Crossing streets at the crosswalk e. Crossing streets with an adult

ANS: A, B, C Pedestrian motor vehicle injuries increase because of activities such as playing in the street, riding tricycles, running after balls, and forgetting safety regulations when crossing streets. Crossing streets at the crosswalk or with an adult are safety measures.

The nurse is preparing to complete documentation on a patient's chart. Which should be included in documentation of nursing care? (Select all that apply.) a. Reassessments b. Incident reports c. Initial assessments d. Nursing care provided e. Patient's response of care provided

ANS: A, C, D, E The patient's medical record should include: initial assessments, reassessments, nursing care provided, and the patient's response of care provided. Incident reports are not documented in the patient's chart.

A cancer patient is experiencing neuropathic cancer pain. Which prescription should the nurse expect to be ordered to control anxiety? a. Lorazepam (Ativan) b. Gabapentin (Neurontin) c. Hydromorphone (Dilaudid) d. Morphine sulfate (MS Contin)

ANS: B Anticonvulsants (gabapentin, carbamazepine) have demonstrated effectiveness in neuropathic cancer pain. Ativan is an antianxiety agent, and Dilaudid and MS Contin are opioid analgesics.

The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and symptoms of hypernatremia? (Select all that apply.) a. Apathy b. Lethargy c. Oliguria d. Intense thirst e. Dry, sticky mucos

ANS: B, C, E Signs and symptoms of hypernatremia are nausea; oliguria; and dry, sticky mucos. Apathy and lethargy are signs of hyponatremia.

At which age should the nurse expect most infants to begin to say "mama" and "dada" with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

ANS: C Beginning at about age 10 months, an infant is able to ascribe meaning to the words "mama" and "dada." Four to 6 months is too young for this behavior to develop. At 14 months, the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words.

The school nurse is teaching male school-age children about the average age of puberty. What is the average age of puberty for boys? a. 12 years b. 13 years c. 14 years d. 15 years

ANS: C The average age of puberty is 14 years in boys. Boys experience little sexual maturation during preadolescence.

What factor predisposes an infant to fluid imbalances? a. Decreased surface area b. Lower metabolic rate c. Immature kidney functioning d. Decreased daily exchange of extracellular fluid

ANS: C The infant's kidneys are functionally immature at birth and are inefficient in excreting waste products of metabolism. Infants have a relatively high body surface area (BSA) compared with adults. This allows a higher loss of fluid to the environment. A higher metabolic rate is present as a result of the higher BSA in relation to active metabolic tissue. The higher metabolic rate increases heat production, which results in greater insensible water loss. Infants have a greater exchange of extracellular fluid, leaving them with a reduced fluid reserve in conditions of dehydration.

When teaching a mother how to administer eye drops, where should the nurse tell her to place them? a. At the lacrimal duct b. On the sclera while the child looks to the outside c. In the conjunctival sac when the lower eyelid is pulled down d. Carefully under the eyelid while it is gently pulled upward

ANS: C The lower eyelid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball. The lacrimal duct is not the appropriate placement for the eye medication. It will drain into the nasopharynx, and the child will taste the drug.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips b. Broad jumps c. Rides tricycle d. Walks up and down stairs

ANS: D A 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and broad jumping are skills acquired at age 3 years. Tricycle riding is achieved at age 4 years.

The school nurse recognizes that adolescents should get how many hours of sleep each night? a. 6 hours b. 7 hours c. 8 hours d. 9 hours

ANS: D Adolescents should generally get around 9 hours of sleep each night.

Which type of play is most typical of the preschool period? a. Team b. Parallel c. Solitary d. Associative

ANS: D Associative play is group play in similar or identical activities but without rigid organization or rules. School-age children play in teams. Parallel play is that of toddlers. Solitary play is that of infants.

What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock? a. Thirst b. Irritability c. Apprehension d. Confusion and somnolence

ANS: D Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability, and apprehension are signs of compensated shock.

How is family systems theory best described? a. The family is viewed as the sum of individual members. b. A change in one family member cannot create a change in other members. c. Individual family members are readily identified as the source of a problem. d. When the family system is disrupted, change can occur at any point in the system.

ANS: D Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. The interactions, not the individual members, are considered to be the problem.

What is the most common type of burn in the toddler age group? a. Electric burn from electrical outlets b. Flame burn from playing with matches c. Hot object burn from cigarettes or irons d. Scald burn from high-temperature tap water

ANS: D Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-old children. Temperature should be reduced on the hot water in the house and hot liquids placed out of the child's reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group but not one of the most common types of burn.

An infant, age 6 months, has six teeth. The nurse should recognize that this is what? a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier than expected tooth eruption

ANS: D Six months is earlier than expected to have six teeth. At age 6 months, most infants have two teeth. Although unusual, having six teeth at 6 months is not dangerous.

What physiologic state(s) produces the clinical manifestations of nervous system stimulation and excitement, such as overexcitability, nervousness, and tetany? a. Metabolic acidosis b. Respiratory alkalosis c. Metabolic and respiratory acidosis d. Metabolic and respiratory alkalosis

ANS: D The major symptoms and signs of alkalosis include nervous system stimulation and excitement, including overexcitability, nervousness, tingling sensations, and tetany that may progress to seizures. Acidosis (both metabolic and respiratory) has clinical signs of depression of the central nervous system, such as lethargy, diminished mental capacity, delirium, stupor, and coma. Respiratory alkalosis has the same symptoms and signs as metabolic alkalosis.

Santmyer swallow reflex

Blow in infant's face => exhibits reflexive swallow

The primary reason for introducing solid food to the infant is to: A. increase their overall caloric intake B. provide a substitute for the milk source C. introduce a taste and chewing experience D. increase their weight

C. introduce a taste and chewing experience

Which statement best characterizes the early adolescent mindset regarding body image and self-perception? Unaware of physical changes Comfortable in his or her body Concerned only with him/herself Not concerned about body changes

Concerned only with him/herself Adolescents are developmentally egocentric, believing everyone is obsessed with them.

authoritarian parents

try to control their children's behavior and attitudes through unquestioned mandates do it because i say so punishment - withdrawal of love and approval

setting/personnel

where and who provided care

Debbie is 2 years old and lives with her brother, Mark; her sister, Mary; and her mother. Her father and mother recently divorced, and now her father lives 1 hour away. Debbie sees her father once a month for a day's visit. Her mother retains custody of Debbie. Debbie's grandparents live in a different state, but she visits them each year. Debbie's family represents which of the following? a. Binuclear family b. Extended family c. Single-parent family d. Blended family

c. Single-parent family (p 49-50)

In performing an examination for scoliosis, the nurse understands that which one of the following is an incorrect method? a. The child should be examined only in his or her underpants (and a bra if an older girl). b. The child should stand erect, with the nurse observing from behind. c. The child should squat down with the hands extended forward so the nurse can observe for asymmetry of the shoulder blades. d. The child should bend forward with the back parallel to the floor so that the nurse can observe from the side.

c. The child should squat down with the hands extended forward so the nurse can observe for asymmetry of the shoulder blades.

Which of the following statements as it relates to use tobacco, alcohol, and cannabis among adolescents is true? a. substance abuse decreases with age, and adolescent between 14 and 15 years of age have the highest use pattern b. the prevalence of binge drinking and tobacco use among high school students is increasing c. adolescents may use tobacco, alcohol, and marijuana because these substances provide an opportunity to challenge authority, demonstrate autonomy, gain entry into a peer group, or simply relieve the stress of growing up d. adolescents who begin smoking at a later age are at greater risk for becoming a life-long smoker

c. adolescents may use tobacco, alcohol, and marijuana because these substances provide an opportunity to challenge authority, demonstrate autonomy, gain entry into a peer group, or simply relieve the stress of growing up

Spiritual development during adolescent years can best be described by which of the following? a. places less emphasis on what a person believes b. places more emphasis on whether a person attends religious services c. becomes more focused on spiritual and ideologic matters and less on observing religious customs d. becomes more focused on observing religious customs and less on ideologic matters

c. becomes more focused on spiritual and ideologic matters and less on observing religious customs

An example of an organizational strategy to improve compliance would be for the nurse to: a. incorporate teaching principles that are known to enhance understanding. b. encourage the family to adapt hospital medication schedules to their home routine. c. evaluate and reduce the time the family waits for their appointment. d. all of the above are organizational strategies.

c. evaluate and reduce the time the family waits for their appointment. * increase appt freq, designape a PCP, reduce tx cost and disruption, use "cues" to minimize forgetting higher levels of autonomy invcrease adolescent compliance family support (reminders, communication, etc)

the preschoolers body image has developed to include: a. a well defined body boundary b. knowledge about his or her internal anatomy c. fear of intrusive experiences d. anxiety and fear of separation

c. fear of intrusive experiences

The advantages of a hospital unit specifically for adolescents include: a. exclusive group membership. b. fewer preparation requirements. c. increased socialization with peers. d. all of the above.

c. increased socialization with peers. include wifi, mp3s, dvd players, hi-def TVs and snakcs

research has shown that when two languages are presented to children simulataneously in early childhood, bilingual children are most likely to experience: a. adverse effects in their receptive language development b. adverse effects in performance in the majority language c. language milestones at similar stages to monolinguals d. adverse effects to areas in addition to language

c. language milestones at similar stages to monolinguals

Which of the following guidelines if provided to the adolescent about tanning is correct? a. if using self-tanning cream, no further sun protection is required b. sunscreens should include a sun protective factor higher than 15 and an alcohol base with lanolin c. long-term effects can include premature aging of the skin; increased risk for skin cancer; and, in some adolescents, phototoxic reactions d. dermatologists recommend tanning machines if used no more often than two times monthly

c. long-term effects can include premature aging of the skin; increased risk for skin cancer; and, in some adolescents, phototoxic reactions

When performing a painful procedure on a child, to minimize fear of bodily injury, the nurse should attempt to: a. perform the procedure in the playroom. b. standardize techniques from one age group to the next. c. perform the procedure quickly with the parent present. d. have the parents leave during the procedure.

c. perform the procedure quickly with the parent present.

After administering an intramuscular injection, the nurse would best reassure the young child with poorly defined body boundaries by: a. telling the child that the bleeding will stop after the needle is removed. b. using a large bandage to cover the injection site. c. using a small bandage to cover the injection site. d. using a bandage but removing it a few hours after the injection.

c. using a small bandage to cover the injection site. the bigger the bandage, the more important the wound; successively reducing size of surgical dressing allows child to measure healing/improvement premature dressing removal can concern child

Family Systems Theory

change in any one part of a family system affects all other parts of the family system applicable in everyday life is characterized by interaction among the components of the system and between the system and the environment

50% of all acute conditions of childhood can be accounted for by: a) injuries and accidents b) bacterial infections c) parasitic disease d) respiratory illness

d) respiratory illness

The most common side effect of opioid therapy is: a. respiratory depression. b. pruritus. c. nausea and vomiting. d. constipation.

d. constipation.

sleep problems in the school age child are often demonstrated by

delaying tactics because the child does not wish to go to bed

Developmentally by 12 months of age most children?

eat the same food as the rest of the family

temporal temperature

for fever less than 38 in children 3 month to 4 yo

Which one of the following statements is true about infant mortality in the US? a) There has been a recent dramatic increase in infant mortality in the US b) US is currently a world leader in reducing infant mortality c) in the US, infant mortality for whites is considerably lower than other races d) The US has a lower infant mortality rates than most other developed countries

in the US, infant mortality for whites is considerably lower than other races

according to erikson, what is the developmental goal of middle childhood

industry

Neck righting

infant in supine and turn head to one side, infant log rolls entire body integration:5 years

major causes of death during childhood

injuries high rates for suicide, poisoning, falls, as well as unintentional ijuries (motor vehicle, drowning and burns), fire arms, unintentional medication overdose

murmurs classifications

innocent - no anatomic or physiologic abnormality exist functional - no anatomic cardiac defect exist, but a physiologic abnormality is oresent ( anemia) organic - a cardiac defect with or without a physiologic abnormality exists

school age years communicating

less rely on what they see and mre on what they know want explanation for reasons they are interssted in functional aspects of the procedure, objects thye need to know what is going to happen and why they are sensetive to anything that constitutes a threat or suggestion of injury on it encourage to communicate concerns nurse should provode reassurance. dyspel the myths and fears, implement activities to reduce anxiety ( if one child is shy talk to the other child)

IM injections

less than 1 ml - tuberculin syringe, calibrated in 0.01-ml increments less than 0.5 ml - 0.5 ml low dose syringe when 2 drugs are combined - always draw them up in the same order to maintain a consistent ration between drugs use the same brand of syringe use one-piece syringe units needle length should be sufficient to penetrate SQ and deposit into muscle

which one of the following would the nurse not expect to observe as characteristic of peer group relationships of 8 year old mark

mark demonstrates a greater individual egocentric outlook when comported with other peer group members

What is the main source of calcium and phosphorous in a toddler?How much should they have per day?

milk; 24-28 oz

What nutritional requirement may be difficult to meet in the toddler years?

minerals

List at least five strategies the nurse can use to support the child during and after a procedure.

minimize number of people present during the procedure, distract, allow expression of feelings, involve child by permitting choices, expect success (walk in with confidence expecting cooperation) planned activity post-op to encourage expression of feelings (review procedure details, play, gross motor movement, vent anger with Play-Doh, dramatic play/puppets) positive reinforcement

obesity

most common nutritional problem BMI at or greater than 95%

active listening

most important component of effective cmmmunication, an active process that requires concentration and attention

What type of injuries cause more accidental deaths in all pediatric age groups than any other type of injury?

motor vehicle

Four primary causes of mortality accounting for 75% of all adolescent deaths

motor vehicle injuries, other injuries, homicide, suicide

communicating with infants

nonverbal communication someone who is around for sufficient time smile and coo vs cry - their communicating they quite when cuddled or other form of gentle physical contact loud harsch sounds are feightening

Assymmetric bowlegs before the age of two

normal

Flat feet in an 18 month old toddler

normal

Positive Babinski sign in at nine month toddler

normal

broad based gate Inn and 20 months old toddler

normal

Ear (Aural) Temperature

not a precise measurement

sympathy

not therapeutic in the helping relationship because it involves having similar feelings or emotions to another person as opposed to understanding the person's feelings

What skills ARE necessary for the toddler to acquire before separation and individualization can be achieved?

object permanence -delayed gratification -ability to tolerate a moderate amount of frustration

a major difference in moral development between young school age children and older school age children is best described by which one of the following

older school age children are able to judge an act by the intentions that prompted it and not only bt the consequences

identify which one of the following statements describing fears in the school age child is true

ost of the new fears that trouble school age children are related to school and family

NIPS

pain assessment 26-40 weeks Breathing, face, arms, legs, cry, arousal score range 0-7

binuclear family

parents continuing the parenting role while terminating the spousal unit (joint custody)

What is the best approach to stop a toddler's attention-seeking behavior of a temper tantrum with head banging?

protect the child from injury

What is the most important strategy for parents to use to prepare a toddler for the birth of a sibling?

provide a doll for the toddler to imitate parenting

What is the best technique to deal with the negativity of the toddler?

provide acceptable choices

Describe at least one of the possible psychologic benefits a child might gain from hospitalization.

provides opportunity to master stress and feel competent in their coping abilities new socialization experiences

social development toddler

separation anxiety may reappear at age 18 months, fear of the dark, slow to warm up reapproachment transitional objects (like blanket) 300 words at age 2 use of multiword sentences reading book together toddlers play alongside not with other children 2 they can use spoon and 3 can use fork 15 month helps to put hand and foot in while dressing talking toys, push toys, paint, temper tantrum toilet training

other changes during puberty

size and strength of heart blood volume systolic bp increase hr decrease increase - iron, rbc, hg, htc lungth diameter and length increase, rr decrease metabolic rate decrease MOVING FROM CONCRETE TO FORMAL OPERATIONAL THOUGHT

behavioral methods of pain management preterm and newborn

skin to skin hold breast of mother sucrose fascilitated tucking

What is there a decrease in the frequency of as the child moves through the toddler period?

solitary play

manifestation of separation anxiety

stage of protest - cries -screams - searches for parents with eyes - clings to parents -avoids and rejects strangers toddlers might - verbally attack - like saying go away - physically attack stranger - kick, bite - attempts to escape to find parents - attempts to force parents to stay stage of despair: - inactive, withdrawn, depressd - uncommunicative - regressing behavior - thmb sucking stage of detachment: - shows increased interest in surroundings - intercts with strangers - appears happy - forms superficial relationships

oral temperature

standard non invasive contraindicated to children with altered consciousness, are rceiving O2, mouth breathing, with mucisitis, recend oral surgery r trauma, under 5 yo, or cannot hold thermometer under tongue

The nurse shows Tina a picture of a child having an intravenous infusion started and asks Tina to describe that scene

storytelling

Recommended Dietary Allowance (RDA)

sufficient to meet the nutrient requirements of nearly all healthy individuals for a specific age and gender group

infant mortality

the number of deaths of children under 1 year of age per 1,000 live births

which of the following best identifies the spiritual development of school age children

they begin to learn the difference between the natural and the supernatural

True or false: One quality of a strong family is the flexibility and adaptability of the roles necessary to obtain resources needed for the family

true

nuclear family

two parents and their children may be biologic, step, adoptive or foster

tylenol/ibuprofen

tylenol any age ibuprophen no under 6 months

List the five assessment components to be evaluated in analysis of the symptom of pain

type location severity Duration And Influencing factors

fine motor development infant

use of hand and fingers in the grasp of an object, 1 months hands closed, by 3 open 5 months voluntarily grasps objects palmar grasp changes to pincer grasp - 8-9 moths crude pincer, 10 month sufficient to pick up raisin 7 months transfer objects from hand to hand banging objects 11 moths put object to a container 1 y build try a tower of 2 blocks but fail

growth charts

uses a series of percentile curves to demonstarate the distribution of body measuremtns in children

pharmacologic pain management

using 2 step strategy dosing ta regular intervals using the appropriate route of administration adapting treatment to the individual child

2 Year olds show increased gross motor skill by

walking up and down stairs

gross and fine motor development preschool

walking, running, climbing, jumping well by 36 3 yo rides a bike, copies circles, cross, vertical horisontal lines 4 yo skips and hops, cut pictures, lace sg\hoes 5 yo skips on alternate feet, copy square, can draw several parts ( body) 5-6 triangle and diamond

which finding should the nurse expect when assessing physical growth in the school age child

weight increase 2-3 kg per year

Otolith righting

when the body of an erect infant is tilted, the head is returned to an upright, erect position

parachute

when the infant is suspended in a horizontal prone position and suddenly thrust downward, the hands and fingers extend forward as if to protect against falling

Identify one major category of disease that children tend to contract in infancy and early childhood

- Respiratory illness - Infection - Acute illnesses

Regression in toddlers occurs when there is?

-stress -threat to their autonomy -need to revert to dependency

Early childhood caries may result from?

-using a pacifier coated with honey -feeding the last bottle just before bedtime -long, frequent nocturnal breastfeeding

A health care provider prescribes Kytril (granisetron), 10 mcg/kg IV every 4 to 6 hours as needed for nausea. The medication label states: "Kytril 100 mcg/1 mL." The child weighs 15 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.

1.5 Follow the formula for dosage calculation. Multiply 10 mcg ´ 15 kg to get the dose = 150 mcg Desired ———- ´ Volume = mL per dose Available 150 mcg ———- ´ 1 mL = 1.5 mL 100 mcg

Of the following hematopoietic changes that occur in infancy, the one that is considered abnormal in the first 5 months of life is: A. low iron levels B. physiologic anemia C. presence of fetal hemoglobin D. low hemoglobin level

A. low iron levels

Where in the health history does a record of immunizations belong? a. History b. Present illness c. Review of systems d. Physical assessment

ANS: A The history contains information relating to all previous aspects of the child's health status. The immunizations are appropriately included in the history. The present illness, review of systems, and physical assessment are not appropriate places to record the immunization status.

The nurse is preparing to administer some iron drops to a toddler. Which factor can increase iron absorption? (Select all that apply.) a. Vitamin A b. Acidity (low pH) c. Phosphates (milk) d. Malabsorptive disorders e. Ascorbic acid (Vitamin C)

ANS: A, B, E Factors that increase iron absorption are vitamin A, acidity (low pH), and ascorbic acid (vitamin C). Phosphates (milk) and malabsorptive disorders decrease absorption of iron.

What disease processes require airborne precautions? (Select all that apply.) a. Measles b. Varicella c. Pertussis d. Meningitis e. Tuberculosis

ANS: A, B, E In addition to Standard Precautions, use airborne precautions for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. Examples of such illnesses include measles, varicella (including disseminated zoster), and tuberculosis. Pertussis and meningitis require droplet precautions.

A parent tells the nurse, "My toddler tries to undo the car seat harness and climb out of the seat." What strategies should the nurse recommend to the parent to encourage the child to stay in the seat? (Select all that apply.) a. Allow your child to hold a favorite toy. b. Allow your child out of the seat occasionally. c. Avoid using rewards to encourage cooperative behavior. d. When child tries to unbuckle the seat harness, firmly say, "No." e. It may be necessary to stop the car to reinforce the expected behavior.

ANS: A, D, E Strategies to encourage a child to stay in a car seat include allowing the child to hold favorite toy, firmly saying "No" if the child begins to undo the harness, and stopping the car to reinforce the expected behavior. Rewards, such as stars or stickers, can be used to encourage cooperative behavior. The child should stay in the car seat at all times, even for short trips.

Parents are switching their toddler, who has met the weight requirement, from a rear-facing car seat to a forward-facing seat. The nurse should recommend the parents place the seat where in the car? a. In the front passenger seat b. In the middle of the rear seat c. In the rear seat behind the driver d. In the rear seat behind the passenger

ANS: B Children 0 to 3 years of age riding properly restrained in the middle of the backseat have a 43% lower risk of injury than children riding in the outboard (window) seat during a crash.

The nurse is aware that skin turgor best estimates what? a. Perfusion b. Adequate hydration c. Amount of body fat d. Amount of anemia

ANS: B Skin turgor is one of the best estimates of adequate hydration and nutrition. It does not indicate amount of body fat and is not a test for anemia.

To avoid a fall from a crib, the nurse recommends to parents that their toddler should sleep in a bed rather than a crib when reaching what height? a. 30 in b. 35 in c. 40 in d. 45 in

ANS: B When children reach a height of 89 cm (35 in), they should sleep in a bed rather than a crib.

The nurse is performing an assessment on a 10-week-old infant. The nurse understands that the developmental characteristic of hearing at this age is which? a. The infant responds to his own name. b. The infant localizes sounds by turning his head directly to the sound. c. The infant turns his head to the side when sound is made at the level of the ear. d. The infant locates sound by turning his head to the side and then looking up or down.

ANS: C At 8 to 12 weeks of age, the infant turns the head to the side when sound is made at the level of the ear. At 16 to 24 weeks, the infant locates sound by turning the head to the side and then looking up or down. At 24 to 32 weeks, infants respond to their own name. At 32 to 40 weeks, the infant localizes sounds by turning the head directly toward the sound.

What is an appropriate screening test for hearing that the nurse can administer to a 5-year-old child? a. Rinne test b. Weber test c. Pure tone audiometry d. Eliciting the startle reflex

ANS: C Pure tone audiometry uses an audiometer that produces sounds at different volumes and pitches in the child's ears. The child is asked to respond in some way when the tone is heard in the earphone. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants.

In terms of gross motor development, what should the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from the back to the abdomen. c. Turn from the abdomen to the back. d. Move from a prone to a sitting position.

ANS: C Rolling from the abdomen to the back is developmentally appropriate for a 5-month-old infant. The ability to roll from the back to the abdomen is developmentally appropriate for an infant at age 6 months. Sitting erect without support is a developmental milestone usually achieved by 8 months. A 10-month-old infant can usually move from a prone to a sitting position.

At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 12 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

The nurse suspects shock in a child 1 day after surgery. What should be the initial nursing action? a. Place the child on a cardiac monitor. b. Obtain arterial blood gases. c. Provide supplemental oxygen. d. Put the child in the Trendelenburg position.

ANS: C The initial nursing action for a patient in shock is to establish ventilatory support. Oxygen is provided, and the nurse carefully observes for signs of respiratory failure, which indicates a need for intubation. Cardiac monitoring would be indicated to assess the child's status further, but ventilatory support comes first. Oxygen saturation monitoring should be begun. Arterial blood gases would be indicated if alternative methods of monitoring oxygen therapy were not available. The Trendelenburg position is not indicated and is detrimental to the child. The head-down position increases intracranial pressure and decreases diaphragmatic excursion and lung volume.

What is an important consideration for the school nurse planning a class on injury prevention for adolescents? a. Adolescents generally are not risk takers. b. Adolescents can anticipate the long-term consequences of serious injuries. c. Adolescents need to discharge energy, often at the expense of logical thinking. d. During adolescence, participation in sports should be limited to prevent permanent injuries.

ANS: C The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk. Adolescents are risk takers because their feelings of indestructibility interfere with understanding of consequences. Sports can be a useful way for adolescents to discharge energy. Care must be taken to avoid overuse injuries.

What signals the resolution of the Oedipus or Electra complex? a. Learns sex differences b. Learns sexually appropriate behavior c. Identifies with the same-sex parent d. Has guilt over feelings toward the father or mother

ANS: C The resolution of the Oedipus or Electra complex is identification with the same-sex parent. Learning sex differences and sexually appropriate behavior is a goal in further differentiation of oneself but does not signal the resolution of the Oedipus or Electra complex. Guilt over feelings toward the father or mother is seen as a stage in the complex, not the resolution.

What developmental characteristic does not occur until a child reaches age 2 1/2 years? a. Birth weight has doubled. b. Anterior fontanel is still open. c. Primary dentition is complete. d. Binocularity may be established.

ANS: C Usually by age 30 months, the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

What are characteristics of late adolescence (18-20 years) with regard to sexuality? (Select all that apply.) a. Exploration of "self-appeal" b. Limited dating, usually group c. Intimacy involves commitment d. Growing capacity for mutuality and reciprocity e. May publicly identify as gay, lesbian, or bisexual

ANS: C, D, E Characteristics of late adolescence sexuality include intimacy involving commitment; growing capacity for mutuality and reciprocity; and publicly identifying as gay, lesbian, or bisexual. Exploration of "self-appeal" is a characteristic of middle adolescence sexuality. Limited dating, usually group, is a characteristic of early adolescence sexuality.

The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of which? a. Trust b. Initiative c. Intimacy d. Autonomy

ANS: D Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

The nurse is assessing a child's capillary refill time. This can be accomplished by doing what? a. Inspect the chest. b. Auscultate the heart. c. Palpate the apical pulse. d. Palpate the nail bed with pressure to produce a slight blanching.

ANS: D Capillary refill time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary refill time

Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms? a. Hyperreflexia b. Abdominal cramps c. Cardiac dysrhythmias d. Dry, sticky mucous membranes

ANS: D Dry, sticky mucous membranes are associated with hypernatremia. Hyperreflexia is associated with hyperkalemia. Abdominal cramps, weakness, dizziness, nausea, and apprehension are associated hyponatremia. Cardiac dysrhythmias are associated with hypokalemia.

Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain? a. Tactile stimulation b. Commercial warm packs c. Doing procedure during infant sleep d. Oral sucrose and nonnutritive sucking

ANS: D Nonnutritive sucking attenuates behavioral, physiologic, and hormonal responses to pain. The addition of sucrose has been demonstrated to have calming and pain-relieving effects for neonates. Tactile stimulation has a variable effect on response to procedural pain. No evidence supports commercial warm packs as a pain control measure. With resulting increased blood flow to the area, pain may be greater. The infant should not be disturbed during the sleep cycle. It makes it more difficult for the infant to begin organization of sleep and awake cycles.

What is the role of the peer group in the life of school-age children? a. Decreases their need to learn appropriate sex roles b. Gives them an opportunity to learn dominance and hostility c. Allows them to remain dependent on their parents for a longer time d. Provides them with security as they gain independence from their parents

ANS: D Peer group identification is an important factor in gaining independence from parents. Through peer relationships, children learn ways to deal with dominance and hostility. They also learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. A child's concept of appropriate sex roles is influenced by relationships with peers.

The parents of a newborn say that their toddler "hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away." What is the nurse's best reply? a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

ANS: D The arrival of a new infant represents a crisis for even the best prepared toddler. Toddlers have their entire schedules and routines disrupted because of the new family member. The nurse should work with the parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected, normal response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to imitate parents' behaviors. The child can care for the doll's needs at the same time the parent is performing similar care for the newborn.

Which of the following nursing diagnosis would used most often for health promotion related to development in an infant jennifer's age? A. activity intolerance B. ineffective thermoregulation C. high risk for injury D. altered parenting

C. high risk for injury ( 4 month)

Family systems theory

Continual interaction occurs between family members and the environment (p 47-48; table 3-1) Focus is on the interactions of the family members rather than on an individual member. A problem or dysfunction is not viewed as lying in any one family member but rather in the interactions within the family (p 47-48; table 3-1)

The nurse is assessing the IV site of a pediatric patient and notes yellow drainage. What action should the nurse take? Apply EMLA cream to the infiltrated site. Wrap the site tightly to reduce the drainage. Reduce the infusion rate and notify the health care provider. Discontinue the infusion and the IV catheter and notify the health care provider.

Discontinue the infusion and the IV catheter and notify the health care provider. If drainage is noticed by the nurse at the IV site of a child the IV infusion should be immediately discontinued, the IV catheter removed, and the health care provider notified.

Question 1 of 3 Which cognitive advancements are expected between 19 and 24 months? Domestic mimicry Ability to relate to time of day Abstract thinking to solve problems Imitating an action only while another person is performing it

Domestic mimicry Domestic mimicry (imitating a parent of the same sex) and deferred imitation (imitating an action hours after the toddler watched the original action) are expected cognitive advancements of the toddler.

Describe at least three strategies that can be used in the intensive care unit to support the child and family.

Encourage parents to stay with their child. Provide information about child's condition in understandable language. Establish a routine that maintains some similarity to daily events in child's life whenever possible. Schedule undisturbed times. Reduce stimulation

Which body system changes are expected in the school-age child? Select all that apply. Skeletal muscles fully develop. Enlarged tonsils and adenoids. Lungs and alveoli fully develop. Development of frontal sinuses. Eustachian tubes angle upward.

Enlarged tonsils and adenoids. Enlarged tonsils and adenoids are an expected body system change in the school-age child as the lymphatic tissues grow and are not always indicative of an infection. Lungs and alveoli fully develop. Fully developed lungs and alveoli are an expected body system change in the school-age child. Development of frontal sinuses. Development of frontal sinuses is an expected body system change in the school-age child.

Adoption

Establishment of a legal relationship of parent and child between persons not related by birth (p 49-51, 56-59, 63)

Divided or split custody

Family situation in which each parent is awarded custody of one or more of the children, thereby separating siblings (p 49-51, 56-59, 63)

Joint custody

Family situation in which the children reside with one parent, although both parents act as legal guardians and both participate in childbearing (p 49-51, 56-59, 63)

The nurse is caring for a 9-year-old child with asthma. Where should the nurse place the pulse oximeter to monitor the child's oxygen saturation? Ear Finger Big toe Forehead

Finger The nurse would use the finger to assess the oxygen saturation of a 9-year-old child.

The nurse is performing an assessment on a 3-year-old with a fever and a sore throat. Which part of the hand would the nurse use to palpate cervical lymph nodes? Palm Fingertips Finger pads Back of the hand

Fingertips The nurse would use the fingertips to palpate lymph nodes because the fingertips are more sensitive.

A rapid pace of growth is common in which age group? From birth to 2 years From 10 years to puberty From 2 years to 10 years From 16 to approx. 24 years From puberty to 15 years

From birth to 2 years During this period the growth rate is high compared to other age groups. The child grows rapidly, tripling birth weight at 1 year and quadrupling birth weight by age 2. From puberty to 15 years From the onset of puberty to 15 years, the growth rate is high compared to other age groups. Hormonal influences during this time prepare the body for adulthood, including this growth spurt, a deposition of fats stores, secondary sexual characteristics, and, for girls, menarche.

Which activity could help foster a sense of industry in the school-age child? Discourage the child from competing on a team. Give the child an allowance for completing chores. Allow the child to watch a favorite television show. Tell the child he must make an A on the test tomorrow.

Give the child an allowance for completing chores. Giving the child an allowance for completing chores could help foster a sense of industry in the school-age child by rewarding the child's accomplishment.

The father of a 4-year-old child arrives in the emergency department with the child and states that he believes the child has a sore throat and stomachache. Which is the best indicator that the child is experiencing pain? Red, swollen tonsils Temperature of 102.8° F Decrease in blood pressure Guarding the abdomen during palpation

Guarding the abdomen during palpation Guarding of a painful area (the abdomen in this scenario) during palpation is the best indicator of pain. The nurse knows this indicates the patient is attempting to protect the abdomen from further discomfort.

The nurse is providing discharge teaching to the mother of a two-day-old newborn. The mother expresses concern about how her three-year-old toddler will react to the new baby. The nurse explains that the toddler may experience which common reaction(s) to a new baby? Suspiciousness Intense joy and excitement Depression and withdrawn behavior Jealousy and feelings of resentment

Jealousy and feelings of resentment A three-year-old will likely experience jealousy of a new baby because of the parents' redirected focus on the baby and fear that the baby will replace him or her as the object of the parents' affection. The nurse should suggest that the parents involve the toddler in caring for the baby in age-appropriate ways and schedule quality time with the toddler.

When examining a 15-month-old, which assessment would the nurse perform last? Chest inspection Abdominal auscultation Otoscopic ear examination Palpation of lower extremities

Otoscopic ear examination The otoscopic ear examination should be reserved for last because it is an invasive, potentially uncomfortable procedure.

The parent of a 10-year-old child is distressed by the child's recent tendency to post embarrassing photos of other children on social media sites. Which common behavioral problem do these actions exemplify? Stress Anxiety School refusal Peer victimization

Peer victimization Peer victimization, often called bullying, can include targeting children on social media sites.

Which pattern of development growth can be described as "from the center outward"? Mediolateral Ventrolateral Proximodistal Coronal to sagittal

Proximodistal The term proximo refers to an anatomical area toward the center of the body or midline and distal refers to an area away from the center of the body or midline. Proximodistal describes a pattern of normal growth in infancy. For example, an infant will bat at objects before they can pick up a small object.

Parent--infant attachment is the most important association for which type of development? Biological Physiological Psychosocial Sociocultural

Psychosocial Psychosocial development needs to be reinforced in the infant's life. This is one of the most important aspects in the development of parent-infant attachment.

Match the child safety seat recommendation with the child for which it is age and weight appropriate.

Rear-facing in back seat six-month-old infant Rear- or forward-facing, back seat 15-month-old toddler Forward-facing in back seat three-year-old toddler Booster in back seat School-age child

Closed family

Resists input; views change as threatening and suspicious (p 49-51, 56-59, 63)

The progression of function in infants can be described by which patterns of growth and development? Simple to complex General to specific Complex to simple Specific to general Functional to nonfunctional

Simple to complex This pattern describes progression of functions. For example, as a child develops language, their vocabulary becomes more detailed and enhanced, and, similarly, an infant holds a toy in his or her hand before he or she picks up a small object with pincer grasp. Correct General to specific This pattern describes responses of infant body systems. For example, myelination of the peripheral nerves in the neurological system becomes more developed as the infant grows, allowing the infant to crawl before walking.

Erikson viewed development as a lifelong series of conflicts affected by which factors? Social and cultural Ecological and physical Biological and psychological Educational and environmental

Social and cultural Erikson suggested that development is a lifelong series of conflicts affected by social and cultural factors and that each conflict must be resolved for the child and adult to progress emotionally. According to Erikson, unsuccessful conflict resolution leaves the individual emotionally disabled.

An eight-week-old infant is exclusively formula fed, and take approximately four oz, six times per day. Which nutritional recommendation should the nurse recommend to the infant's parents? Introduce baby food Include infant cereal Add iron supplements Start vitamin D supplements

Start vitamin D supplements Vitamin D supplements are an appropriate nutritional recommendation because the infant is drinking less than 32 ounces of formula a day.

Question 2 of 3 The nurse is preparing to administer an intramuscular injection to a pediatric patient. What information does the nurse require to accurately determine which site is best to administer the injection? Select all that apply. The child's age. The child's height. The child's weight. The volume of medication. The child's body surface area.

The child's weight. The child's weight should be considered when determining the site for an intramuscular injection. By evaluating the child's weight and overlying fat the nurse will be able to select a needle of the appropriate length. The volume of medication. The volume and properties of the medication must be considered when determining the site for an intramuscular injection. Certain sites are only able to contain a limited volume of injectable material. The child's age. The child's age is a factor that should be used to determine the site for an intramuscular injection. For instance, a neonate should not be injected in the deltoid muscle, but that site is OK for a toddler.

Another term for "the new morbidity" is a) pediatric social illness b) pediatric noncompliance c) learning disorder d) autism spectrum disorder

a) pediatric social illness

The nurse then identifies a possible human response pattern to further classify the data. Which one of the following functional health patterns would be best for the nurse to select? a) role-relationship pattern b) nutritional-metabolic pattern c) coping-stress tolerance pattern d) self-perception/self-concept pattern

a) role-relationship pattern

If 5-year-old Brian becomes neutropenic, the nurse knows to avoid which one of the following medications for pain? a. Acetaminophen. b. Morphine. c. All IM medications. d. Codeine.

a. Acetaminophen.

which of the following social factors contributes to increased morbidity in children? a. poverty b. geographic region c. birth order d. paternal age

a. poverty

What is a choke tube test and for whom is the test performed?

all objects within reach of <3y.o. should pass the choke tube test - NO LATEX BALLOONS can it fit in a toilet paper tube?

coanalgesic adjuvant

antidepressants ( amitriptyline, nortriptyline) anticonvulsants (gabapentin, pregablin, carbamazepine) anxiolytics ( lorazepam, diazepam) corticosteroids (dexamethasone) others ( clonidine, mexiletine)

which of the following is not a potential consequence of mass media? a. body dissatisfaction b. visual imparment c. violence desensitization d. sedentary lifestyle

b. visual imparment

The disease that continues to be a leading cause of death in all age-groups of children is: a) Type 1 DM b) AIDS c) cancer d) infectious diseases

c) cancer

Which environmental substances are known to have a teratogenic effect on the developing fetus? Select all that apply. Statins Ethanol Penicillin Vitamin D Acetaminophen (Tylenol

Statins Statins should be avoided during pregnancy. Statins have been associated with hearing impairments in children of mothers who took statins during pregnancy. Ethanol Ethanol can lead to fetal alcohol syndrome if ingested during pregnancy and therefore it is one of the environmental substances known to have a teratogenic effect on the fetus.

cultural diffusion

school is the center, standards of the larger group are dessiminated into community

empathy

the capacity to understand what another person is experiencing from within that person's frame of reference

Actively attempting to make friends with children Before they have had An opportunity To evaluate an unfamiliar personWill increase their anxiety

true

The nurse is discussing sleeping habits with the parents of a five-year-old child. Which assessment findings would be concerning to the nurse? Select all that apply. The child takes a nap more than once during the day. Parents allow the child to stay up until tired. The parents use a bedtime routine to help the child relax. Parents offer the child snacks while in bed to encourage going to bed. Parents withhold playtime until the child agrees to go to bed at a certain time.

Parents allow the child to stay up until tired. Children need a core routine during the day and night, and a regular bedtime should be set and followed every night. Parents offer the child snacks while in bed to encourage going to bed. Offering the child snacks while in bed may interfere with the bedtime routine. Moreover, if the snacks are sugary in nature, they may be detrimental to the deciduous teeth. Correct Parents withhold playtime until the child agrees to go to bed at a certain time. Although it is important that the child have a nightly routine, it is more important that the parents interact and bond with the child. Parent-child playtime is an important act that should not be used as a reward or punishment.

An adolescent gives the nurse a 24-hour diet recall of: Breakfast: black coffee; lunch: chicken salad with tomatoes and lettuce; snack: yogurt and granola with fruit and an energy drink; dinner: cheese omelet with broccoli; snack: whole grain toast with peanut butter. Which recommendations or observations should the nurse make to improve or reinforce the nutritional choices of this patient? Select all that apply. Substitute the energy drink for the morning coffee. Peanut butter is a good choice for meals and snacks. Only eat eggs or omelets during the morning mealtime. Discuss appetizing breakfast foods to include in the diet. Eating yogurt more often is a good way to increase calcium.

Peanut butter is a good choice for meals and snacks. Peanut butter is a good source of protein and fat. Discuss appetizing breakfast foods to include in the diet. Eating breakfast is a very important meal because it helps to boost metabolism and improves cogntion. Eating yogurt more often is a good way to increase calcium. Calcium and vitamin D are crucial to the development of the bones and milk (or milk substitute) should be consumed daily.

The nurse percusses the chest of a 7-year-old patient with asthma and notes a dull area over the lower left quadrant. How would the nurse describe this finding? Percussion over a hollow organ Percussion over an air-filled organ Percussion over a solid mass, or bone Percussion over a high-density organ or mass

Percussion over a high-density organ or mass Percussion over high-density organs produces a dull sound.

The mother of a one-month-old infant asks the nurse for advice on establishing safe and consistent sleep practices. What recommendations does the nurse provide? Select all that apply. Place the baby to sleep on the back. Give the baby a warm bath before bed. Put the baby to sleep at the same time every night. Allow the baby to have a bottle while sleeping in crib. Put the baby to sleep when the baby is drowsy, but awake.

Place the baby to sleep on the back. Placing the baby to sleep in the back is a safe practice that decreases the risk of SIDS. Correct Give the baby a warm bath before bed. A warm bath before bed helps with relaxation. Correct Put the baby to sleep at the same time every night. Putting the child to sleep at the same time every night helps to establish a predictable sleep routine. Put the baby to sleep when the baby is drowsy, but awake. Putting the child to sleep in the crib when the child is drowsy but still awake allows the baby to learn how to go to sleep on their own.

An adolescent experiences an avulsed tooth while playing football. The family recovers the tooth and brings the adolescent to the emergency room. What is the priority action by the nurse? Place tooth in milk. Scrub the tooth clean. Place tooth back in socket. Ensure that all debris is removed from tooth.

Place tooth in milk. The tooth should be placed in saline, milk, or a commercial tooth-preserving liquid until it can be reattached.

The nurse is discussing appropriate safety for school-aged children with the parents of a six-year-old and a 10-year-old. Which safety recommendations can the nurse make that are appropriate for both children? Select all that apply. "Always use sunscreen while outdoors." "Discuss not allowing unfamiliar adults into the home." "Ensure guns are in a locked vault, in a separate location from the ammunition." "Both children can be restrained with only the three-point harness while in the motor vehicle." "Children should protect their eardrums by listening to only moderate-volume music and television."

"Always use sunscreen while outdoors." Sun protection is an important safety issue for all ages and should be addressed for any child spending time outdoors. "Discuss not allowing unfamiliar adults into the home." Not opening the door to strangers is an important safety issue for both six and 10-year-old children. "Ensure guns are in a locked vault, in a separate location from the ammunition." Gun safety is similar for all school-aged children and includes keeping guns locked up and ammunition separate. "Children should protect their eardrums by listening to only moderate-volume music and television." Listening to loud music is a safety concern for all school-aged children.

An adolescent patient is concerned by sore gums and worries that it is a manifestation of a serious disease. Which actions does the nurse recommend to address the underlying cause of the patient's symptoms? Select all that apply. "Only eat soft, bland foods." "Use only a medium bristled toothbrush." "Be sure to clean around your braces really well." "Eliminate sweets and sugary beverages from your diet." "Gargle with a mix of salt and baking soda a few times per day."

"Be sure to clean around your braces really well." Wearing bracing can result in less effective cleaning, leading to gingivitis, resulting in sore and bleeding gums. "Eliminate sweets and sugary beverages from your diet." Eating sweets and sugary beverages can contribute to gingivitis, leading to sore gums. Moreover, the high amounts of sugar is not healthy for the tooth enamel. "Gargle with a mix of salt and baking soda a few times per day." Salt and baking soda reduces germs and rinses away debris, helping gums to heal.

The mother of an infant asks the nurse for suggestions about ways to calm her infant's crying. Which response(s) by the nurse are appropriate? Select all that apply. "Crying may cause increased gas causing pain." "You shouldn't try to stop your baby from crying." "You can try swaddling. This can be very calming." "Crying is how infants communicate their needs." "Using a baby swing can comfort an irritable infant."

"Crying may cause increased gas causing pain." Infants who have colic cry frequently and regularly because of the gas pain they have. Parents should be aware of this so they do not blame themselves. "You can try swaddling. This can be very calming." Many babies like to be wrapped up and are soothed by the familiar pressure (similar to that of the womb). Caregivers can pull the infant's arms and legs in toward the center of the body and then wrap the baby in a light blanket as way to help calm the child. "Using a baby swing can comfort an irritable infant." Motion such as from an infant swing or rocking the baby in your arms can help soothe the infant's irritability and decrease crying.

A family has told the nurse that they have guns in their household. Which statement is most appropriate from the nurse to the family? "Families with children should not have guns in the home." "I can't believe you would expose your children to guns and violence." "Having guns is okay as long as they are placed out of reach of the children." "Ensure that the weapons are stored unloaded, in a locked location, out of the child's reach, at all times."

"Ensure that the weapons are stored unloaded, in a locked location, out of the child's reach, at all times." The nurse should encourage proper gun safety to protect the child and family, including locking the guns away safely, keeping them unloaded, and storing ammunition separately.

Which statement made by a child suggests that bullying may be occurring? Select all that apply. "He told me he has a crush on me." "I think they just want to be my friends." "He made fun of me at school because of my weight." "He told people that I failed my test when really I didn't." "He sent me unwanted email messages that made me feel nervous."

"He made fun of me at school because of my weight." Teasing is a form of bullying when it makes a person feel distressed. "He told people that I failed my test when really I didn't." Spreading rumors about another person is a type of bullying. "He sent me unwanted email messages that made me feel nervous." The incidence of cyberbullying, or bullying via email or social media, has increased in the past 10 years and continues to be a problem among school-aged children.

A parent brings his 3-year-old child to the clinic because the child doesn't feel well. The nurse asks the child to point to where it hurts, and the child points at his stomach. Which questions would the nurse ask the parent? Select all that apply. "Is there a family history of intestinal issues?" "How long has he complained of a stomachache?" "Have you given him anything for the stomachache?" "Does anyone in the home smoke cigarettes or cigars?" "Has he had any other symptoms since the stomachache began?"

"How long has he complained of a stomachache?" The onset and duration of the patient's symptoms should be determined. Correct "Have you given him anything for the stomachache?" The nurse would question the parents about treatment for the patient's current problem. "Has he had any other symptoms since the stomachache began?" The nurse would ask about the presence of accompanying symptoms when obtaining a problem-based history.

A mother of a 3-month-old infant is requesting information on the motor milestones she can expect to see in her child. The nurse can tell the parent to expect to see which activities at 3 months? Select all that apply. Puts foot in mouth Places hand in mouth Turns from back to abdomen Turns from abdomen to back Can lift head off bed in prone position.

Places hand in mouth The nurse can tell the parent that at 3 months the child will attempt to place their hand in the mouth. Can lift head off bed in prone position. By 3 months the infant should be able to lift the head off a bed in prone position, so the nurse can tell the parent to expect this activity.

The nurse teaches the 14-year-old patient about reliable resources for sexual education. The nurse knows further teaching is needed when the patient makes what statements? Select all that apply. "I have a friend whose older brother has had a bunch of girlfriends." "I look at websites on the back of the pamphlet from the health department." "Sometimes I go to my friends' house and we look at videos of naked girls." "I talk about sex with my older friends who know things because they've done 'it'." "Once a year they do this thing at school where they talk about condoms and stuff."

"I have a friend whose older brother has had a bunch of girlfriends." Listening to a friend in class discuss sexual education they learned from an older sibling is not an appropriate environment to learn about sex. The information may not be accurate. "Sometimes I go to my friends' house and we look at videos of naked girls." The videos referenced provide a limited and fantasy-oriented view of sex. Correct "I talk about sex with my older friends who know things because they've done 'it'." Discussing sex in a group of peers is not an appropriate environment to learn about sex. The information received may be inaccurate.

The nurse is ordered to administer a stat IV medication to a 3-month-old patient. The parent asks, "Why can't you just give this medication by mouth; it'll take some time to start working anyway?" What is the best response by the nurse? "IV medications will begin to take effect immediately." "Oral medications are not absorbed as well as IV medications." "The healthcare provider ordered the medication IV, so I have to give it that way." "I can request the health care provider change the medication to be given orally."

"IV medications will begin to take effect immediately." IV medications have a rapid onset of action, and this is a stat medication. This would be the preferred method, and the most accurate and best response by the nurse to the parent's query.

An adolescent reports eating primarily salads with low-fat dressing and raw vegetables. Which recommendations should the nurse make to ensure the patient consumes a healthy nutritious diet? Select all that apply. "Have cooked vegetables sometimes." "Include an energy drink every afternoon." "Drink a supplement drink between meals." "Include chicken, tuna, or tofu in your salad." "Add a slice of whole wheat bread to your meal."

"Include chicken, tuna, or tofu in your salad." Adding protein such as tofu, soy, beans, or eggs, will help ensure the patient has sufficient protein in the diet. Correct "Add a slice of whole wheat bread to your meal." Grains should represent a significant portion of the daily calories. An adolescent eating mostly salads and vegetables should add more grains to the diet.

A mother requests the use of a numbing agent on the infant's skin before starting an IV. Which response from the nurse best explains the concerns with using a topical numbing agent? "Infants are prone to skin irritation and contact dermatitis." "Numbing agents can change the blood flow and affect the IV medication." "The use of a numbing agent will not be effective when applied to the skin of an infant." "Infants and young children have a higher body surface area-to-weight ratio and thinner skin than adults."

"Infants and young children have a higher body surface area-to-weight ratio and thinner skin than adults." The large body surface area-to-weight ratio of infants coupled with thinner outer skin layer results in a higher absorption of topical medications. Therefore, the nurse must be careful in the use of a numbing agent and ensure the agent is approved for use in infants

The nurse is preparing to administer medication to a pediatric patient. Which statements describe how the nurse can encourage and empower the parents of the patient? Select all that apply. "Is your child able to swallow pills or capsules whole?" "Please list all current medication allergies for your child." "I am going to document this medication administration in your child's records." "I am going to crush two pills and mix them with applesauce for your child to eat." "This medication is going to alleviate your child's pain. You can administer it while the child sits on your lap." "When your child takes all of the medication, be sure to praise her. A small token, such as a star sticker, can encourage repeat dosing."

"Is your child able to swallow pills or capsules whole?" The nurse should learn from the parents if the child can take medications and what their previous experience is with administering medication. Asking a parent about their child's ability includes them in the care of the child. "Please list all current medication allergies for your child." The parents will feel empowered by knowing they are helping their children by discussing the medications and allergies of their children. "I am going to crush two pills and mix them with applesauce for your child to eat." The nurse should explain methods to administer medication. These methods include mixing the medication with something flavored such as syrup, jelly, yogurt, or applesauce. Explanations of the care that is about to be provided empowers the parents. "This medication is going to alleviate your child's pain. You can administer it while the child sits on your lap." The nurse should provide a thorough explanation of all medications before administering the medication. The nurse will also describe the proper position of the child while administering a medication. Education regarding medications and administration empowers the parents. "When your child takes all of the medication, be sure to praise her. A small token, such as a star sticker, can encourage repeat dosing." The use of positive reinforcements such as rewards or stickers after the child has taken a medication will encourage the child to continue to take the medication. Education regarding medications and administration empowers the parents.

The nurse prepares to teach the caregivers of a three-year-old about gun safety. The caregivers stop the nurse, indicating that the child will not be exposed to guns because there are no guns in the house and therefore gun safety teaching is unnecessary. What is the best response by the nurse regarding the need for gun safety education? "It is important to learn gun safety now in case you decide to purchase a gun in the future." "It is prudent to learn gun safety before your child is exposed to guns outside of the home." "Gun safety is important to learn because it applies to other weapons that may be in the house." "Let me know if you decide to purchase a gun, and I would be happy to educate you on gun safety at that time."

"It is prudent to learn gun safety before your child is exposed to guns outside of the home." Even though parents may not keep a gun in the house, children may visit friends whose parents do. Parents and caregivers should learn about and teach children gun safety before the children are exposed to guns outside of the house.

The nurse is preparing medication for an 8-month-old infant by mixing it with applesauce. The infant's parent asks why the medication should not be mixed into the infant's breast milk, since that is what the infant prefers. What is the appropriate response from the nurse? "Breastmilk may alter the effectiveness of the medication being administered." "It may result in the child refusing to drink breast milk, an essential food for an 8-month-old." "Using nonessential food provides you with better options for timing of the delivery of the medication." "The medication should be mixed with nonessential foods like pudding so your child will more readily take it."

"It may result in the child refusing to drink breast milk, an essential food for an 8-month-old." A medication may alter the taste of a food which could result in the child refusing to eat that food. By using a nonessential food the medication may be administered using different foodstuffs that the child may enjoy.

During a well visit, the patient's parent asks "Why do you need to know about my mother's health? Shouldn't we focus on the baby's health?" How does the nurse respond? "The family history can indicate the risk for exposure to environmental hazards." "Understanding the family history can give the health care provider useful information about the patient's emotional state." "The family history can give the provider helpful information about the patient's current condition and proper treatment methods." "Knowing the family history helps the health care provider determine hereditary factors that could affect your baby's health later."

"Knowing the family history helps the health care provider determine hereditary factors that could affect your baby's health later." The family history helps the provider identify genetic/hereditary patterns that could affect the child in the future.

A nurse is teaching caregivers appropriate safety guidelines for their four-year-old child regarding firearm safety, burn safety, and personal safety. Which teaching from the nurse is appropriate for all safety situations? Select all that apply. "Make the child aware of the danger." "Demonstrate, rather than explain, to the child." "The child should go to a trusted adult if there is a safety concern." "Communicate your safety rules in a clear and precise manner." "Educate the child to immediately leave the house when in danger."

"Make the child aware of the danger." For any dangerous situation, it is important to communicate with the child so that they are informed and prepared if put in that situation. "The child should go to a trusted adult if there is a safety concern." In every situation involving child safety, the child should understand that a trusted adult should be alerted. Correct "Communicate your safety rules in a clear and precise manner." When reviewing safety measures, communication is key. Clear and precise instructions can help a child understand the appropriate action.

The 16-year-old patient talks excitedly with the nurse about the freedom of having a driver's license. Which statements by the patient need clarification by the nurse? Select all that apply. "Driving really cheers me up when I feel upset about anything at school." "Sometimes I accidentally leave my phone off even after I get out of the car." "My friends and I are headed to the water fall this weekend for a camping trip." "It feels good to know that if things get too out of control at home that I can leave." "Soon I'll be able to get a job and buy my own clothes without getting them approved."

"My friends and I are headed to the water fall this weekend for a camping trip." Swimming in a dangerous area without supervision contributes to adolescent drowning deaths. If it is this patient's intention to be the driver, it is dangerous for multiple teenagers to ride together. Correct "It feels good to know that if things get too out of control at home that I can leave." This statement needs immediate clarification. What gets out of control? If there is violence in the home, the nurse will need to get child protective services involved.

Question 1 of 3 The nurse is evaluating the teaching provided to the parents of a three-year-old. Which statements made by the parents about motor vehicle safety recommendations would indicate to the nurse that teaching has been effective? Select all that apply. "Our child should be positioned in a rear-facing car seat." "Our child should be positioned in a forward-facing car seat." "Our child should be fastened into the car seat with a five-point harness." "Our child's car seat should be secured in the passenger side, front-seat position." "Sometimes I forget my purse in the house. I leave the child in the car when I quickly run into the house. This is OK."

"Our child should be positioned in a forward-facing car seat." Use of a forward-facing car seat is an appropriate motor vehicle safety recommendation for a three-year-old toddler. "Our child should be fastened into the car seat with a five-point harness." Use of a car seat with a five-point harness is an appropriate motor vehicle safety recommendation for a three-year-old, as it will safely secure the child in the car seat.

A patient who is pregnant asks the nurse how to prevent sudden infant death syndrome (SIDS) when the baby is born. Which recommendations should the nurse provide to the patient? Select all that apply. "Place your baby on the back to sleep." "Have your baby sleep in the crib only." "Do not expose your baby to second-hand smoke." "Avoid smoking and alcohol during your pregnancy." "Provide a soft mattress and linens in your baby's crib."

"Place your baby on the back to sleep." Laying the baby on the back to sleep is a recommendation that will reduce the extrinsic risk for SIDS. Studies have associated the prone sleeping position with SIDS; therefore, infants should always be placed supine in the crib. "Have your baby sleep in the crib only." Having the baby sleep only in the crib is a recommendation to reduce the extrinsic risk for SIDS. When infants are left to sleep in other places like sofas or large beds with pillows and blankets, the risk of SIDS is increased. "Do not expose your baby to second-hand smoke." Avoid second-hand smoke around the baby is a recommendation that will reduce the extrinsic risk for SIDS. Smoking is one of the modifiable risk factors for SIDS. "Avoid smoking and alcohol during your pregnancy." Smoking and drinking alcohol while pregnant should be avoided for many reasons. These activities are also associated with a greater risk of SIDS after the baby is born.

The nurse is working with parents who have reported that their toddler has had several temper tantrums. Which statements by the nurse suggest appropriate strategies for responding to a temper tantrum? "Tell the child to stop acting childish." "Tell the child he has no reason to act that way." "Let the temper tantrum run its course. The child just needs to wear himself out." "Tell the child that temper tantrums are not okay and put the child in his room until he calms down."

"Tell the child that temper tantrums are not okay and put the child in his room until he calms down." Isolating a child communicates to the child that the behavior is not acceptable. Also, explaining that temper tantrums are not tolerated provides the child with appropriate guidance and discipline. As a result, the child may be less likely to resort to temper tantrums.

The nurse is teaching the parents of an infant about motor vehicle safety recommendations in order to protect their child in the event of a car crash. Which statements would indicate to the nurse that the teaching has been effective? Select all that apply. "The infant car seat should have a three or five-point harness." "The baby should be in a rear-facing car seat until age 12 months." "The infant car seat should be placed in the middle of the back seat." "If we place the baby in the front seat, the car seat should be forward-facing." "Ideally, we should make sure our car seat and the car itself use the LATCH system."

"The infant car seat should have a three or five-point harness." This safety recommendation is crucial to protecting the infant from impact. This harness system will provide support to the infant and hold the infant securely in place in the event of a crash. "The infant car seat should be placed in the middle of the back seat." This is a correct safety recommendation that is crucial for protecting the infant from impact in the event of a crash. This position will ensure the child is as far as possible from either side of the car in the event of crash. "Ideally, we should make sure our car seat and the car itself use the LATCH system." This safety recommendation is crucial to protecting the infant. The LATCH system will hold the infant securely in place and prevent the baby from moving forward in the event of a crash.

Which is the best response to a parent's concern that his 6-year-old frequently lies to get out of trouble? "Children this age are aware of rules and should not lie." "This is normal and you can set an example for what is right." "Lying is expected for children this age and should be ignored." "A school-age child may tell lies to avoid embarrassment. Strict punishment should be enforced."

"This is normal and you can set an example for what is right." The parent should be informed that lying is normal at this age and should be encouraged to set an example in order to instill values in the child.

An 8-year-old child is prescribed a medication that must be delivered by injection. Which statements should the nurse make to prepare the child for administration of this medication? Select all that apply. "This may sting a bit but should not last very long." "This medication is necessary to help your body function properly." "This medication is going to help you and you did not do anything wrong." "I am going to ask your parents to leave briefly while I administer your medication." "You may feel a warm sensation at the injection site, but it is normal and will only last a few minutes."

"This may sting a bit but should not last very long." Preparing the child for what to expect will help him process the situation and encourage his involvement in the process. Correct "This medication is necessary to help your body function properly." The nurse should explain the reason for the injection and help the child understand that the medication will help with her illness. This will help the child remain calm if she understands that it is for her benefit. Correct "This medication is going to help you and you did not do anything wrong." Helping the child to understand that the injection will help her feel better is an important aspect of increasing the child's confidence in the procedure. The nurse should help the child understand that the injection in NOT a punishment. "You may feel a warm sensation at the injection site, but it is normal and will only last a few minutes." The nurse should explain the length of time sensations associated with the injection should last when preparing the child for an injection. If the child knows what to expect then he or she is more likely to be cooperative.

The nurse is evaluating the teaching provided to parents about fall prevention for toddlers. Which statement(s) by the parents indicate that the teaching was effective? Select all that apply. "We need to install screen guards in our windows." "We should let our child freely explore and learn from experience." "We should remove any furniture that can be easily moved or tilted." "We should make sure our child doesn't climb on any breakable furniture." "We should check on our children periodically, so they learn how to maintain safety independently."

"We need to install screen guards in our windows." This is an important safety precaution. Toddlers can easily fall from windows, and screen guards are an important way to prevent these accidents. "We should remove any furniture that can be easily moved or tilted." This is necessary to protect toddlers, especially as they grow more curious and begin to meet their motor development milestones. Toddlers often pull on furniture to stand, and furniture may topple and fall on them.

A 14-year-old female patient tells the nurse she is concerned about being taller than her peers and is worried she will continue to grow in height. Which question by the nurse is most useful for giving guidance regarding expected changes in height related to puberty? "How tall is your mother?" "What was your height at age 11?" "Have you noticed any pubic hair?" "When did you start menstruation?"

"When did you start menstruation?" Typically, girls cease height growth 2 to 2 ½ years after menarche. Asking when menstruation began can help the nurse give appropriate guidance related to height growth for the adolescent.

A child is being seen with dental malocclusion. The child's caregiver asks the nurse how the child's oral health routine will have to change with braces. What is the nurse's best response? "No change is necessary with braces." "Your child will not be able to eat most snacks." "Sticky snacks should be limited to the morning and not consumed at bedtime." "Your child should clean the teeth and use a water flosser several times per day."

"Your child should clean the teeth and use a water flosser several times per day." Brushing after every meal or snack and using a water flosser is recommended to keeping gums healthy and removing any food particles that may be stuck in the braces.

Which factors could be classified as prenatal environmental exposure? Select all that apply. Pregnant mother smokes cigarettes. Pregnant mother has chickenpox virus. Pregnant mother lives in hot, desert climate. Pregnant mother drinks four cups of coffee daily. Pregnant mother lives in a home built in the 1940s.

Pregnant mother smokes cigarettes. Maternal smoking exposes the fetus to nicotine and other chemicals. Pregnant mother has chickenpox virus. Maternal varicella infection exposes the fetus to the virus and can lead to birth defects. Pregnant mother drinks four cups of coffee daily. Excessive coffee drinking exposes the fetus to caffeine. Pregnant mother lives in a home built in the 1940s. Homes built in the 1940s are more likely to have lead-based paint and pipes.

A child who acts in a way to avoid consequences rather than internal feelings of right and wrong is demonstrating which of Kohlberg's levels of moral development? Premorality Morality of conventional role conformity Morality of self-accepted moral principles Morality of postconvential role conformity

Premorality Children at this level do not have a good understanding of right and wrong and will not feel guilty. Children will do what they are told to do rather than what is right. The child will demonstrate acceptable behavior because of a fear of punishment.

Match the scenarios with the corresponding stages or levels of morality as stated by Kohlberg.

Premorality or preconventional morality, stage 0 Decisions are made on the basis of what pleases the child. Morality of conventional role conformity Morality is based on avoiding disapproval or disturbing the conscience. Morality of self-accepted moral principles Right is determined by what is best for the majority. Premorality or preconventional morality, stage 2 Child conforms to rules out of self-interest.

A 5-year-old who steals money from his or her mother's purse and does not understand consequences is likely at which stage of morality? Premorality/preconventional morality Morality of conventional role conformity Morality of self-accepted moral principles Morality of nonconventional role conformity Instrumental hedonism and concrete reciprocity

Premorality/preconventional morality At this level a child does not have a developed conscience. Right or wrong is determined by physical consequences: "If I get caught and punished for doing it, it is wrong. If I am not caught or punished, then it must be right." Instrumental hedonism and concrete reciprocity This is another stage found within the level of premorality, when the child will not understand the difference between right and wrong. The conscience is not fully developed at this stage. The child thinks at this stage, "If you do something bad to me, then it's OK if I do something bad to you."

If a child begins to make judgments and his or her thinking becomes more logical, Piaget would suggest the child is at which stage of cognitive development? Sensorimotor Preoperational Formal operational Concrete operational

Preoperational During the period of preoperational thought, language becomes increasingly useful to children. Children are able to make judgments and thinking becomes more logical.

List 3 strategies that may be used to prevent fatal accidents in children

- Car restraints - Bicycle helmets - Smoke detectors

List 3 Factors that contribute to increasing morbidity of any disorder in children

- Homelessness - Poverty - Low birth weight - Chronic illnesses - Adoption - Daycare attendance

key elements of family centered care

- Incorporating into policy and practice the recognition that the family is the constant in a child's life, whereas the service systems and support personnel within those systems fluctuate - Facilitating family-professional collaboration at all levels of hospital, home, and community care - Exchanging complete and unbiased information between families and professionals in a supportive manner at all times -Encouraging and facilitating family-to-family support and networking -Appreciating families as families and children as children; recognizing that they possess a wide range of strengths, concerns, emotions, and aspirations beyond their need for specialized health and developmental services and support.

key elements of family centered care

- Incorporating into policy and practice the recognition that the family is the constant in a child's life, whereas the service systems and support personnel within those systems fluctuate - Facilitating family-professional collaboration at all levels of hospital, home, and community care - Exchanging complete and unbiased information between families and professionals in a supportive manner at all times -Encouraging and facilitating family-to-family support and networking -Appreciating families as families and children as children; recognizing that they possess a wide range of strengths, concerns, emotions, and aspirations beyond their need for specialized health and developmental services and support.

sexual maturation of girls

- changes in nipples, areola, development of a small bud of breast tissue -pubic hair - clear/yellow vaginal discharge (physiologic leukorrhea) - menstrual period - late puberty

telephone triage guidelines

- date and time - background (name, age, contact info, chronic illness, allergies, current medications, treatments, or recent immunizations) - chief complaint - general symptoms ( severity, duration, other symptoms, pain) - systems review - steps taken

List 3 patient-centered outcome measures that may be applicable to an acutely ill, hospitalized child

- falls prevalence - failure to rescue - central line catheter infection (p 14, Box 1-5)

Pediatric Health History

- identifying info - chief complaint - present illness - past history - review of systems - family medical history - psychosocial history - sexual history - family history - nutritional assessment

sexual maturation in boys

- testicular enlargement, thinning, reddening and increasing looseness of the scrotum (9 1/2- 14) - scant pubic hair - penile enlargement - mascularity, voice deepens, facial hair - gynecpmastia is common

Role of the Pediatric Nurse

-Therapeutic relationship- essential, well defined boundaries that are positive and prof. & promote family's control over care. -Family advocacy and caring-work with family members to ID goals, needs, and plan interventions that best address problems. -Disease prevention and health promotion- thorough assessment, education and anticipatory guidance, age group related edu. -Health teaching- help understand dx, encourage questions, referrals, literature, anticipatory guidance -Injury prevention- dev. approach to safety counseling for all ages. -Support and counseling- support by listening, touching, physical presence, involves teaching to cope, referrals -Coordination and collaboration- unified interdisciplinary approach of HC services. -Ethical decision making- must determine most beneficial or least harmful action within framework of issue. -Research & EBP- involves analyzing & translating published clinical research into everyday nursing.

Standard Precautions are:

-Wear gloves when collecting and handling blood, bodily fluids or tissue specimen. -Wear face shields when there is is a danger for splashing on mucous membranes. -Dispose of all needles and sharp objects in puncture-proof containers without recapping. - gloves, gown, goggles, mask to prevent contamination from blood, bodily fluids, secretions ( except sweat, regardless whether they contain visible blood), non intact skin, mucous membranes

What are APPROPRIATE methods to help a toddler adjust to the initial dental checkup?

-have the child observe their siblings exam -have the child perform a checkup on a doll -ask the dentist to reserve a thorough exam for another visit

What strategy should parents use to prevent fluorosis in toddlers?

-supervise the use of tooth paste -store fluoride products out of reach -administer fluoride supplements on an empty stomach

measures to assess pain in children

-type ( sharp, throbbing, dull, stabbing) - location - severity ( how affects child's usual behavior) - duration ( onset and frequency) influencing factors ( precipitating events, releving events, temporal events- when pain is releived or increases, positional events, associated events - stress, coughing

What are 5 characteristics in a toddler that would indicate readiness for toilet training?

-voluntary control of anal and urethral sphincters -ability to stay dry for 2 hours -regular bowel movements -gross motor skills of sitting, walking, squatting -fine motor skills to remove clothing

Which of the following statements about developmental assessment is true? a. Screening procedures are designed to identify normal developmental levels. b. They provide a means of obtaining subjective measurements of present developmental function. c. The Denver-II is the most sensitive and specific method for testing age-appropriate developmental markers. d. The Ages & Stages Questionnaires are age-specific surveys asking parents about developmental skills common to daily life for the children.

. The Ages & Stages Questionnaires are age-specific surveys asking parents about developmental skills common to daily life for the children

A child weighs 26.4 lbs and is 90 cm tall. The child requires a medication with a dose of 15 mg/m2 and the drug comes in a 10 mg/mL concentration. The required dose is mL. BSA (m2) = √weight (kg) x height (cm) 3600

0.49 The nurse will convert the weight to kilograms (26.4 lbs/2.2 = 12 kg). The next step is to calculate the BSA. BSA (m2) = √weight (kg) x height (cm) 3600 BSA (m2) = √(12 x 90) = √1080 = √0.3 3600 3600 BSA (m2) = √0.3 = 0.55 m2 The nurse will then determine the approximate dose (0.55 m2/1.7) *15 mg/m2 = 4.9 mg. In the final step, the nurse will determine the number of milliliters required for administration. 4.9 mg / 10 mg/mL = 0.485 mL The nurse should administer 0.485 mL of the medication.

infancy sensorimotor phase

1 stage (birth to 1 month)- reflexes (express individuality and temperament through the physiologic reflexes of sucking, rooting, grasping) 2 stage (1-4 months) - primary circular reaction - replacement of reflexive behavior with voluntary acts 3 stage - until 8 months old - secondary circular reaction- primary circular reactions are repeated and prolonged for the response 4 stage - coordination of secondary schemas and their application to new situations - increasing morot skill for the exploring of the environment

Match the milestone with the corresponding age group

1-2 months (gross motor) Can lift head when held against the shoulder 3 months (gross motor) Can lift head off the bed when in prone position 4-5 months (gross motor) Bears some weight when held in the standing position 4-5 months (fine motor) Will reach and grasp with palm

IM administration

1. aspiration no longer recommended exception - pinicillin into ventrogluteal 2. as straight as possible insertion 3. to withdraw from ampule use needle with filter 4. better if someone holds a child during insertion of a needle 5. carry extra needle if child pulls away or jerks to change contaminated one 5. say you put medicine under skin 6. perform as aoon as possible 7. if meds around the clock, wake the child ( not to make afraid going back to sleep) 8. apply topical lidocaine if time permits 9. med should be room temp 10 for small and debilitated use vastus lateralis or ventrogluteal 11. explain what to be done 12. with multiple injection at the same time - injection sites in the same muscle group must be at least 1 " apart 13 no standing child when inject

general guidelines for preparing children for procedures, including surgery

1. determine details of exact procedure 2. review parent and childs present understanding though open ended questions 3. base teaching on developmental age and existing knwlege 4. incorporate parent into teaching if they desire 5. inform parent of their supportive role 6. prevent informtion overload 7. use concrete not abstract terms 8. emphasize that no other body part will be involve 9 if the body part is associsated with a specific function, stress the change or noninvolvement of that ability 10. use language and sentences length appropriate to the child's level 11. avoid phrases witi dual meaning 12. clarify all unfamiliar words 13. emphasize sesory aspects of procedure 14. allow child to practive procedure 15. introduce anxiety inducing information last 16 be honest with the child about unpleasant aspects 17 emphasize end of procedurw and any pleasurable events afterwards (going home) 18 stress positive benefits 19 prase efforts for cooperatiosn

six national quality priorities for health care quality improvement

1. making care safer by reducing harm caused in the delivery care 2. ensuring that each person and famity is engaged as partners in their care 3. promoting effective communication and coordination of care 4. promoting the most effective prevention and treatment practice for the leading causes of mortality, starting with cardiovascular disease 5. working with communities to promite wide use of best practices to enable healthy living 6. making quality care more affordable

PPQ

1. pain history 2. pain language 3. the colors the child associates with pain 4. emotions the child experiences 5. the worst pain experiences 6. the way the child copes with the pain 7. the positive aspects of pain 8. location of current pain

Which activities correspond to normal motor development during the first year of life? Select all that apply. 10-12 months: can stand alone 8-9 months: sits steadily, unsupported 1-2 months: can roll from front to back 4-5 months: turns from back to abdomen 6-7 months: sits and leans forward on both hands

10-12 months: can stand alone At 10-12 months the child has the motor development to be able to stand on his or her own. 8-9 months: sits steadily, unsupported The baby's motor development will be mature enough to allow the child to sit steadily, unsupported. 6-7 months: sits and leans forward on both hands At 6-7 months the baby's motor development will be mature enough to sit and lean forward on both hands (tripod sitting).

A new mother at the clinic asks at what age her baby will be able to actively participate in a game of pat-a-cake with her. Which would be the correct response from the nurse? 4 months 6 months 9 months 12 months

12 months At 12 months the child is likely to participate in pat-a-cake with the mother. This is considered a critical developmental milestone.

A female patient who experienced her first period on her 13th birthday can expect her peak height to be achieved by age .

15 Height in female adolescents increases rapidly until it reaches its peak height at 2 to 2½ years after menarche. Therefore, the female patient who experienced menarche at age 13 would stop growing by age 13 + 2.5 = 15.5, or age 15.

Match the activity with the age at which it is first exhibited.

15 months Walking independently 18 months Turning the pages as they are read to 24 months Stacking multiple blocks to build towers 36 months Dressing themselves

A female patient who experiences menarche at age 12 would be expected to reach reproductive maturity by no later than age .

17 Females are expected to reach reproductive maturity 2 to 5 years after menarche. If a patient experienced menarche at age 12, maturity would be expected by 12 + 5 = 17 years of age.

boys growth ceases

18-20 yo

late adolescence/ young adulthood

18-22 full physical maturation and transition toward adult behavior

Which head circumference measurement would be expected for a two-year-old whose head circumference was 18 inches at the 12-month checkup? 18 inches 17 inches 19.5 inches 21.5 inches

19.5 inches Head circumference increases approximately 1.5 inches from 12 months to 24 months.

A health care provider prescribes midazolam (Versed) syrup 0.5 mg/kg per mouth (PO) 30 minutes before a burn wound dressing change on a child. The medication label states: "Versed 2 mg/1 ml." The child weighs 8 kg. The nurse prepares to administer the dose. How many milliliters will the nurse prepare to administer the dose? Fill in the blank. Record your answer in a whole number.

2 Follow the formula for dosage calculation. Multiply 0.5 mg ´ 8 kg to get the dose = 4 mg Desired ———- ´ Volume = ml per dose Available 4 mg ———- ´ 1 ml = 2 ml 2 mg

A health care provider prescribes diphenhydramine (Benadryl), 1 mg/kg PO every 4 to 6 hours as needed for pruritus to a child with a mild cutaneous anaphylactic reaction. The child weighs 5 kg. The medication label states: "Diphenhydramine 12.5 mg/5 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.

2 Follow the formula for dosage calculation. Multiply 1 mg ´ 5 kg to get the dose = 5 mg Desired ———- ´ Volume = ml per dose Available 5 mg ———- ´ 5 mL = 2 mL 12.5 mg

growth in girls ceases

2-2 1/2 years after first menarche

A typical dietary pattern for optimal growth and development includes which proportions of fat, carbohydrate, and protein? Correct 20% fat, 50% carbohydrate, and 30% protein 50% fat, 30% carbohydrate, and 20% protein 15% fat, 35% carbohydrate, and 50% protein 40% fat, 40% carbohydrate and 20% protein

20% fat, 50% carbohydrate, and 30% protein These proportions allow infants and children the nutrients to meet metabolic needs. When these proportions are not included in daily meals, children are at increased risk for developing disease.

COMFORT-neo

24-42 weeks prolonged pain scored 1-5 each alertness calmness respiratory response body mobement muscle tone facial tension 6-30

The nurse has an order to administer 250mg cephalexin p.o. every 12 hours to a pediatric patient who weighs 25 lbs. The pediatric dose limit is 45 mg/kg/day BID. The patient can receive mg/dose.

256.5 The nurse will have to convert the weight to kilograms (25 lbs/2.2= 11.4 kg). The next step is the multiplication of the weight times the dose (11.4 kg*45 mg/kg/day = 513 mg/day). The final step in calculation is the determination of the amount per dose. The order reads that the patient should receive two doses p.o. per day—513 mg/day /2 = 256.5 mg/dose. The ordered 250 mg/dose is a safe dose to administer.

What is an appropriate feeding serving size of a vegetable for a 3 year old?

3 TBSP

How many words should be acquired by the age of 2 years?

300

A toddler who weighs 22 lbs at 1 year of age would be expected to weigh approximately lbs by the third birthday.

32 The average weight gain is 5 lbs (2.26 kg) per year. Therefore, a toddler weighing 22 pounds at 1 year of age would be expected to weigh approximately 32 pounds (22 + 5 + 5) by the third birthday.

CRIES

32-40 weeks postoperative pain scored 0-2 each crying oxygen requirement changes to vital signs facial expressions sleeplessness 0-10

A toddler who was 33 inches in height on his or her second birthday would be expected to measure approximately inches in height on his or her third birthday.

36 The average toddler grows approximately 3 in. (7.62 cm) each year. The toddler would therefore be expected to be 36 inches (33 + 3) on his or her third birthday.

A preschooler who weighed 33 lbs (15 kg) on his or her fourth birthday would be expected to weigh ____ lbs/kg on his or her fifth birthday. 34 pounds/15.42 kg 38 pounds/17.23 kg 40 pounds/18.14 kg 42 pounds/19.05 kg

38 pounds/17.23 kg Preschool children gain approximately 5 pounds/2.23 kg per year. Therefore, the child would be expected to gain 5 pounds/2.27, for a total weight of 38 pounds or 17.26 kg.

A 3-year-old is using both the left and right hand interchangeably when writing and eating. The dominant hand should prevail by 4 years of age.

4 years of age

Separation anxiety begins between ages ________ and _____ months, when the infant progresses through the first stage of separation-individualization and begins to have some awareness of self and mother as separate begins.

4 and 8 months

gross motor development infant

4 months: no head lag, has head control 5-6 months: rolls over 7 months: sits alone 10 months: moves from prone to sitting crawling by 9 month, stand while holding onto the furniture 11 month walk while holding

separation anxiety

4-8 months by 11-12 months they anticipate her leaving and protest in advance

A 7-year-old child who is 48 inches is expected to be approximately inches at age 9.

52 An average height increase of 2 inches per year is expected for the school-age child. Therefore, 48 + 2 + 2 = 52 inches.

A weight gain of 1.49 lb (0.68 kg) per month is expected from birth until which month?

6 months An infant is expected to gain 1.49 lb (0.68 kg) per month from birth until 6 months.

stranger fear

6-8 months

The nurse is observing a mother who is interacting with her infant and notices the infant trying to imitate the sounds that the mother is making. The nurse knows that the child must be at least what age? 3-4 months 4-6 months 6-8 months 1-3 months

6-8 months An infant who is 6-8 months of age will be able to imitate the sounds the mother is making and therefore the nurse knows the patient must be at least this age.

Which would be the expected adult height for a toddler who is 34 inches tall at the 30-month checkup? __

68 Children attain half their adult height between ages 2 and 3 years. A child who was 34 inches tall at the 30-month checkup would be expected to be approximately 68 inches tall as an adult.

Childhood obesity is defined as a BMI in which category? >50th percentile >75th percentile >85th percentile >95th percentile

>95th percentile A child with a BMI >95th percentile and a score >30 would be considered obese.

The nurse is assessing vital signs for children. Which patient finding would be most concerning? A 12-year-old patient breathing 30 breaths/min An 8-year-old child with a temperature of 36.8° C A 3-month-old infant with a pulse of 116 beats/min A 4-year-old patient with blood pressure of 90/52 mmHg

A 12-year-old patient breathing 30 breaths/min A respiratory rate of 30 is considered tachypnea in a 12-year-old and requires further evaluation.

Which statements describe the cognitive difference in regard to object permanence between a 6-month-old and a 9-month-old? Select all that apply. A 6-month-old will not notice if you hide a toy. A 9-month-old will look for a toy if it is hidden from view. A 6-month-old will look for a toy if it is hidden from view. A 6-month-old will look for the toy and will likely show no interest once the toy is found. A 9-month-old will ignore the toy if it is hidden and immediately seek another object of interest.

A 6-month-old will not notice if you hide a toy. At 6 months the cognitive development of the child will not be mature enough to understand that the object still exists if it is hidden from view. A 9-month-old will look for a toy if it is hidden from view. The development of object permanence occurs in children around the age of nine months and therefore a child at this age will look for a toy if it is hidden from view.

Which scenario would indicate that a child is at the latency stage of psychosexual development? A 2-year-old child who constantly places objects in his or her mouth A 13-year-old boy who finds excuses to talk to his female friend in class A 9-year-old girl who refuses to sit next to a boy on the bus because she is afraid of "boy germs" A 15-year-old child who fights with his or her mother about wanting to stay out late on weekends

A 9-year-old girl who refuses to sit next to a boy on the bus because she is afraid of "boy germs" This scenario would indicate that a child is at the latency stage of psychosexual development. It corresponds to the school-age child and is characterized by a time when sexuality can be repressed by the superego

Family

A group of people, living together or in close contact, who take care of one another and provide guidance for their dependent members (p 49-51, 56-59, 63)

The nurse can expect that an infant will begin to respond discriminately to others, particularly the mother, and respond by crying, smiling, and vocalizing at about ______ months of age A. 2 B. 4 C. 6 D. 8

A. 2

According to recent studies, the best place for the infant care restraint is in the: A. back seat of the care, facing the rear B. back seat of the car, facing front C. front passenger seat of the car with an air bag, facing front D. front passenger seat of the car without an air bag, facing back

A. back seat of the care, facing the rear

Which one of the following techniques is recommended to assist in weaning an infant? A. gradually replace one bottle-feeding or breastfeeding at a time B. Always wean to a bottle first C. always wean directly to a cup D. eliminate the nighttime feeding first

A. gradually replace one bottle-feeding or breastfeeding at a time

The infant is predisposed to a more rapid loss of total body fluid and dehydration because: A. of a high proportion of extracellular fluid B. of a high proportion of intracellular fluid C. total body water is about 40% D. extracellular fluid is 20% of the total

A. of a high proportion of extracellular fluid

If parents are concerned about the fact that their 14-month-old infant is not walking, the nurse should evaluate the cephalocaudal gross motor skill patterns and particularly evaluate whether the infant: A. pulls up to furniture B. uses pincer grasp C. transfers objects D. had developed object permanence

A. pulls up to furniture

The factor that best determines the quality of the infant's formulation of trust is the: A. quality of the interpersonal relationship B. degree of mothering skill C. quantity of the mother's breast milk D. length of suckling time

A. quality of the interpersonal relationship

A child receiving morphine sulfate (Morphine) is experiencing respiratory depression. A health care provider prescribes naloxone (Narcan), 0.5 mcg/kg IV in 2-minute increments until breathing improves. The medication label states: "Naloxone 400 mcg/1 mL." The child weighs 40 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using two decimal places.

ANS: 0.05 Follow the formula for dosage calculation. Multiply 0.5 mcg ´ 40 kg to get the dose = 20 mcg Desired ———- ´ Volume = mL per dose Available 20 mcg ———- ´ 1 mL = 0.05 mL 400 mcg

A health care provider prescribes promethazine (Phenergan), 9 mg IV every 6 to 8 hours as needed for pruritus. The medication label states: "Promethazine 25 mg/1 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using two decimal places.

ANS: 0.36 Follow the formula for dosage calculation. Desired ———- ´ Volume = mL per dose Available 9 mg ———- ´ 1 mL = 0.36 mL 25 mg

A health care provider prescribes sodium fluoride drops, 0.25 mg PO daily. The medication label states: "Sodium fluoride drops 0.5 mg/1 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.

ANS: 0.5 Follow the formula for dosage calculation. Desired ———- ´ Volume = ml per dose Available 0.25 mg ———- ´ 1 ml = 0.5 ml 0.5 mg

A health care provider prescribes OxyContin (oxycodone), 3 mg PO every 4 to 6 hours as needed for pain. The medication label states: "OxyContin 5 mg/1 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place. ________________

ANS: 0.6 Follow the formula for dosage calculation. Desired ———- ´ Volume = mL per dose Available 3 mg ———- ´ 1 mL = 0.6 mL 5 mg

A health care provider prescribes acetaminophen (Tylenol) gtt, 10 mg/kg/dose PO every 4 to 6 hours as needed for pain. The infant weighs 8 kg. The medication label states: "Acetaminophen 80 mg/0.8 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.

ANS: 0.8 Follow the formula for dosage calculation. Multiply 10 mg ´ 8 kg to get the dose = 80 mg Desired ———- ´ Volume = mL per dose Available 80 mg ———- ´ 0.8 mL = 0.8 mL 80 mg

A health care provider prescribes choline magnesium trisalicylate (Trilisate), 15 mg/kg PO every 8 to 12 hours as needed for pain. The child weighs 10 kg. The medication label states: "Choline magnesium trisalicylate 500 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.

ANS: 1.5 Follow the formula for dosage calculation. Multiply 15 mg ´ 10 kg to get the dose = 150 mg Desired ———- ´ Volume = mL per dose Available 150 mg ———- ´ 5 mL = 1.5 mL 500 mg

A health care provider prescribes ibuprofen (Motrin), 5 mg/kg PO every 6 to 8 hours as needed for pain. The child weighs 8 kg. The medication label states: "Ibuprofen 100 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.

ANS: 2 Follow the formula for dosage calculation. Multiply 5 mg ´ 8 kg to get the dose = 40 mg Desired ———- ´ Volume = mL per dose Available 40 mg ———- ´ 5 mL = 2 mL 100 mg

A health care provider prescribes haloperidol (Haldol), 0.15 mg/kg IV every 4 to 6 hours as needed for confusion. The medication label states: "Haloperidol 2 mg/1 mL." The child weighs 30 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer rounding to one decimal place.

ANS: 2.3 Follow the formula for dosage calculation. Multiply 0.15 mg ´ 30 kg to get the dose = 4.5 mg Desired ———- ´ Volume = mL per dose Available 4.5 mg ———- ´ 1 mL = 2.25 mL = rounded to one decimal space = 2.3 mL 2 mg

The nurse is determining if a newborn is classified in the low birth weight (LBW) category of less than 2500 g. The newborn's weight is 5 lb, 4 oz. What is the newborn's weight in grams? Record your answer in a whole number.

ANS: 2386 Convert the 4 oz to a decimal by dividing 4 by 16 = 0.25. Use 5.25 lb and divide by 2.2 to get 2.386 kg. Multiply by 1000 to convert to grams = 2386.

A health care provider prescribes diphenhydramine (Benadryl), 1 mg/kg PO every 4 to 6 hours as needed for pruritus. The child weighs 10 kg. The medication label states: "Diphenhydramine 12.5 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.

ANS: 4 Follow the formula for dosage calculation. Multiply 1 mg ´ 10 kg to get the dose = 10 mg Desired ———- ´ Volume = mL per dose Available 10 mg ———- ´ 5 mL = 4 mL 12.5 mg

A health care provider prescribes dopamine (Intropin), 5 mcg/kg/min in a continuous intravenous (IV) infusion for a child in shock. The child weighs 25 kg. The medication is available as dopamine 400 mg in 250 ml. The nurse prepares to calculate the rate. How many milliliters per hour will the nurse set the IV infusion pump to deliver 5 mcg/kg/min? Fill in the blank. Round to one decimal place.

ANS: 4.7 Follow the formula for dosage calculation. 5 ´ kg ´ 60 _________________ = Pump rate ml/hr Drug concentration The patient weighs 10 kg, and the drug is available as 400 mg in 250 ml. Calculate the drug concentration. 400 ´ 1000 ___________ = 1600 mcg/ml 250 Then calculate the infusion rate. 5 ´ 25 ´ 60 _____________________ = 4.6875 ml/hr = rounded to 4.7 ml/hr 1600

A health care provider prescribes nitroprusside (Nipride), 1 mcg/kg/min in a continuous intravenous (IV) infusion for a child in shock. The child weighs 20 kg. The medication is available as nitroprusside 50 mg in 250 ml. The nurse prepares to calculate the rate. How many milliliters per hour will the nurse set the IV infusion pump to deliver 1 mcg/kg/min? Fill in the blank. Record your answer in a whole number.

ANS: 6 Follow the formula for dosage calculation. 1 ´ kg ´ 60 _________________ = Pump rate ml/hr Drug concentration The patient weighs 20 kg and the drug is available as 50 mg in 250 ml. Calculate the drug concentration. 50 ´ 1000 ___________ = 200 mcg/ml 250 Then calculate the infusion rate. 1 ´ 20 ´ 60 _____________________ = 6 ml/hr 200

A health care provider prescribes hydroxyzine (Atarax), 0.6 mg/kg PO every 4 to 6 hours as needed for pruritus. The medication label states: "Hydroxyzine 10 mg/5 mL." The child weighs 20 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.

ANS: 6 Follow the formula for dosage calculation. Multiply 0.6 mg ´ 20 kg to get the dose = 12 mg Desired ———- ´ Volume = mL per dose Available 12 mg ———- ´ 5 mL = 6 mL 10 mg

A health care provider prescribes naproxen (Naprosyn), 7 mg/kg PO every 12 hours for pain. The child weighs 25 kg. The medication label states: "Naproxen 125 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number. ________________

ANS: 7 Follow the formula for dosage calculation. Multiply 7 mg ´ 25 kg to get the dose = 175 mg Desired ———- ´ Volume = mL per dose Available 175 mg ———- ´ 5 mL = 7 mL 125 mg

Children as young as age 3 years can use facial scales for discrimination. What are some suggested anchor words for the preschool age group? a. "No hurt." b. "Red pain." c. "Zero hurt." d. "Least pain."

ANS: A "No hurt" is a phrase that is simple, concrete, and appropriate to the preoperational stage of the child. Using color is complicated for this age group. The child needs to identify colors and pain levels and then choose an appropriate symbolic color. This is appropriate for an older child. Zero is an abstract construct not appropriate for this age group. "Least pain" is less concrete than "no hurt."

The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which statement by a parent indicates a correct understanding of the teaching? a. "I should expect my 24-month-old child to express some signs of readiness for toilet training." b. "I should be firm and structured when disciplining my 18-month-old child." c. "I should expect my 12-month-old child to start to develop a fear of darkness and to need a security blanket." d. "I should expect my 36-month-old child to understand time and proximity of events."

ANS: A A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline because the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot "hurry up or we will be late."

A burn patient is experiencing anxiety over dressing changes. Which prescription should the nurse expect to be ordered to control anxiety? a. Lorazepam (Ativan) b. Oxycodone (OxyContin) c. Fentanyl (Sublimaze) d. Morphine Sulfate (Morphine)

ANS: A A benzodiazepine such as lorazepam is prescribed as an antianxiety agent. Oxycodone, fentanyl, and morphine sulfate are opioid analgesics.

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which? a. A normal finding b. A sign of a possible visual defect and a need for vision screening c. An abnormal finding requiring referral to an ophthalmologist d. A sign of small hemorrhages, which usually resolve spontaneously

ANS: A A brilliant, uniform red reflex is an important normal finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.

Girls experience an increase in weight and fat deposition during puberty. What do nursing considerations related to this include? a. Give reassurance that these changes are normal. b. Suggest dietary measures to control weight gain. c. Encourage a low-fat diet to prevent fat deposition. d. Recommend increased exercise to control weight gain.

ANS: A A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the adolescent's gender. A healthy balance must be achieved between expected healthy weight gain and obesity. Suggesting dietary measures or increased exercise to control weight gain would not be recommended unless weight gain was excessive because eating disorders can develop in this group. Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low.

The school nurse needs to obtain authorization for a child who requires medications while at school. From whom does the nurse obtain the authorization? a. The parents b. The pharmacist c. The school administrator d. The prescribing practitioner

ANS: A A child who requires medication during the school day requires written authorization from the parent or guardian. Most schools also require that the medication be in the original container appropriately labeled by the pharmacist or physician. Some schools allow children to receive over-the-counter medications with parental permission. The pharmacist may be asked to appropriately label the medication for use at the school, but authorization is not required. The school administration should have a policy in place that facilitates the administration of medications for children who need them. The prescribing practitioner is responsible for ensuring that the medication is appropriate for the child. Because the child is a minor, parental consent is required.

In teaching parents about appropriate pacifier selection, the nurse should recommend which characteristic? a. Easily grasped handle b. Detachable shield for cleaning c. Soft, pliable material d. Ribbon or string to secure to clothing

ANS: A A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate, posing a risk for aspiration. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks.

Which data should be included in a health history? a. Review of systems b. Physical assessment c. Growth measurements d. Record of vital signs

ANS: A A review of systems is done to elicit information concerning any potential health problems. This further guides the interview process. Physical assessment, growth measurements, and a record of vital signs are components of the physical examination.

The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a large family. The nurse recognizes that the adolescent is likely to relate to which group? a. Peers b. Parents c. Siblings d. Teachers

ANS: A Adolescents from a large family are more peer oriented than family oriented. Adolescents in small families identify more strongly with their parents and rely more on them for advice.

A 2-year-old child has to receive Rocephin IM injections every 12 hours. What nursing intervention should be implemented for the child? a. Hold the child while rocking in a chair after each injection. b. Prepare the child several hours before the injection is given. c. Allow the child to watch a younger child receive an injection. d. Encourage the child to draw a picture of the pain experienced when an injection is given.

ANS: A After the procedure, the child continues to need reassurance that he or she performed well and is accepted and loved. The other options are not appropriate for a toddler.

The clinic nurse is reviewing statistics on infant mortality for the United States versus other countries. Compared with other countries that have a population of at least 25 million, the nurse makes which determination? a. The United States is ranked last among 27 countries. b. The United States is ranked similar to 20 other developed countries. c. The United States is ranked in the middle of 20 other developed countries. d. The United States is ranked highest among 27 other industrialized countries.

ANS: A Although the death rate has decreased, the United States still ranks last in infant mortality among nations with a population of at least 25 million. The United States has the highest infant death rate of developed nations.

A 1-month-old infant is admitted to the hospital. The infant's mother is 17 years old and single and lives with her parents. Who signs the informed consent for the 1-month-old infant? a. The infant's mother b. The maternal grandparents of the infant c. The paternal grandparents of the infant d. Both the infant's mother and the maternal grandparents

ANS: A An emancipated minor is one who is legally under the age of majority but is recognized as having the legal capacity of an adult under circumstances prescribed by state law, such as pregnancy, marriage, high school graduation, independent living, or military service.

A toddler, age 16 months, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. What is this an example of? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to toddlers. Irreversibility is the inability to reverse or undo actions initiated physically. The toddler is acting in an age-appropriate manner.

An infant, age 5 months, is brought to the clinic by his parents for a well-baby checkup. What is the best advice that the nurse should include at this time about injury prevention? a. "Keep buttons, beads, and other small objects out of his reach." b. "Do not permit him to chew paint from window ledges because he might absorb too much lead." c. "When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall." d. "Lock the crib sides securely because he may stand and lean against them and fall out of bed."

ANS: A Aspiration of foreign objects is a great risk at this age. Parents are instructed to keep small objects out of the infant's reach. At this age, the child is not mobile enough to reach window sills. If window sills have cracked or chipped paint, it needs to be removed before he is a toddler. This child should already be rolling over. This information is reinforced but should have been taught earlier. Pulling to a stand occurs between 8 and 12 months of age.

The parents of a 2-year-old child tell the nurse they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. What should the nurse recommend? a. Ignore the baby talk. b. Tell the toddler frequently, "You are a big kid now." c. Explain to the toddler that baby talk is for babies. d. Encourage the toddler to practice more advanced patterns of speech.

ANS: A Baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored while the parents praise the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

Because children younger than 5 years are egocentric, the nurse should do which when communicating with them? a. Focus communication on the child. b. Use easy analogies when possible. c. Explain experiences of others to the child. d. Assure the child that communication is private.

ANS: A Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding.

What is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands help with kinetic stimulation. Imitating animal sounds helps with auditory stimulation.

What is most descriptive of the spiritual development of older adolescents? a. Beliefs become more abstract. b. Rituals and practices become increasingly important. c. Strict observance of religious customs is common. d. Emphasis is placed on external manifestations, such as whether a person goes to church.

ANS: A Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols. Rituals, practices, and strict observance of religious customs become less important as adolescents question values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors.

According to Piaget, magical thinking is the belief of which? a. Thoughts are all powerful. b. God is an imaginary friend. c. Events have cause and effect. d. If the skin is broken, the insides will come out.

ANS: A Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all powerful. Believing God is an imaginary friend is an example of concrete thinking in a preschooler's spiritual development. Cause-and-effect implies logical thought, not magical thinking. Believing that if the skin is broken, the insides will come out is an example of concrete thinking in development of body image.

The nurse is teaching parents about instilling a positive body image for the preschool age. What statement made by the parents indicates the teaching is understood? a. "We will make sure our child is praised about his or her looks." b. "We will help our child compare his or her size with other children." c. "We understand our child will have well-defined body boundaries." d. "We will be sure our child understands about being little for his or her age."

ANS: A Because these are formative years for both boys and girls, parents should make efforts to instill positive principles regarding body image. Children at this age are aware of the meaning of words such as "pretty" or "ugly," and they reflect the opinions of others regarding their own appearance. Despite the advances in body image development, preschoolers have poorly defined body boundaries. By 5 years of age, children compare their size with that of their peers and can become conscious of being large or short, especially if others refer to them as "so big" or "so little" for their age. Parents should not suggest their child compare him- or herself with other children in regard to size, and parents should not focus on their child's size as being little.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." What should the nurse interpret this as? a. A common belief at this age b. Indicative of excessive family pressure c. Faith that forms the basis for most religions d. Suggestive of a failure to develop a conscience

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined misbehavior. School-age children expect to be punished and tend to choose a punishment that they think "fits the crime." This is a common belief and not related to excessive family pressure. Many faiths do not include a God that causes cancer in response for "bad" behavior. This statement reflects the child's belief in what is right and wrong.

What is an effective strategy to reduce the stress of burn dressing procedures? a. Involve the child and give choices as feasible. b. Explain to the child why analgesics cannot be used. c. Reassure the child that dressing changes are not painful. d. Encourage the child to master stress with controlled passivity.

ANS: A Children who have an understanding of the procedure and some perceived control demonstrate less maladaptive behavior. They respond well to participating in decisions and should be given as many choices as possible. Analgesia and sedation can and should be used. The dressing change procedure is very painful and stressful. Misinformation should not be given to the child. Encouraging the child to master stress with controlled passivity is not a positive coping strategy.

The nurse is describing clinical reasoning to a group of nursing students. Which is most descriptive of clinical reasoning? a. Purposeful and goal directed b. A simple developmental process c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate

ANS: A Clinical reasoning is a complex developmental process based on rational and deliberate thought. When thinking is clear, precise, accurate, relevant, consistent, and fair, a logical connection develops between the elements of thought and the problem at hand.

Which is the leading cause of death in infants younger than 1 year in the United States? a. Congenital anomalies b. Sudden infant death syndrome c. Disorders related to short gestation and low birth weight d. Maternal complications specific to the perinatal period

ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year compared with sudden infant death syndrome, which accounts for 8.2%; disorders related to short gestation and unspecified low birth weight, which account for 16.5%; and maternal complications such as infections specific to the perinatal period, which account for 6.1% of deaths in infants younger than 1 year of age.

A 16-year-old girl comes to the pediatric clinic for information on birth control. The nurse knows that before this young woman can be examined, consent must be obtained from which source? a. Herself b. Her mother c. Court order d. Legal guardian

ANS: A Contraceptive advice is one of the conditions that is considered "medically emancipated." The adolescent is able to provide her own informed consent.

The nurse has just given a subcutaneous injection to a preschool child, and the child asks for a Band-Aid over the site. Which action should the nurse implement? a. Place a Band-Aid over the site. b. Massage the injection site with an alcohol swab. c. Show the child there is no bleeding from the site. d. Explain that a Band-Aid is not needed after a subcutaneous injection.

ANS: A Despite the advances in body image development, preschoolers have poorly defined body boundaries and little knowledge of their internal anatomy. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin (e.g., injections and surgery). They fear that all their blood and "insides" can leak out if the skin is "broken." Therefore, preschoolers may believe it is critical to use bandages after an injury. The nurse should place a Band-Aid over the site.

Nurses should be alert for increased fluid requirements in which circumstance? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure

ANS: A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. The mechanically ventilated child has decreased fluid requirements. Congestive heart failure is a case of fluid overload in children. Increased intracranial pressure does not lead to increased fluid requirements in children.

When discussing discipline with the mother of a 4-year-old child, which should the nurse include? a. Parental control should be consistent. b. Withdrawal of love and approval is effective at this age. c. Children as young as 4 years rarely need to be disciplined. d. One should expect rules to be followed rigidly and unquestioningly.

ANS: A For effective discipline, parents must be consistent and must follow through with agreed-on actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child will test limits and may misbehave. Children of this age do not respond to verbal reasoning. Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals. Discipline strategies should be appropriate to the child's age and temperament and the severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old child.

The nurse is selecting a site to begin an intravenous infusion on a 2-year-old child. The superficial veins on his hand and arm are not readily visible. What intervention should increase the visibility of these veins? a. Gently tap over the site. b. Apply a cold compress to the site. c. Raise the extremity above the level of the body. d. Use a rubber band as a tourniquet for 5 minutes.

ANS: A Gently tapping the site can sometimes cause the veins to be more visible. This is done before the skin is prepared. Warm compresses (not cold) may be useful. The extremity is held in a dependent position. A tourniquet may be helpful, but if too tight, it could cause the vein to burst when punctured. Five minutes is too long.

The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What should the nurse tell her? a. Fluids in addition to breast milk are not needed. b. Water should be given if the infant seems to nurse longer than usual. c. Clear juices are better than water to promote adequate fluid intake. d. Water once or twice a day will make up for losses resulting from environmental temperature.

ANS: A Infants who are breastfed or bottle fed do not need additional water during the first 4 months of life. Excessive intake of water can create problems such as water intoxication, hyponatremia, or failure to thrive. Juices provide empty calories for infants.

A 4-year-old girl is admitted to outpatient surgery for removal of a cyst on her back. Her mother puts the hospital gown on her, but the child is crying because she wants to leave on her underpants. What is the most appropriate nursing action at this time?? a. Allow her to wear her underpants. b. Discuss with her mother why this is important to the child. c. Ask her mother to explain to her why she cannot wear them. d. Explain in a kind, matter-of-fact manner that this is hospital policy.

ANS: A It is appropriate for the child to leave her underpants on. If necessary, the underpants can be removed after she has received the initial medications for anesthesia. This allows her some measure of control in this procedure. The mother should not be required to make the child more upset. The child is too young to understand what hospital policy means.

The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother staying in the room or leaving. This action should be considered which? a. Appropriate because of child's age b. Appropriate, but the mother may be uncomfortable c. Inappropriate because of child's age d. Inappropriate because child is same sex as mother

ANS: A It is appropriate to give older school-age children the option of having the parent present or not. During the examination, the nurse should respect the child's need for privacy. Children who are 10 years old are minors, and parents are responsible for health care decisions. The mother of a 10-year-old child would not be uncomfortable. The child should help determine who is present during the examination.

A 6-year-old boy is hospitalized for intravenous antibiotic therapy. He eats very little on his "regular diet" trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. What nursing action is the most appropriate? a. Request these favorite foods for him. b. Identify healthier food choices that he likes. c. Explain that he needs fruits and vegetables. d. Reward him with ice cream at the end of every meal that he eats.

ANS: A Loss of appetite is a symptom common to most childhood illnesses. To encourage adequate nutrition, the nurse should request favorite foods for the child. The foods he likes provide nutrition and can be supplemented with additional fruits and vegetables. Ice cream and other desserts should not be used as rewards or punishment.

A 10-year-old child requires daily medications for a chronic illness. Her mother tells the nurse that the child continually forgets to take the medicine unless reminded. What nursing action is most appropriate to promote adherence to the medication regimen? a. Establish a contract with her, including rewards. b. Suggest time-outs when she forgets her medicine. c. Discuss with her mother the damaging effects of her rescuing the child. d. Ask the child to bring her medicine containers to each appointment so they can be counted.

ANS: A Many factors can contribute to the child's not taking the medication. The nurse should resolve those issues such as unpleasant side effects, difficulty taking medicine, and time constraints before school. If these factors do not contribute to the issue, then behavioral contracting is usually an effective method to shape behaviors in children. Time-outs provide negative reinforcement. If part of a contract, negative consequences can work, but they need to be structured. Discussing with her mother the damaging effects of her rescuing the child is not the most appropriate action to encourage compliance. For a school-age child, parents should refrain from nagging and rescuing the child. This child is old enough to partially assume responsibility for her own care. If the child brings her medicine containers to each appointment so they can be counted, this will help determine if the medications are being taken, but it will not provide information about whether the child is taking them by herself.

Parents tell the nurse that their toddler eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." What should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirements associated with the slower growth rate. Parents should assist the child in developing healthy eating habits. Toddlers are often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat non-nutritious foods in response. A toddler is not able to understand explanations of what is expected of her and comply with the expectations.

What describes nonpharmacologic techniques for pain management? a. They may reduce pain perception. b. They usually take too long to implement. c. They make pharmacologic strategies unnecessary. d. They trick children into believing they do not have pain.

ANS: 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. The nonpharmacologic strategy should be matched with the child's pain severity and be taught to the child before the onset of the painful experience. Tricking children into believing they do not have pain may mitigate the child's experience with mild pain, but the child will still know the discomfort was present.

Which is a complication that can occur after abdominal surgery if pain is not managed? a. Atelectasis b. Hypoglycemia c. Decrease in heart rate d. Increase in cardiac output

ANS: A Pain associated with surgery in the abdominal region (e.g., appendectomy, cholecystectomy, splenectomy) may result in pulmonary complications. Pain leads to decreased muscle movement in the thorax and abdominal area and leads to decreased tidal volume, vital capacity, functional residual capacity, and alveolar ventilation. The patient is unable to cough and clear secretions, and the risk for complications such as pneumonia and atelectasis is high. Severe postoperative pain also results in sympathetic overactivity, which leads to increases in heart rate, peripheral resistance, blood pressure, and cardiac output. Hypoglycemia, decreases in heart rate, and increases in cardiac output are not complications of poor pain management.

What is descriptive of the nutritional requirements of preschool children? a. The quality of the food consumed is more important than the quantity. b. The average daily intake of preschoolers should be about 3000 calories. c. Nutritional requirements for preschoolers are very different from requirements for toddlers. d. Requirements for calories per unit of body weight increase slightly during the preschool period.

ANS: A Parents need to be reassured that the quality of food eaten is more important than the quantity. Children are able to self-regulate their intake when offered foods high in nutritional value. The average daily caloric intake should be approximately 1800 calories. Toddlers and preschoolers have similar nutritional requirements. There is an overall slight decrease in needed calories and fluids during the preschool period.

The nurse is preparing to assess a 10-month-old infant. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which initial actions by the nurse should be most appropriate? a. Initiate a game of peek-a-boo. b. Ask the infant's father to place the infant on the examination table. c. Talk softly to the infant while taking him from his father. d. Undress the infant while he is still sitting on his father's lap.

ANS: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done with the child on the father's lap. The nurse should have the father undress the child as needed during the examination.

When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which? a. Permissive b. Dictatorial c. Democratic d. Authoritarian

ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children's actions. Dictatorial or authoritarian parents attempt to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children's behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their children's individual natures.

The nurse is aware that which age group is at risk for childhood injury because of the cognitive characteristic of magical and egocentric thinking? a. Preschool b. Young school age c. Middle school age d. Adolescent

ANS: A Preschool children have the cognitive characteristic of magical and egocentric thinking, meaning they are unable to comprehend danger to self or others. Young and middle school-aged children have transitional cognitive processes, and they may attempt dangerous acts without detailed planning but recognize danger to themselves or others. Adolescents have formal operational cognitive processes and are preoccupied with abstract thinking.

What is an important consideration in preventing injuries during middle childhood? a. Achieving social acceptance is a primary objective. b. The incidence of injuries in girls is significantly higher than it is in boys. c. Injuries from burns are the highest at this age because of fascination with fire. d. Lack of muscular coordination and control results in an increased incidence of injuries.

ANS: A School-age children often participate in dangerous activities in an attempt to prove themselves worthy of acceptance. The incidence of injury during middle childhood is significantly higher in boys compared with girls. Motor vehicle collisions are the most common cause of severe injuries in children. Children have increasing muscular coordination. Children who are risk takers may have inadequate self-regulatory behavior.

Ongoing fluid losses can overwhelm the child's ability to compensate, resulting in shock. What early clinical sign precedes shock? a. Tachycardia b. Slow respirations c. Warm, flushed skin d. Decreased blood pressure

ANS: A Shock is preceded by tachycardia and signs of poor tissue perfusion and decreased pulse oximetry values. Respirations are increased as the child attempts to compensate. As a result of the poor peripheral circulation, the child has skin that is cool and mottled with decreased capillary refilling after blanching. In children, lowered blood pressure is a late sign and may accompany the onset of cardiovascular collapse.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her school work satisfactorily but lately has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as which? a. Signs of stress b. Developmental delay c. Lack of adjustment to school environment d. Physical problem that needs medical intervention

ANS: A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to earlier behaviors. The child is completing school work satisfactorily; any developmental delay would have been diagnosed earlier. The teacher reports that this is a departure from the child's normal behavior. Adjustment issues would most likely be evident soon after a change. Medical intervention is not immediately required. Recognizing that this constellation of symptoms can indicate stress, the nurse should help the child identify sources of stress and how to use stress reduction techniques. The parents are involved in the evaluation process.

A breastfed infant is being seen in the clinic for a 6-month checkup. The mother tells the nurse that the infant recently began to suck her thumb. Which is the best nursing intervention? a. Reassure the mother that this is normal at this age. b. Recommend the mother substitute a pacifier for her thumb. c. Assess the infant for other signs of sensory deprivation. d. Suggest the mother breastfeed the infant more often to satisfy her sucking needs.

ANS: A Sucking is an infant's chief pleasure, and the infant may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. The nurse should explore with the mother her feelings about a pacifier versus the thumb. No data support that the child has sensory deprivation.

Which is the most frequently used test for measuring visual acuity? a. Snellen letter chart b. Ishihara vision test c. Allen picture card test d. Denver eye screening test

ANS: A The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. The Ishihara Vision Test is used for color vision. The Allen picture card test and Denver eye screening test involve single cards for children ages 2 years and older who are unable to use the Snellen letter chart.

How does the onset of the pubertal growth spurt compare in girls and boys? a. In girls, it occurs about 1 year before it appears in boys. b. In girls, it occurs about 3 years before it appears in boys. c. In boys. it occurs about 1 year before it appears in girls. d. It is about the same in both boys and girls.

ANS: A The average age of onset is 9 1/2 years for girls and 10 1/2 years for boys. Although pubertal growth spurts may occur in girls 3 years before it appears in boys on an individual basis, the average difference is 1 year. Usually girls begin their pubertal growth spurt earlier than boys.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend? a. Determine whether the water supply is fluoridated. b. Use fluoridated mouth rinses in children older than 1 year. c. Give fluoride supplements to infants beginning at age 2 months. d. Brush teeth with fluoridated toothpaste unless the fluoride content of water supply is adequate.

ANS: A The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used.

What laboratory finding should the nurse expect in a child with an excess of water? a. Decreased hematocrit b. High serum osmolality c. High urine specific gravity d. Increased blood urea nitrogen

ANS: A The excess water in the circulatory system results in hemodilution. The laboratory results show a falsely decreased hematocrit. Laboratory analysis of blood that is hemodiluted reveals decreased serum osmolality and blood urea nitrogen. The urine specific gravity is variable relative to the child's ability to correct the fluid imbalance.

The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should the nurse do first? a. Introduce him- or herself. b. Make the family comfortable. c. Give assurance of privacy. d. Explain the purpose of the interview.

ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. Clarification of the purpose of the interview and the nurse's role is the second thing that should be done. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. The interview also should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.

The nurse is interviewing the mother of an infant. The mother reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which heading? a. History b. Present illness c. Chief complaint d. Review of systems

ANS: A The history refers to information that relates to previous aspects of the child's health, not to the current problem. The difficult delivery and prematurity are important parts of the infant's history. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of the present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It should not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth but might include sequelae such as pulmonary dysfunction.

What is the most immediate threat to life in children with thermal injuries? a. Shock b. Anemia c. Local infection d. Systemic sepsis

ANS: A The immediate threat to life in children with thermal injuries is airway compromise and profound shock. Anemia is not of immediate concern. During the healing phase, local infection or sepsis is the primary complication.

The nurse is administering an IM injection into a vastus lateralis muscle of a 6-month-old infant. What should the length of the needle and amount to be given be? a. 5/8 to 1 inch; 0.5 to 1.0 ml b. 1 inch to 1 1/2 inch; 1.0 to 2.0 ml c. 1 inch to 1 1/2 inch; 0.5 to 1.0 ml d. 5/8 to 1 inch; 0.75 to 2 ml

ANS: A The length of a needle for an infant should be 5/8 to 1 inch, and the amount of solution should not exceed 1 ml.

The parent of 16-month-old child asks, "What is the best way to keep my child from getting into our medicines at home?" What should the nurse advise? a. "All medicines should be locked securely away." b. "The medicines should be placed in high cabinets." c. "Your child just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible because many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

The nurse is planning a teaching session to adolescents about deaths by unintentional injuries. Which should the nurse include in the session with regard to deaths caused by injuries? a. More deaths occur in males. b. More deaths occur in females. c. The pattern of deaths does not vary according to age and sex. d. The pattern of deaths does not vary widely among different ethnic groups.

ANS: A The majority of deaths from unintentional injuries occur in males. The pattern of death does vary greatly among different ethnic groups, and the causes of unintentional deaths vary with age and gender.

The nurse is caring for a child receiving a continuous intravenous (IV) low-dose infusion of morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to do which first? a. Administer naloxone (Narcan). b. Discontinue the IV infusion. c. Discontinue morphine until the child is fully awake. d. Stimulate the child by calling his or her name, shaking gently, and asking the child to breathe deeply.

ANS: A The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused, then IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued, but naloxone is indicated if the child is unresponsive.

A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. What is the most appropriate intervention? a. Refer the child for a professional psychosocial assessment. b. Explain that this is normal in preschoolers, especially boys. c. Encourage the parent to try more consistent and firm discipline. d. Talk to the preschool teacher to obtain validation for behavior parent reports.

ANS: A The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior but the severity, frequency, and duration. This child's behavior meets the definition requiring professional evaluation. Some aggressive behavior is within normal limits, but at 8 to 10 weeks, this behavior has persisted too long. There is no indication that the parent is using inconsistent discipline. A part of the evaluation is to obtain validation for behavior parent reports.

A child, age 7 years, has a fever associated with a viral illness. She is being cared for at home. What is the principal reason for treating fever in this child? a. Relief of discomfort b. Reassurance that illness is temporary c. Prevention of secondary bacterial infection d. Avoidance of life-threatening complications

ANS: A The principal reason for treating fever is the relief of discomfort. Relief measures include pharmacologic and environmental intervention. The most effective is the use of pharmacologic agents to lower the set point. Although the nurse can reassure the child that the illness is temporary, the child is often uncomfortable and irritable. Intervention helps the child and family minimize the discomfort. Most fevers result from viral, not bacterial, infections. Few life-threatening events are associated with fever. The use of antipyretics does not seem to reduce the incidence of febrile seizures.

What flush solution is recommended for intravenous catheters larger than 24 gauge? a. Saline b. Heparin c. Alteplase d. Heparin and saline combination

ANS: A The recommended solution for flushing venous access devices is saline. The turbulent flow flush with saline is effective for catheters larger than 24 gauge. The use of heparin does not increase the longevity of the venous access device. In 24-gauge catheters, heparin may offer an advantage. Alteplase is used for treating catheter-related occlusions in children. The heparin and saline combination does not offer any advantage over saline or heparin individually.

Which type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular b. Bronchial c. Adventitious d. Bronchovesicular

ANS: A This is the definition of vesicular breath sounds. They are heard over the entire surface of the lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions, where the trachea and bronchi bifurcate.

Parents of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. What is the nurse's best interpretation of this behavior? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

According to Erikson, the psychosocial task of adolescence is developing what? a. Identity b. Intimacy c. Initiative d. Independence

ANS: A Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Independence is not one of Erikson's developmental stages.

The nurse is talking to a group of parents of school-age children at an after-school program about childhood health problems. Which statement should the nurse include in the teaching? a. Childhood obesity is the most common nutritional problem among children. b. Immunization rates are the same among children of different races and ethnicity. c. Dental caries is not a problem commonly seen in children since the introduction of fluoridated water. d. Mental health problems are typically not seen in school-age children but may be diagnosed in adolescents.

ANS: A When teaching parents of school-age children about childhood health problems, the nurse should include information about childhood obesity because it is the most common problem among children and is associated with type 2 diabetes. Teaching parents about ways to prevent obesity is important to include. Immunization rates differ depending on the child's race and ethnicity; dental caries continues to be a common chronic disease in childhood; and mental health problems are seen in children as young as school age, not just in adolescents.

The nurse is checking reflexes on a 7-month-old infant. When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended. Which reflex is this? a. Landau b. Parachute c. Body righting d. Labyrinth righting

ANS: A When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended; this describes the Landau reflex. It appears at 6 to 8 months and persists until 12 to 24 months. The parachute reflex occurs when the infant is suspended in a horizontal prone position and suddenly thrust downward; the infant extends the hands and fingers forward as if to protect against falling. This appears at age 7 to 9 months and lasts indefinitely. Body righting occurs when turning the hips and shoulders to one side causes all other body parts to follow. It appears at 6 months of age and persists until 24 to 36 months. The labyrinth-righting reflex appears at 2 months and is strongest at 10 months. This reflex involves holding infants in the prone or supine position. They are able to raise their heads.

The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal? a. Adapt, as necessary, ethnic practices to health needs. b. Attempt, in a nonjudgmental way, to change ethnic beliefs. c. Encourage continuation of ethnic practices in the hospital setting. d. Strive to keep ethnic background from influencing health needs.

ANS: A Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.

The nurse's approach when introducing hospital equipment to a preschooler who seems afraid should be based on which principle? a. The child may think the equipment is alive. b. Explaining the equipment will only increase the child's fear. c. One brief explanation will be enough to reduce the child's fear. d. The child is too young to understand what the equipment does.

ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. Simple, concrete explanations about what the equipment does and how it will feel will help alleviate the child's fear. Preschoolers need repeated explanations as reassurance.

The nurse is teaching parents about the effects of media on childhood obesity. The nurse realizes the parents understand the teaching if they make which statements? (Select all that apply.) a. "Advertising of unhealthy food can increase snacking." b. "Increased screen time may be related to unhealthy sleep." c. "There is a link between the amount of screen time and obesity." d. "Increased screen time can lead to better knowledge of nutrition." e. "Physical activity increases when children increase the amount of screen time."

ANS: A, B, C A number of studies have demonstrated a link between the amount of screen time and obesity. Advertising of unhealthy food to children is a long-standing marketing practice, which may increase snacking in the face of decreased activity. In addition, both increased screen time and unhealthy eating may also be related to unhealthy sleep. Increased screen time does not lead to a better knowledge of nutrition or increased physical activity.

The nurse is conducting a teaching session for parents on nutrition. Which characteristics of families should the nurse consider that can cause families to struggle in providing adequate nutrition? (Select all that apply.) a. Homelessness b. Lower income c. Migrant status d. Working parents e. Single parent status

ANS: A, B, C Families that struggle with lower incomes, homelessness, and migrant status generally lack the resources to provide their children with adequate food intake, nutritious foods such as fresh fruits and vegetables, and appropriate protein intake. Working parents and single parent status do not mean the families will struggle to provide adequate nutrition.

Parents ask the nurse, "Should we be concerned our preschooler has an imaginary friend, and how should we react?" Which responses should the nurse give to the parents? (Select all that apply.) a. "The imaginary playmate is a sign of health." b. "You can acknowledge the presence of the imaginary companion." c. "It is normal for a preschool-aged child to have an imaginary friend." d. "If your child wants a place setting at the table for the child, it is best to refuse." e. "It is OK to allow the child to blame the imaginary playmate to avoid punishment."

ANS: A, B, C Parents should be reassured that the child's fantasy is a sign of health that helps differentiate between make-believe and reality. Parents can acknowledge the presence of the imaginary companion by calling him or her by name and even agreeing to simple requests such as setting an extra place at the table, but they should not allow the child to use the playmate to avoid punishment or responsibility.

The clinic nurse is teaching parents about when to call the office immediately for a child with a fever. What should the nurse include in the teaching session? (Select all that apply.) a. The child has a stiff neck. b. The fever is over 40.6° C (105° F). c. The child is younger than 2 months. d. The fever has lasted for more than 3 days. e. The fever went away for more than 24 hours and then returned.

ANS: A, B, C Parents should call the office immediately if a child has a fever over 40.6° C (105° F), the child is younger than 2 months, or the child has a stiff neck. Parents are to call within 24 hours if the fever went away for more than 24 hours and then returned or the fever has lasted for more than 3 days.

What are the advantages of an implanted port (Port-a-Cath)? (Select all that apply.) a. Reduced risk of infection b. Reduced cost for the family c. Placed completely under the skin d. Easy to use for self-administered infusions e. Removal does not require a surgical procedure

ANS: A, B, C The advantages of an implanted port include reduced risk of infection, reduced cost for the family, and placed completely under the skin. Because it is implanted and must be accessed, it is not easy to use for self-administered infusions, and removal does require a surgical procedure.

In what condition should the nurse be alert for altered fluid requirements in children? (Select all that apply.) a. Oliguric renal failure b. Increased intracranial pressure c. Mechanical ventilation d. Compensated hypotension e. Tetralogy of Fallot f. Type 1 diabetes mellitus

ANS: A, B, C The nurse should recognize that conditions such as oliguric renal failure, increased intracranial pressure, and mechanical ventilation can cause an increase or a decrease in fluid requirements. Conditions such as hypotension, tetralogy of Fallot, and diabetes mellitus (type 1) do not cause an alteration in fluid requirements.

The nurse is preparing a presentation on compensated, decompensated, and irreversible shock in children. What clinical manifestations related to decompensated shock should the nurse include? (Select all that apply.) a. Tachypnea b. Oliguria c. Confusion d. Pale extremities e. Hypotension f. Thready pulse

ANS: A, B, C, D As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs are more obvious. Signs include tachypnea, oliguria, confusion, and pale extremities, as well as decreased skin turgor and poor capillary filling. Hypotension and a thready pulse are clinical manifestations of irreversible shock.

The nurse is planning strategies to assist difficult or easily distracted children when they participate in activities. What strategies should the nurse plan? (Select all that apply.) a. Role-play before the activity. b. Handle behavior with firmness. c. Acquaint them with what to expect. d. Be patient with inappropriate behavior. e. Don't give them much information about the activity.

ANS: A, B, C, D Difficult or easily distracted children may benefit from "practice" sessions in which they are prepared for a given event by role-playing, visiting the site, reading or listening to stories, or using other methods to acquaint them with what to expect. Nurses need to handle children with difficult temperaments with exceptional patience, firmness, and understanding so they can learn appropriate behavior in their interactions with others.

Which describe the feelings and behaviors of adolescents related to divorce? (Select all that apply.) a. Disturbed concept of sexuality b. May withdraw from family and friends c. Worry about themselves, parents, or siblings d. Expression of anger, sadness, shame, or embarrassment e. Engage in fantasy to seek understanding of the divorce

ANS: A, B, C, D Feelings and behaviors of adolescents related to divorce include a disturbed concept of sexuality; withdrawing from family and friends; worrying about themselves, parents, and siblings; and expressions of anger, sadness, shame, and embarrassment. Engaging in fantasy to seek understanding of the divorce is a reaction by a child who has preconceptual cognitive processes, not the formal thinking processes adolescents have.

The nurse is preparing a staff education program about growth and development of an 18-month-old toddler. Which characteristics should the nurse include in the staff education program? (Select all that apply.) a. Eats well with a spoon and cup b. Runs clumsily and can walk up stairs c. Points to common objects d. Builds a tower of three or four blocks e. Has a vocabulary of 300 words f. Dresses self in simple clothes

ANS: A, B, C, D Tasks accomplished by an 18-month-old toddler include eating well with a spoon and cup, running clumsily, walking up stairs, pointing to common objects such as shoes, and building a tower with three or four blocks. An 18-month-old toddler has a vocabulary of only 10 words, not 300. Toddlers cannot dress themselves in simple clothing until 24 months of age.

The nurse is performing an oral examination on a preschool child. Which strategies should the nurse use to encourage the child to open the mouth for the examination? (Select all that apply.) a. Lightly brush the palate with a cotton swab. b. Perform the examination in front of a mirror. c. Let the child examine someone else's mouth first. d. Have the child breathe deeply and hold his or her breath. e. Use a tongue blade to help the child open his or her mouth.

ANS: A, B, C, D To encourage a child to open the mouth for examination, the nurse can lightly brush the palate with a cotton swab, perform the examination in front of a mirror, let the child examine someone else's mouth first, and have the child breathe deeply and hold his or her breath. A tongue blade may elicit the gag reflex and should not be used.

What methods should the nurse use to measure compliance to a treatment plan? (Select all that apply.) a. Pill counts b. Chemical assays c. Direct observation d. Third-party reporting e. Monitoring therapeutic response

ANS: A, B, C, E Assessment of compliance must include direct measurement techniques. Pill counts, chemical assays, direct observation, and monitoring therapeutic response are direct measurement techniques. Third-party reporting would not always be available and would not be a method to measure compliance.

What interventions should the nurse implement to prevent a pressure ulcer in a critically ill child? (Select all that apply.) a. Nutrition consults b. Using skin moisturizers c. Turning the child every 2 hours d. Using plastic disposable underpads e. Using draw sheets to minimize shear

ANS: A, B, C, E Interventions found to prevent pressure ulcers in critically ill children include nutrition consults, using skin moisturizers, turning the child every 2 hours, and using draw sheets to minimize shear. Dryweave underpads, not underpads with plastic, should be used to reduce moisture.

What play activities should the nurse implement to encourage fluid intake for a child? (Select all that apply.) a. Have a tea party. b. Use a crazy straw. c. Cut gelatin into fun shapes. d. Place liquid in large Styrofoam cups. e. Make ice pops using the child's favorite juice.

ANS: A, B, C, E Play activities to encourage fluid intake for a child include tea parties, crazy straws, cutting gelatin into fun shapes, and making ice pops using the child's favorite juice. Small cups, not large Styrofoam cups, should be used.

The school nurse recognizes that students who are targeted for repeated harassment and bullying may exhibit what? (Select all that apply.) a. Skip school b. Attempt suicide c. Bring weapons to school d. Attend extracurricular activities e. Report symptoms of depression

ANS: A, B, C, E Students targeted for repeated teasing and harassment are more likely to skip school, to report symptoms of depression, and to attempt suicide. Equally troubling, teens who are regularly harassed or bullied are also more likely to bring weapons to school to feel safe. Students who are bullied do not want to attend extracurricular activities.

Which actions by the nurse demonstrate overinvolvement with patients and their families? (Select all that apply.) a. Buying clothes for the patients b. Showing favoritism toward a patient c. Focusing on technical aspects of care d. Spending off-duty time with patients and families e. Asking questions if families are not participating in care

ANS: A, B, D Actions that show overinvolvement include buying clothes for patients, showing favoritism toward a patient, and spending off-duty time with patients and families. Focusing on technical aspects of care is an action that indicates underinvolvement, and asking questions if families are not participating in care indicates a positive action.

Which are included in the evaluation step of the nursing process? (Select all that apply.) a. Determination if the outcome has been met b. Ascertaining if the plan requires modification c. Establish priorities and selecting expected patient goals d. Selecting alternative interventions if the outcome has not been met e. Determining if a risk or actual dysfunctional health problem exists

ANS: A, B, D Evaluation is the last step in the nursing process. The nurse gathers, sorts, and analyzes data to determine whether (1) the established outcome has been met, (2) the nursing interventions were appropriate, (3) the plan requires modification, or (4) other alternatives should be considered. Establishing priorities and selecting expected patient goals are done in the outcomes identification stage. Determining if a risk or actual dysfunctional health problem exists is done in the diagnosis stage of the nursing process.

Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.) a. Regressive behavior b. Fear of abandonment c. Fear regarding the future d. Blame themselves for the divorce e. Intense desire for reconciliation of parents

ANS: A, B, D Feelings and behaviors of early preschool children related to divorce include regressive behavior, fear of abandonment, and blaming themselves for the divorce. Fear regarding the future and intense desire for reconciliation of parents is a reaction later school-age children have to divorce.

Which should the nurse teach to parents regarding oral health of children? (Select all that apply.) a. Fluoridated water should be used. b. Early childhood caries is a preventable disease. c. Dental caries is a rare chronic disease of childhood. d. Dental hygiene should begin with the first tooth eruption. e. Childhood caries does not happen until after 2 years of age.

ANS: A, B, D Oral health instructions to parents of children should include use of fluoridated water and dental hygiene beginning with the first tooth eruption. In addition, early childhood caries is a preventable disease and should be included in the teaching session. Dental caries is a common, not rare, chronic disease of childhood. Childhood caries may begin before the first birthday.

The nurse is reviewing the Healthy People 2020 leading health indicators for a child health promotion program. Which are included in the leading health indicators? (Select all that apply.) a. Decrease tobacco use. b. Improve immunization rates. c. Reduce incidences of cancer. d. Increase access to health care. e. Decrease the number of eating disorders.

ANS: A, B, D The Healthy People 2020 leading health indicators provide a framework for identifying essential components for child health promotion programs designed to prevent future health problems in our nation's children. Some of the leading health indicators include decreasing tobacco use, improving immunization rates, and increasing access to health care. Reducing the incidence of cancer and decreasing the number of eating disorders are not on the list as leading health indicators.

An adolescent asks the nurse about the "safety of getting a tattoo." The nurse explains to the adolescent that it is important to find a qualified operator using proper sterile technique because an unsterilized needle or contaminated tattoo ink can cause what? (Select all that apply.) a. Hepatitis C virus b. Hepatitis B virus c. Hepatitis E virus d. Human immunodeficiency virus (HIV) e. Mycobacterium chelonae skin infections

ANS: A, B, D, E Using the same unsterilized needle to tattoo body parts of multiple teenagers presents the same risk for human immunodeficiency virus (HIV), hepatitis C virus, and hepatitis B virus transmission as occurs with other needle-sharing activities. Contaminated tattoo ink can cause nontuberculous M. chelonae skin infections. The hepatitis E virus is transmitted via the fecal-oral route, principally via contaminated water, not by contaminated needles.

The nurse is evaluating a 7-month-old infant's cognitive development. Which behaviors should the nurse anticipate evaluating? (Select all that apply.) a. Imitates sounds b. Shows interest in a mirror image c. Comprehends simple commands d. Actively searches for a hidden object e. Attracts attention by methods other than crying

ANS: A, B, E A 7-month-old infant is in the secondary circular reactions (4-8 months) stage of cognitive development. Behaviors in this stage include imitating sounds, showing interest in a mirror image, and attracting attention by methods other than crying. Comprehending simple commands and actively searching for a hidden object are behaviors seen in the coordination of secondary schemas (9-12 months).

The nurse is providing anticipatory guidance to parents of a 4-month-old infant on preventing an aspiration injury. What should the nurse include in the teaching? (Select all that apply.) a. Keep baby powder out of reach. b. Inspect toys for removable parts. c. Allow the infant to take a bottle to bed. d. Teething biscuits can be used for teething discomfort. e. The infant should not be fed hard candy, nuts, or foods with pits.

ANS: A, B, E Anticipatory guidance to prevent aspiration for a 4-month-old infant takes into account that the infant will begin to be more active and place objects in the mouth. Toys should be checked for removable parts; baby powder should be kept out of reach; and hard candy, nuts, and foods with pits should be avoided. The infant should not go to bed with a bottle. Teething biscuits should be used with caution because large chunks may be broken off and aspirated.

What growth and development milestones are expected between the ages of 8 and 9 years? (Select all that apply.) a. Can help with routine household tasks b. Likes the reward system for accomplished tasks c. Uses the telephone for practical purposes d. Chooses friends more selectively e. Goes about home and community freely, alone or with friends f. Enjoys family time and is respectful of parents

ANS: A, B, E Children between the age of 8 and 9 years accomplish many growth and development milestones, including helping with routine household tasks, liking the reward system when a task is accomplished well, and going out with friends or alone more independently and freely. Using the telephone for practical reasons, choosing friends more selectively, and finding enjoyment in family with new-found respect for parents are tasks accomplished between the ages of 10 and 12 years.

Parents of an adolescent ask the school nurse, "It is OK for our adolescent to get a job?" The nurse should answer telling the parents the effects of adolescents who work more than 20 hours a week are what? (Select all that apply.) a. Can lead to fatigue b. Can lead to poorer grades c. Improves an interest in school d. Enhances development and identity e. Can reduce extracurricular involvement

ANS: A, B, E Detrimental effects are likely for adolescents who work more than 20 hours a week. Greater involvement in work can lead to fatigue, decreased interest in school, reduced extracurricular involvement, and poorer grades. Involvement in work may take time away from other activities that could contribute to identity development. Adolescent work as it exists today may negatively affect development.

What guidelines should the nurse use when interviewing adolescents? (Select all that apply.) a. Ensure privacy. b. Use open-ended questions. c. Share your thoughts and assumptions. d. Explain that all interactions will be confidential. e. Begin with less sensitive issues and proceed to more sensitive ones.

ANS: A, B, E Guidelines for interviewing adolescents include ensuring privacy, using open-ended questions, and beginning with less sensitive issues and proceeding to more sensitive ones. The nurse should not share thoughts but maintain objectivity and should avoid assumptions, judgments, and lectures. It may not be possible for all interactions to be confidential. Limits of confidentiality include a legal duty to report physical or sexual abuse and to get others involved if an adolescent is suicidal.

Parents are worried that their preschool-aged child is showing hyperaggressive behavior. What are signs of hyperaggresive behavior? (Select all that apply.) a. Disrespect b. Noncompliance c. Infrequent impulsivity d. Occasional temper tantrums e. Unprovoked physical attacks on other children

ANS: A, B, E Hyperaggressive behavior in preschoolers is characterized by unprovoked physical attacks on other children and adults, destruction of others' property, frequent intense temper tantrums, extreme impulsivity, disrespect, and noncompliance.

What disease processes require contact isolation? (Select all that apply.) a. Rotavirus b. Hepatitis A c. Streptococcal pharyngitis d. Mycoplasmal pneumonia e. Respiratory syncytial virus

ANS: A, B, E In addition to Standard Precautions, use contact precautions for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient's environment. Examples of such illnesses include rotavirus, hepatitis A, and respiratory syncytial virus. Streptococcal pharyngitis and mycoplasmal pneumonia require droplet precautions.

What preventive measures should the nurse teach parents of toddlers to prevent early childhood caries? (Select all that apply.) a. Avoid using a bottle as a pacifier. b. Eliminate bedtime bottles completely. c. Place juice in a bottle for the child to drink. d. Wean from the bottle by 18 months of age. e. Avoid coating pacifiers in a sweet substance.

ANS: A, B, E Prevention of dental caries involves eliminating the bedtime bottle completely, feeding the last bottle before bedtime, substituting a bottle of water for milk or juice, not using the bottle as a pacifier, and never coating pacifiers in sweet substances. Juice in bottles, especially commercially available ready-to-use bottles, is discouraged; these beverages are especially damaging because the sugar is more readily converted to acid. Juice should always be offered in a cup to avoid prolonging the bottle-feeding habit. Toddlers should be encouraged to drink from a cup at the first birthday and weaned from a bottle by 14 months of age, not 18 months.

The nurse is teaching parents of a 4-year-old child about socialization developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Very independent b. Has mood swings c. Has better manners d. Eager to do things right e. Tends to be selfish and impatient

ANS: A, B, E The socialization milestones of a 4-year-old child include being very independent, having moods swings, and tending to be selfish and impatient. Having better manners and being eager to do things right are socialization milestones seen at the age of 5 years.

The nurse understands that blocks to therapeutic communication include what? (Select all that apply.) a. Socializing b. Use of silence c. Using clichés d. Defending a situation e. Using open-ended questions

ANS: A, C, D Blocks to communication include socializing, using clichés, and defending a situation. Use of silence and using open-ended questions are therapeutic communication techniques.

What are common causes of speech problems? (Select all that apply.) a. Autism b. Prematurity c. Hearing loss d. Developmental delay e. Overstimulated environment

ANS: A, C, D Common causes of speech problems are hearing loss, developmental delay, autism, lack of environmental stimulation, and physical conditions that impede normal speech production. Prematurity and an overstimulated environment are not causes of speech problems.

The nurse is teaching parents of a toddler how to handle temper tantrums. What should the nurse include in the teaching? (Select all that apply.) a. Provide realistic expectations. b. Avoid using rewards for good behavior. c. Ensure consistency among all caregivers in expectations. d. During tantrums, ignore the behavior and continue to be present. e. Use time-outs for managing temper tantrums, starting at 12 months.

ANS: A, C, D The best approach toward tapering temper tantrums requires consistency and developmentally appropriate expectations and rewards. Ensuring consistency among all caregivers in expectations, prioritizing what rules are important, and developing consequences that are reasonable for the child's level of development help manage the behavior. During tantrums, ignore the behavior, provided the behavior is not injurious to the child, such as violently banging the head on the floor. Continue to be present to provide a feeling of control and security to the child after the tantrum has subsided. Starting at 18 months, time-outs work well for managing temper tantrums, but not at 12 months.

The nurse is teaching parents of a 3-year-old child about gross motor developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Rides a tricycle b. Catches a ball reliably c. Jumps off the bottom step d. Stands on one foot for a few seconds e. Walks downstairs using alternate footing

ANS: A, C, D The gross motor milestones of a 3-year-old child include riding a tricycle, jumping off the bottom step, and standing on one foot for a few seconds. Catching a ball reliably and walking downstairs using alternate footing are gross motor milestones seen at the age of 4 years.

The nurse is teaching parents of a 3-year-old child about language developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Asks many questions b. Names one or more colors c. Repeats sentence of six syllables d. Uses primarily "telegraphic" speech e. Has a vocabulary of 1500 words or more

ANS: A, C, D The language milestones of a 3-year-old child include asking many questions, repeating a sentence of six syllables, and using primarily "telegraphic" speech. Naming one or more colors and having a vocabulary of 1500 words or more footing are language milestones seen at the age of 4 years.

The nurse is presenting a staff development program about understanding culture in the health care encounter. Which components should the nurse include in the program? (Select all that apply.) a. Cultural humility b. Cultural research c. Cultural sensitivity d. Cultural competency

ANS: A, C, D There are several different ways health care providers can best attend to all the different facets that make up an individual's culture. Cultural competence tends to promote building information about a specific culture. Cultural sensitivity, a second way of understanding culture in the context of the clinical encounter, may be understood as a way of using one's knowledge, consideration, understanding, respect, and tailoring after realizing awareness of self and others and encountering a diverse group or individual. Cultural humility, the third component, is a commitment and active engagement in a lifelong process that individuals enter into for an ongoing basis with patients, communities, colleagues, and themselves. Cultural research is not a component of understanding culture in the health care encounter.

A school-age child has been a victim of bullying. What characteristics does the nurse assess for in this child? (Select all that apply.) a. Anxiety b. Outgoing c. Low self-esteem d. Psychosomatic complaints e. Good academic performance

ANS: A, C, D Victims of bullying are at increased risk for low self-esteem; anxiety; depression; feelings of insecurity and loneliness; poor academic performance; and psychosomatic complaints such as feeling tense, tired, or dizzy.

The nurse is providing anticipatory guidance to parents of an 8-month-old infant on preventing a drowning injury. Which should the nurse include in the teaching? (Select all that apply.) a. Fence swimming pools. b. Keep bathroom doors open. c. Eliminate unnecessary pools of water. d. Keep one hand on the child while in the tub. e. Supervise the child when near any source of water.

ANS: A, C, D, E Anticipatory guidance to prevent drowning for an 8-month-old infant takes into account that the child will begin to crawl, cruise around furniture, walk, and climb. Fences should be placed around swimming pools, unnecessary pools of water should be eliminated, one hand should be kept on the child when bathing, and the child should be supervised when near any source of water. The bathroom doors should be kept closed.

The nurse is providing anticipatory guidance to the parents of a 1-month-old infant on preventing a suffocation injury. Which should the nurse include in the teaching? (Select all that apply.) a. Do not place pillows in the infant's crib. b. Crib slats should be 4 inches or less apart. c. Keep all plastic bags stored out of the infant's reach. d. Plastic over the mattress is acceptable if it is covered with a sheet. e. A pacifier should not be tied on a string around the infant's neck.

ANS: A, C, E Anticipatory guidance for a 1-month-old infant to prevent a suffocation injury takes into account that the infant will have increased eye-hand coordination and a voluntary grasp reflex as well as a crawling reflex that may propel the infant forward or backward. Pillows should not be placed in the infant's crib, plastic bags should be kept out of reach, and a pacifier should not be tied on a string around the neck. Crib slats should be 2.4 inches apart (4 inches is too wide), and the mattress should not be covered with plastic even if a sheet is used to cover it.

The nurse is assessing heart sounds on a school-age child. Which should the nurse document as abnormal findings if found on the assessment? (Select all that apply.) a. S4 heart sound b. S3 heart sound c. Grade II murmur d. S1 louder at the apex of the heart e. S2 louder than S1 in the aortic area

ANS: A, C, E S4 is rarely heard as a normal heart sound; it usually indicates the need for further cardiac evaluation. A grade II murmur is not normal; it is slightly louder than grade I and is audible in all positions. S3 is normally heard in some children. Normally, S1 is louder at the apex of the heart in the mitral and tricuspid area, and S2 is louder near the base of the heart in the pulmonic and aortic area.

Parents are concerned about their child riding an all-terrain vehicle. What should the nurse tell the parents about safe use of all-terrain vehicles? (Select all that apply.) a. Restrict riding to familiar terrain. b. Limit street use to the neighborhood. c. Nighttime riding should not be allowed. d. Vehicles should not carry more than two persons. e. Vehicles should include seat belts, roll bars, and automatic headlights.

ANS: A, C, E Safe use of all-terrain vehicles includes restricting riding to familiar terrain; not allowing nighttime riding; and assuring the vehicle has seat belts, roll bars, and automatic headlights. Street use should not be allowed, and the vehicle should not carry more than one person.

Which coanalgesics should the nurse expect to be prescribed for pruritus? (Select all that apply.) a. Naloxone (Narcan) b. Inapsine (Droperidol) c. Hydroxyzine (Atarax) d. Promethazine (Phenergan) e. Diphenhydramine (Benadryl)

ANS: A, C, E The coanalgesics prescribed for pruritus include naloxone, hydroxyzine, and diphenhydramine. Inapsine and promethazine are administered as antiemetics.

Which responsibilities are included in the pediatric nurse's promotion of the health and well-being of children? (Select all that apply.) a. Promoting disease prevention b. Providing financial assistance c. Providing support and counseling d. Establishing lifelong friendships e. Establishing a therapeutic relationship f. Participating in ethical decision making

ANS: A, C, E, F The pediatric nurse's role includes promoting disease prevention, providing support and counseling, establishing a therapeutic relationship, and participating in ethical decision making; a pediatric nurse does not need to establish lifelong friendships or provide financial assistance to children and their families. Boundaries should be set and clear.

The nurse is planning strategies to assist a slow-to-warm child to try new experiences. What strategies should the nurse plan? (Select all that apply.) a. Attend after-school activities with a friend. b. Suggest the child move quickly into a new situation. c. Avoid trying new experiences until the child is ready. d. Allow the child to adapt to the experience at his or her own pace. e. Contract for permission to withdraw after a trial of the experience.

ANS: A, D, E The nurse should encourage slow-to-warm children to try new experiences but allow them to adapt to their surroundings at their own speed. Pressure to move quickly into new situations only strengthens their tendency to withdraw. After-school activities can be a cause for reaction, but attending with a friend or contracting for permission to withdraw after a trial of a specified number of times may provide them with sufficient incentive to try.

The nurse is caring for a 12-year-old child who is on fall precautions secondary to seizures. What interventions should be included in the child's care plan? (Select all that apply.) a. Place a call light and desired items within reach. b. Keep the bed in the highest position with the two side rails up. c. Turn off the lights and television at night. d. Keep personal belongings and clutter contained in one area of the floor. e. Have the child wear an appropriate-size gown and nonskid footwear.

ANS: A, E Prevention of falls requires alterations in the environment, including keeping call light and desired items within reach and having the child wear appropriate-size gowns and nonskid footwear. The bed should be in the lowest position possible with all the side rails up; at least a dim light should be left on at night; and personal belongings and clutter should not be on the floor—they should be in a cabinet.

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse they will be back to visit at 6 PM. When he asks the nurse when his parents are coming, what would the nurse's best response be? a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be."

ANS: B A 4-year-old child understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. "I will tell you every time I see you how much longer it will be" assumes the child understands the concepts of hours and minutes, which does not occur until age 5 or 6 years.

Which type of family should the nurse recognize when a mother, her children, and a stepfather live together? a. Traditional nuclear b. Blended c. Extended d. Binuclear

ANS: B A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children. No other relatives or nonrelatives are present in the household. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which? a. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure. b. Use a combination of fentanyl and midazolam for conscious sedation. c. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure. d. Apply a transdermal fentanyl (Duragesic) "patch" immediately before the procedure.

ANS: B A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.

The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching? a. Lack of congruence among family members b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit

ANS: B A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Varied coping strategies are used by strong families. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

The parent of an 8.2-kg (18-lb) 9-month-old infant is borrowing a federally approved car seat from the clinic. The nurse should explain that the safest way to put in the car seat is what? a. Front facing in back seat b. Rear facing in back seat c. Front facing in front seat with air bag on passenger side d. Rear facing in front seat if an air bag is on the passenger side

ANS: B A rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. 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.

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, okay?" What action should the nurse take? a. Postpone starting the IV until the next shift. b. Start the IV line and then allow for expression of feelings. c. Change the route of the antibiotics to PO. d. Postpone starting the IV line until the child is ready.

ANS: B A school-age child may try to delay the procedure, but it is best to complete the procedure and allow time for the child to express his or her feelings. The nurse should not postpone administering the antibiotic, change it to PO, or wait to start the IV line until the child is ready.

What aspects of cognition develop during adolescence? a. Ability to see things from the point of view of another b. Capability of using a future time perspective c. Capability of placing things in a sensible and logical order d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: B Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit thought processes that enable them to see things from the point of view of another, place things in a sensible and logical order, and progress from making judgments based on what they see to making judgments based on what they reason.

When the nurse interviews an adolescent, which is especially important? a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Use the same type of language as the adolescent. d. Emphasize that confidentiality will always be maintained.

ANS: B Adolescents, like all children, need opportunities to express their feelings. Often they interject feelings into their words. The nurse must be alert to the words and feelings expressed. The nurse should maintain a professional relationship with adolescents. To avoid misunderstanding or misinterpretation of words and phrases used, the nurse should clarify the terms used, what information will be shared with other members of the health care team, and any limits to confidentiality. Although the peer group is important to this age group, the interview should focus on the adolescent.

The nurse gives an injection in a patient's room. How should the nurse dispose of the needle? a. Remove the needle from the syringe and dispose of it in a proper container. b. Dispose of the syringe and needle in a rigid, puncture-resistant container in the patient's room. c. Close the safety cover on the needle and return it to the medication preparation area for proper disposal. d. Place the syringe and needle in a rigid, puncture-resistant container in an area outside of the patient's room.

ANS: B All needles (uncapped and unbroken) are disposed of in a rigid, puncture-resistant, tamper-proof container located near the site of use. Consequently, these containers should be installed in the patient's room. Needles and syringes are disposed of uncapped and unbroken. A used needle should not be transported to an area distant from use for disposal.

The nurse has just collected blood by venipuncture in the antecubital fossa. What should the nurse do next? a. Keep the child's arm extended while applying a Band-Aid to the site. b. Keep the child's arm extended and apply pressure to the site for a few minutes. c. Apply a Band-Aid to the site and keep the arm flexed for 10 minutes. d. Apply a gauze pad or cotton ball to the site and keep the arm flexed for several minutes.

ANS: B Applying pressure to the site of venipuncture stops the bleeding and aids in coagulation. Pressure should be applied before a bandage or gauze pad is applied.

An adolescent patient wants to make decisions about treatment options, along with his parents. Which moral value is the nurse displaying when supporting the adolescent to make decisions? a. Justice b. Autonomy c. Beneficence d. Nonmaleficence

ANS: B Autonomy is the patient's right to be self-governing. The adolescent is trying to be autonomous, so the nurse is supporting this value. Justice is the concept of fairness. Beneficence is the obligation to promote the patient's well-being. Nonmaleficence is the obligation to minimize or prevent harm.

Which is the most consistent and commonly used data for assessment of pain in infants? a. Self-report b. Behavioral c. Physiologic d. Parental report

ANS: B Behavioral assessment is useful for measuring pain in young children and preverbal children who do not have the language skills to communicate that they are in pain. Infants are not able to self-report. Physiologic measures are not able to distinguish between physical responses to pain and other forms of stress. Parental report without a structured tool may not accurately reflect the degree of discomfort.

What is an advantage of the ventrogluteal muscle as an injection site in young children? a. Easily accessible from many directions b. Free of significant nerves and vascular structures c. Can be used until child reaches a weight of 9 kg (20 lb) d. Increased subcutaneous fat, which provides sustained drug absorption

ANS: B Being free of significant nerves and vascular structure is one of the advantages of the ventrogluteal site. In addition, it is considered less painful than the vastus lateralis. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. The vastus lateralis is a more accessible site. The ventrogluteal muscle site has safely been used from newborn through adulthood. Clinical guidelines address the need for the child to be walking. The site has less subcutaneous tissue, which facilitates intramuscular deposition of the drug rather than subcutaneous.

What is the most frequent cause of hypovolemic shock in children? a. Sepsis b. Blood loss c. Anaphylaxis d. Heart failure

ANS: B Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Heart failure contributes to hypervolemia, not hypovolemia.

The school nurse is assessing children for risk factors related to childhood injuries. Which child has the most risk factors related to childhood injury? a. Female, multiple siblings, stable home life b. Male, high activity level, stressful home life c. Male, even tempered, history of previous injuries d. Female, reacts negatively to new situations, no serious previous injuries

ANS: B Boys have a preponderance for injuries over girls because of a difference in behavioral characteristics, a high activity temperament is associated with risk-taking behaviors, and stress predisposes children to increased risk taking and self-destructive behaviors. Therefore, a male child with a high activity level and living in a stressful environment has the highest number of risk factors. A girl with several siblings and a stable home life is low risk. A boy with previous injuries has two risk factors, but an even temper is not a risk factor for injuries. A girl who reacts negatively to new situations but has no previous serious illnesses has only one risk factor.

The nurse is interviewing the father of a 10-month-old girl. The child is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says "no" firmly and moves her away from the outlet. The nurse should use this opportunity to teach the father what? a. That the child should be given a time-out b. That the child is old enough to understand the word "no" c. That the child will learn safety issues better if she is spanked d. That the child should already know that electrical outlets are dangerous

ANS: B By age 10 months, children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. A time-out is not appropriate. The child is just learning about the environment. Physical discipline should be avoided. The 10-month-old child is too young to understand the purpose of an electrical outlet.

The school nurse is providing guidance to families of children who are entering elementary school. What is essential information to include? a. Meet with teachers only at scheduled conferences. b. Encourage growth of a sense of responsibility in children. c. Provide tutoring for children to ensure mastery of material. d. Homework should be done as soon as child comes home from school.

ANS: B By being responsible for school work, children learn to keep promises, meet deadlines, and succeed in their jobs as adults. Parents should meet with the teachers at the beginning of the school year, for scheduled conferences, and whenever information about the child or parental concerns needs to be shared. Tutoring should be provided only in special circumstances in elementary school, such as in response to prolonged absence. The parent should not dictate the study time but should establish guidelines to ensure that homework is done.

Which explains the importance of detecting strabismus in young children? a. Color vision deficit may result. b. Amblyopia, a type of blindness, may result. c. Epicanthal folds may develop in the affected eye. d. Corneal light reflexes may fall symmetrically within each pupil.

ANS: B By the age of 3 to 4 months, infants are able to fixate on one visual field with both eyes simultaneously. In strabismus, or cross-eye, one eye deviates from the point of fixation. If misalignment is constant, the weak eye becomes "lazy," and the brain eventually suppresses the image produced from that eye. If strabismus is not detected and corrected by age 4 to 6 years, blindness from disuse, known as amblyopia, may occur. Color vision is not the only concern. Epicanthal folds are not related to amblyopia. In children with strabismus, the corneal light reflex will not be symmetric for each eye.

The nurse is explaining different parenting styles to a group of parents. The nurse explains that an authoritative parenting style can lead to which child behavior? a. Shyness b. Self-reliance c. Submissiveness d. Self-consciousness

ANS: B Children raised by parents with an authoritative parenting style tend to have high self-esteem and are self-reliant, assertive, inquisitive, content, and highly interactive with other children. Children raised by parents with an authoritarian parenting style tend to be sensitive, shy, self-conscious, retiring, and submissive.

A foster parent is talking to the nurse about the health care needs for the child who has been placed in the parent's care. Which statement best describes the health care needs of foster children? a. Foster children always come from abusive households and are emotionally fragile. b. Foster children tend to have a higher than normal incidence of acute and chronic health problems. c. Foster children are usually born prematurely and require technologically advanced health care. d. Foster children will not stay in the home for an extended period, so health care needs are not as important as emotional fulfillment.

ANS: B Children who are placed in foster care have a higher incidence of acute and chronic health problems and may experience feelings of isolation and confusion; therefore, they should be monitored closely. Foster children do not always come from abusive households and may or may not be emotionally fragile; not all foster children are born prematurely or require technically advanced health care; and foster children may stay in the home for extended periods, so their health care needs require attention.

The nurse is reviewing the importance of role learning for children. The nurse understands that children's roles are primarily shaped by which members? a. Peers b. Parents c. Siblings d. Grandparents

ANS: B Children's roles are shaped primarily by the parents, who apply direct or indirect pressures to induce or force children into the desired patterns of behavior or direct their efforts toward modification of the role responses of the child on a mutually acceptable basis.

Which situation denotes a nontherapeutic nurse-patient-family relationship? a. The nurse is planning to read a favorite fairy tale to a patient. b. During shift report, the nurse is criticizing parents for not visiting their child. c. The nurse is discussing with a fellow nurse the emotional draw to a certain patient. d. The nurse is working with a family to find ways to decrease the family's dependence on health care providers.

ANS: B Criticizing parents for not visiting in shift report is nontherapeutic and shows an underinvolvement with the parents. Reading a fairy tale is a therapeutic and age appropriate action. Discussing feelings of an emotional draw with a fellow nurse is therapeutic and shows a willingness to understand feelings. Working with parents to decrease dependence on health care providers is therapeutic and helps to empower the family.

The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which technique should be most helpful? a. Recommend that the child keep a diary. b. Provide supplies for the child to draw a picture. c. Suggest that the parent read fairy tales to the child. d. Ask the parent if the child is always uncommunicative.

ANS: B Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the children's inner self. A diary should be difficult for a 6-year-old child, who is most likely learning to read. The parent reading fairy tales to the child is a passive activity involving the parent and child; it should not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not always uncommunicative.

Evidence-based practice (EBP), a decision-making model, is best described as which? a. Using information in textbooks to guide care b. Combining knowledge with clinical experience and intuition c. Using a professional code of ethics as a means for decision making d. Gathering all evidence that applies to the child's health and family situation

ANS: B EBP helps focus on measurable outcomes; the use of demonstrated, effective interventions; and questioning what is the best approach. EBP involves decision making based on data, not all evidence on a particular situation, and involves the latest available data. Nurses can use textbooks to determine areas of concern and potential involvement.

A 12-year-old girl asks the nurse about an increase in clear white odorless vaginal discharge. What response should the nurse give? a. "This may mean a yeast infection." b. "This is normal before menstruation starts." c. "This is caused by an increase in progesterone." d. "This is possibly a sign of a sexually transmitted infection."

ANS: B Early in puberty, there is often an increase in normal vaginal discharge (physiologic leukorrhea) associated with uterine development. Girls or their parents may be concerned that this vaginal discharge is a sign of infection. The nurse can reassure them that the discharge is normal and a sign that the uterus is preparing for menstruation. It is caused by an increase in estrogen, not progesterone.

The nurse is aware that if patients' different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what? a. Acculturation b. Ethnocentrism c. Cultural shock d. Cultural sensitivity

ANS: B Ethnocentrism is the belief that one's way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one's ethnic group are superior to those of others. Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences.

The nurse is evaluating research studies according to the GRADE criteria and has determined the quality of evidence on the subject is moderate. Which type of evidence does this determination indicate? a. Strong evidence from unbiased observational studies b. Evidence from randomized clinical trials showed inconsistent results c. Consistent evidence from well-performed randomized clinical trials d. Evidence for at least one critical outcome from randomized clinical trials had serious flaws

ANS: B Evidence from randomized clinical trials with important limitations indicates that the evidence is of moderate quality. Strong evidence from unbiased observational studies and consistent evidence from well-performed randomized clinical trials indicates high quality. Evidence for at least one critical outcome from randomized clinical trials that has serious flaws indicates low quality.

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Family stress theory c. Erikson's psychosocial theory d. Developmental systems theory

ANS: B Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Erikson's theory applies to individual growth and development, not families. Developmental systems theory is an outgrowth of Duvall's theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.

The clinic nurse is teaching parents about physiologic anemia that occurs in infants. What statement should the nurse include about the cause of physiologic anemia? a. Maternally derived iron stores are depleted in the first 2 months. b. Fetal hemoglobin results in a shortened survival of red blood cells. c. The production of adult hemoglobin decreases in the first year of life. d. Low levels of fetal hemoglobin depress the production of erythropoietin.

ANS: B Fetal hemoglobin results in a shortened survival of red blood cells (RBCs) and thus a decreased number of RBCs. Maternally derived iron stores are present for the first 5 to 6 months results in a shortened survival of RBCs and thus a decreased number of RBCs. High levels of fetal hemoglobin depress the production of erythropoietin, a hormone released by the kidney that stimulates RBC production.

The nurse has just started assessing a young child who is febrile and appears ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. Which is the most appropriate action? a. Ask the parent when the neck was injured. b. Refer for immediate medical evaluation. c. Continue assessment to determine the cause of the neck pain. d. Record "head lag" on the assessment record and continue the assessment of the child.

ANS: B Hyperextension of the child's head with pain on flexion is indicative of meningeal irritation and needs immediate evaluation. No indication of injury is present. This situation is not descriptive of head lag.

The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed? a. "We will try to preserve the adopted child's racial heritage." b. "We are glad we will be getting full medical information when we adopt our child." c. "We will make sure to have everyone realize this is our child and a member of the family." d. "We understand strangers may make thoughtless comments about our child being different from us."

ANS: B In international adoptions, the medical information the parents receive may be incomplete or sketchy; weight, height, and head circumference are often the only objective information present in the child's medical record. Further teaching is needed if the parents expect full medical information. It is advised that parents who adopt children with different ethnic backgrounds do everything to preserve the adopted children's racial heritage. Strangers may make thoughtless comments and talk about the children as though they were not members of the family. It is vital that family members declare to others that this is their child and a cherished member of the family.

A child who has cystic fibrosis is admitted to the pediatric unit with methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse recognizes that in addition to a private room, the child is placed on what precautions? a. Droplet b. Contact c. Airborne d. Standard

ANS: B MRSA is an increasingly significant source of hospital-acquired infections. This organism meets the criteria of being epidemiologically important and can be transmitted by direct contact. Gowns and gloves should be worn when exposed to potentially contagious materials, and meticulous hand washing is required. S. aureus is not an organism that is spread through airborne or droplet mechanisms. Additional precautions, beyond Standard Precautions, are needed to prevent spread of this organism.

In terms of cognitive development, a 5-year-old child should be expected to do which? a. Think abstractly. b. Use magical thinking. c. Understand conservation of matter. d. Understand another person's perspective.

ANS: B Magical thinking is believing that thoughts can cause events. An example is thinking of the death of a parent might cause it to happen. Abstract thought does not develop until the school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A 5-year-old child cannot understand another person's perspective

What amount of fluid loss occurs with moderate dehydration? a. <50 ml/kg b. 50 to 90 ml/kg c. <5% total body weight d. >15% total body weight

ANS: B Moderate dehydration is defined as a fluid loss of between 50 and 90 ml/kg. Mild dehydration is defined as a fluid loss of less than 50 ml/kg. Weight loss up to 5% is considered mild dehydration. Weight loss over 15% is severe dehydration.

What do mortality statistics describe? a. Disease occurring regularly within a geographic location b. The number of individuals who have died over a specific period c. The prevalence of specific illness in the population at a particular time d. Disease occurring in more than the number of expected cases in a community

ANS: B Mortality statistics refer to the number of individuals who have died over a specific period. Morbidity statistics show the prevalence of specific illness in the population at a particular time. Data regarding disease within a geographic region, or in greater than expected numbers in a community, may be extrapolated from analyzing the morbidity statistics.

The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching? a. "I can give my baby a ball of yarn to pull apart or different textured fabrics to feel." b. "I can use a music box and soft mobiles as appropriate play activities for my baby." c. "I should introduce a cup and spoon or push-pull toys for my baby at this age." d. "I do not have to worry about appropriate play activities at this age."

ANS: B Music boxes and soft mobiles are appropriate play activities for a 2-month-old infant. A ball of yarn to pull apart or different textured fabrics are appropriate for an infant at 6 to 9 months. A cup and spoon or push-pull toys are appropriate for an older infant. Infants of all ages should be exposed to appropriate types of stimulation.

The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurse's response should be based on which characteristic about preterm infants' pain? a. They may react to painful stimuli but are unable to remember the pain experience. b. They perceive and react to pain in much the same manner as children and adults. c. They do not have the cortical and subcortical centers that are needed for pain perception. d. They lack neurochemical systems associated with pain transmission and modulation.

ANS: B Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.

To facilitate the administration of an oral medication to a preschool-age child, what action should the nurse take? a. Dilute the medication in a large amount of favorite liquid and allow the child to hold the cup. b. Set limits about the need to take medication and offer praise immediately after the task is accomplished. c. Mix the medication in a moderate amount of the child's favorite food. d. Explain the purpose of the medication and allow the child time to express resistance before giving the medication.

ANS: B Nurses who approach children with confidence and who convey the impression that they expect to be successful are less likely to encounter difficulty. It is best to approach a child as though cooperation is expected. The medication should not be placed in a favorite liquid or food. Allowing the child time to express resistance will delay administration of the medication.

A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as what? a. Indicative of maladjustment b. A common reaction to divorce c. Suggestive of a lack of adequate parenting d. An unusual response that indicates a need for referral

ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. The child's responses are common reactions of school-age children to parental divorce.

The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. What is the nurse's best response? a. "Allow him to cry for no longer than 15 minutes and then pick him up." b. "Babies need comforting and cuddling. Meeting these needs will not spoil him." c. "Babies this young cry when they are hungry. Try feeding him when he cries." d. "If he isn't soiled or wet, leave him, and he'll cry himself to sleep."

ANS: B Parents need to learn that a "spoiled child" is a response to inconsistent discipline and limit setting. It is important to meet the infant's developmental needs, including comforting and cuddling. The data suggest that responding to a child's crying can actually decrease the overall crying time. Allowing him to cry for no longer than 15 minutes and then picking him up will reinforce prolonged crying. Infants at this age have other needs besides feeding. The parents should be taught to identify their infant's cues. Counseling parents on letting the baby cry himself to sleep when not soiled or wet refers to sleep issues, not general infant behavior.

Fentanyl and midazolam (Versed) are given before débridement of a child's burn wounds. What is the purpose of using these medications? a. Facilitate healing b. Provide pain relief c. Minimize risk of infection d. Decrease amount of débridement needed

ANS: B Partial-thickness burns require débridement of devitalized tissue to promote healing. The procedure is painful and requires analgesia and sedation before the procedure. Fentanyl and midazolam provide excellent intravenous sedation and analgesia to control procedural pain in children with burns.

What is the best age to introduce solid food into an infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

ANS: B Physiologically and developmentally, 4- to 6-month-old infants are in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding. Two to 3 months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. No research indicates that the addition of solid food to a bottle has any benefit. Infant birth weight doubles at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

Children may believe that they are responsible for their parents' divorce and interpret the separation as punishment. At which age is this most likely to occur? a. 1 year b. 4 years c. 8 years d. 13 years

ANS: B Preschool-age children are most likely to blame themselves for the divorce. A 4-year-old child will fear abandonment and express bewilderment regarding all human relationships. A 4-year-old child has magical thinking and believes his or her actions cause consequences, such as divorce. For infants, divorce may increase their irritability and interfere with the attachment process, but they are too young to feel responsibility. School-age children will have feelings of deprivation, including the loss of a parent, attention, money, and a secure future. Adolescents are able to disengage themselves from the parental conflict.

Rectal temperatures are indicated in which situation? a. In the newborn period b. Whenever accuracy is essential c. Rectal temperatures are never indicated d. When rapid temperature changes are occurring

ANS: B Rectal temperatures are recommended when definitive measurements are necessary in infants older than age 1 month. Rectal temperatures are not done in the newborn period to avoid trauma to the rectal mucosa. Rectal temperature is an intrusive procedure that should be avoided whenever possible.

Which is an appropriate recommendation in preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

ANS: B Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

The nurse is caring for an 18-month-old child with rotavirus. What clinical manifestations should the nurse expect to observe? a. Severe abdominal cramping and bloody diarrhea b. Mild fever and vomiting followed by onset of watery stools c. Colicky abdominal pain and vomiting d. High fever, diarrhea, and lethargy

ANS: B Rotavirus is one of the most common pathogens that cause gastroenteritis in children younger than the age of 2 years. Clinical manifestations include mild to moderate fever and vomiting followed by the onset of watery stools. The fever and vomiting usually abate in 1 or 2 days, but the diarrhea persists for 5 to 7 days. Severe abdominal cramping and bloody diarrhea are seen with Escherichia coli infection; colicky abdominal pain and vomiting are seen with salmonella infection; and high fever, diarrhea, and lethargy are seen with infection by Salmonella typhi.

What is the earliest age at which a satisfactory radial pulse can be taken in children? a. 1 year b. 2 years c. 3 years d. 6 years

ANS: B Satisfactory radial pulses can be taken in children older than 2 years. In infants and young children, the apical pulse is more reliable.

A school-age child has begun to sleepwalk. What does the nurse advise the parents to perform? a. Wake the child and help determine what is wrong. b. Leave the child alone unless he or she is in danger of harming him- or herself or others. c. Arrange for psychologic evaluation to identify the cause of stress. d. Keep the child awake later in the evening to ensure sufficient tiredness for a full night of sleep.

ANS: B Sleepwalking is usually self-limiting and requires no treatment. The child usually moves about restlessly and then returns to bed. Usually the actions are repetitive and clumsy. The child should not be awakened unless in danger. If there is a need to awaken the child, it should be done by calling the child's name to gradually bring to a state of alertness. Some children, who are usually well behaved and tend to repress feelings, may sleepwalk because of strong emotions. These children usually respond to relaxation techniques before bedtime. If a child is overly fatigued, sleepwalking can increase.

Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the purpose of hydrotherapy? a. Provide pain relief b. Débride the wounds c. Destroy bacteria on the skin d. Increase peripheral blood flow

ANS: B Soaking in a tub or showering once or twice a day acts to loosen and remove sloughing tissue, exudate, and topical medications. The hydrotherapy cleanses the wound and the entire body and helps maintain range of motion. Appropriate pain medications are necessary. Dressing changes are extremely painful. The total bacterial count of the skin is reduced by the hydrotherapy, but this is not the primary goal. There may be an increase in peripheral blood flow, but the primary purpose is for wound débridement.

In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years? a. Suicide and cancer b. Suicide and homicide c. Drowning and cancer d. Homicide and heart disease

ANS: B Suicide and homicide account for 16.7% of deaths in this age group. Suicide and cancer account for 10.9% of deaths, heart disease and cancer account for approximately 5.5%, and homicide and heart disease account for 10.9% of the deaths in this age group.

The American Academy of Pediatrics (AAP) recommends that children younger than the age of 16 years be prohibited from participating in what? a. Skateboarding b. Snowmobiling c. Trampoline use d. Horseback riding

ANS: B The AAP views the use of snowmobiles and all-terrain vehicles as major health hazards for children. This group opposes the use of these vehicles by children younger than 16 years of age. The AAP recommends that children younger than the age of 10 years not use skateboards without parental supervision. Protective gear is always suggested. Trampoline use has increased along with injuries. Adults should supervise use. Horseback riding injuries are also a source of concern. Parents should determine the instructor's safety record with students.

What is an important consideration when using the FACES pain rating scale with children? a. Children color the face with the color they choose to best describe their pain. b. The scale can be used with most children as young as 3 years. c. The scale is not appropriate for use with adolescents. d. The FACES scale is useful in pain assessment but is not as accurate as physiologic responses.

ANS: B The FACES scale is validated for use with children ages 3 years and older. Children point to the face that best describes their level of pain. The scale can be used through adulthood. The child's estimate of the pain should be used. The physiologic measures may not reflect more long-term pain

What is true concerning masturbation during adolescence? a. Homosexuality is encouraged by the practice of masturbation. b. Many girls do not begin masturbation until after they have intercourse. c. Masturbation at an early age leads to sexual intercourse at an earlier age. d. Development of intimate relationships is delayed when masturbation is regularly practiced.

ANS: B The age of first masturbation for girls is variable. Some begin masturbating in early adolescence; many do not begin until after they have had intercourse. Boys typically begin masturbation in early adolescence. Masturbation provides an opportunity for self-exploration. Both heterosexual and homosexual youth use masturbation. It does not affect the development of intimacy.

The nurse is explaining average weight gain during the preschool years to a group of parents. Which average weight gain should the nurse suggest to the parents? a. 1 to 2 kg b. 2 to 3 kg c. 3 to 4 kg d. 4 to 5 kg

ANS: B The average weight gain remains approximately 2 to 3 kg (4.5-6.5 lb) per year during the preschool period.

The nurse is taking a health history of an adolescent. Which best describes how the chief complaint should be determined? a. Request a detailed listing of symptoms. b. Ask the adolescent, "Why did you come here today?" c. Interview the parent away from the adolescent to determine the chief complaint. d. Use what the adolescent says to determine, in correct medical terminology, what the problem is.

ANS: B The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. Requesting a detailed list of symptoms makes it difficult to determine the chief complaint. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help.

A laboratory technician is performing a blood draw on a toddler. The toddler is holding still but crying loudly. The nurse should take which action? a. Have the lab technician stop the procedure until the child stops crying. b. Do nothing. It's Okay for a child to cry during a painful procedure. c. Tell the child to stop crying; it's only a small prick. d. Tell the child to stop crying because the procedure is almost over.

ANS: B The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. It is natural for children to strike out in frustration or to try to avoid stress-provoking situations. The child needs to know that it is all right to cry.

The development of sexual orientation during adolescence is what? a. Inflexible b. A developmental process c. Differs for boys and girls d. Proceeds in a defined sequence

ANS: B The development of sexual orientation as a part of sexual identity includes several developmental milestones during late childhood and throughout adolescence. The sequence and time spent in phases are different for each individual. Boys and girls pass through the same developmental milestones.

The nurse is preparing to administer a liquid medication by a nasogastric feeding tube. What is the first thing the nurse should do? a. Check placement of the tube. b. Check the pH of the gastric aspirate. c. Flush the tube with a small amount of water. d. Give the medication and then flush with a small amount of water.

ANS: B The most accurate way to check the position of the nasogastric tube is by checking the pH. Auscultation as a verification tool is reliable only 60% to 80% of the time and should not be used without additional methods. The tube should not be flushed or the medication administered until placement of the tube is checked.

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? a. Codeine sulfate (Codeine) b. Morphine (Roxanol) c. Methadone (Dolophine) d. Meperidine (Demerol)

ANS: B The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant. Meperidine is not used for continuous and extended pain relief.

What is an important consideration for the school nurse who is planning a class on bicycle safety? a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear a bicycle helmet if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra large seat.

ANS: B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. Children should not ride double unless it is a tandem bike (built for two).

A toddler is being sent to the operating room for surgery at 9 AM. As the nurse prepares the child, what is the priority intervention? a. Administering preoperative antibiotic b. Verifying that the child and procedure are correct c. Ensuring that the toddler has been NPO since midnight d. Informing the parents where they can wait during the procedure

ANS: B The most important intervention is to ensure that the correct child is going to the operating room for the identified procedure. It is the nurse's responsibility to verify identification of the child and what procedure is to be done. If an antibiotic is ordered, administering it is important, but correct identification is a priority. Clear liquids can be given up to 2 hours before surgery. If the child was NPO (taking nothing by mouth) since midnight, intravenous fluids should be administered. Parents should be encouraged to accompany the child to the preoperative area. Many institutions allow parents to be present during induction.

The nurse is teaching a parent of a 10-year-old child who will be discharged with a venous access device (VAD). What statement by the parent indicates a correct understanding of the teaching? a. "I should have my child wear a protective vest when my child wants to participate in contact sports." b. "I should apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed." c. "I can expect my child to have feelings of general malaise for 1 week after the VAD is inserted." d. "I should give my child a sponge bath for the first 2 weeks after the VAD is inserted; then I can allow my child to take a bath."

ANS: B The parents of a child with a VAD should be taught to apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed. The child should not participate in contact sports, even with a protective vest, to prevent the VAD from becoming dislodged. General malaise is a sign of an infection, not an expected finding after insertion of the VAD. The child can shower or take a bath after insertion of the VAD; the child does not need a sponge bath for any length of time.

An 11-month-old hospitalized boy is restrained because he is receiving intravenous (IV) fluids. His grandmother has come to stay with him for the afternoon and asks the nurse if the restraints can be removed. What nurse's response is best? a. "Restraints need to be kept on all the time." b. "That is fine as long as you are with him." c. "That is fine if we have his parents' consent." d. "The restraints can be off only when the nursing staff is present."

ANS: B The restraints are necessary to protect the IV site. If the child has appropriate supervision, restraints are not necessary. The nurse should remove the restraints whenever possible. When parents or staff members are present, the restraints can be removed and the IV site protected. Parental permission is not needed for restraint removal.

What is the appropriate placement of a tongue blade for assessment of the mouth and throat? a. On the lower jaw b. Side of the tongue c. Against the soft palate d. Center back area of the tongue

ANS: B The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. On the lower jaw and against the soft palate are not appropriate places for the tongue blade. Placement in the center back area of the tongue elicits the gag reflex.

A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened, yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely what? a. Nightmare b. Sleep terror c. Sleep apnea d. Seizure activity

ANS: B This is a description of a sleep terror. The child is observed during the episode and not disturbed unless there is a possibility of injury. A child who awakes from a nightmare is distressed. She is aware of and reassured by the parent's presence. This is not the case with sleep apnea. This behavior is not indicative of seizure activity.

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child's mother says she has rubbed the edge of a coin on her child's oiled skin. The nurse should recognize this as what? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture

ANS: B This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the child's oiled skin. The mother is attempting to rid the child's body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline.

In terms of fine motor development, what should the 3-year-old child be expected to do? a. Tie shoelaces. b. Copy (draw) a circle. c. Use scissors or a pencil very well. d. Draw a person with seven to nine parts.

ANS: B Three-year-old children are able to accomplish the fine motor skill of copying (drawing) a circle. The ability to tie shoelaces, to use scissors or a pencil very well, and to draw a person with seven to nine parts are fine motor skills of 5-year-old children.

Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. What is the most appropriate recommendation for the nurse to make? a. Punish the children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Get counseling for this unusual and dangerous behavior. d. Allow the children unrestricted permission to satisfy this curiosity.

ANS: B Three-year-old children become aware of anatomic differences and are concerned about how the other sex "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. This is age appropriate and not dangerous behavior. Encouraging the children to ask their parents questions and redirecting their activity is more appropriate than giving permission.

The nurse understands that which guideline should be followed to determine serving sizes for toddlers? a. 1/2 tbsp of solid food per year of age b. 1 tbsp of solid food per year of age c. 2 tbsp of solid food per year of age d. 2 1/2 tbsp of solid food per year of age

ANS: B To determine serving sizes for young children, the guideline to follow is 1 tbsp of solid food per year of age. One-half tbsp per year of age would not be adequate. Two or 2 1/2 tbsp per year of age would be excessive.

The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache. Which statement by the parents indicates understanding the teaching? a. "We will allow the child to miss school if a headache occurs." b. "We will respond matter-of-factly to requests for special attention." c. "We will be sure to give much attention to our child when a headache occurs." d. "We will be sure our child doesn't have to perform at a band concert if a headache occurs."

ANS: B To modify behavior patterns that increase the risk of headache or reinforce headache activity, the nurse instructs the parents to avoid giving excessive attention to their child's headache and to respond matter-of-factly to pain behavior and requests for special attention. Parents learn to assess whether the child is avoiding school or social performance demands because of headache.

A nurse must do a venipuncture on a 6-year-old child. What consideration is important in providing atraumatic care? a. Use an 18-gauge needle if possible. b. Show the child the equipment to be used before the procedure. c. If not successful after four attempts, have another nurse try. d. Restrain the child completely.

ANS: B To provide atraumatic care the child should be able to see the equipment to be used before the procedure begins. Use the smallest gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Restrain the child only as needed to perform the procedure safely; use therapeutic hugging.

At which age should a nurse keep teaching time short (5 minutes)? a. Infant b. Toddler c. Preschool d. School age

ANS: B Toddlers have limited time concept, and teaching time should be kept short (5-10 minutes).

The mother of a 6-month-old infant has returned to work and is expressing breast milk to be frozen. She asks for directions on how to safely thaw the breast milk in the microwave. What should the nurse recommend? a. Heat only 10 oz or more. b. Do not thaw or heat breast milk in a microwave oven. c. Always leave the bottle top uncovered to allow heat to escape. d. Shake the bottle vigorously for at least 30 seconds after heating.

ANS: B Using a microwave oven to thaw or heat breast milk decreases the anti-infective properties of the breast milk, lowers the vitamin C content, and changes the fat content. Breast milk should be thawed overnight in a refrigerator or in a warm water bath. A microwave should not be used. If steam is created, the milk is too hot. The bottle should be inverted several times after defrosting or warming.

Which is considered a block to effective communication? a. Using silence b. Using clichés c. Directing the focus d. Defining the problem

ANS: B Using stereotyped comments or clichés can block effective communication. After the nurse uses such trite phrases, parents often do not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximum freedom of expression. By using open-ended questions and guiding questions, the nurse can obtain the necessary information and maintain a relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention.

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.

ANS: B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing him- or herself by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

When teaching injury prevention during the school-age years, what should the nurse include? a. Teach children about the need to fear strangers. b. Teach basic rules of water safety. c. Avoid letting children cook in microwave ovens. d. Caution children against engaging in competitive sports.

ANS: B Water safety instruction is an important component of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check sufficient water depth for diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes telling the child not to go with strangers, not to wear personalized clothing in public places, to tell parents if anyone makes child feel uncomfortable, and to say no in uncomfortable situations. Teach the child safe cooking. Caution against engaging in dangerous sports such as jumping on trampolines.

What is an approximate method of estimating output for a child who is not toilet trained? a. Have parents estimate output. b. Weigh diapers after each void. c. Place a urine collection device on the child. d. Have the child sit on a potty chair 30 minutes after eating.

ANS: B Weighing diapers will provide an estimate of urinary output. Each 1 g of weight is equivalent to 1 ml of urine. Having parents estimate output would be inaccurate. It is difficult to estimate how much fluid is in a diaper. The urine collection device would irritate the child's skin. It would be difficult for a toddler who is not toilet trained to sit on a potty chair 30 minutes after eating.

What is the nursing action related to the applying of biologic or synthetic skin coverings for a child with partial-thickness burns of both legs? a. Splint the legs to prevent movement. b. Observe wounds for signs of infection. c. Monitor closely for manifestations of shock. d. Examine dressings for indications of bleeding.

ANS: B When applied early to a superficial partial-thickness injury, biologic dressings stimulate epithelial growth and faster wound healing. If the dressing covers areas of heavy microbial contamination, infection occurs beneath the dressing. In the case of partial-thickness burns, such infection may convert the wound to a full-thickness injury. Infection is the primary concern when biologic dressings are used.

A toddler is in the sensorimotor, tertiary circular reactions stage of cognitive development. What behavior should the nurse expect to assess? (Select all that apply.) a. Refers to self by pronoun b. Gestures "up" and "down" c. Able to insert round object into a hole d. Can find hidden objects but only in the first location e. Uses future-oriented words, such as "tomorrow"

ANS: B, C, D Children in the sensorimotor, tertiary circular reactions stage of cognitive development show the behaviors of gesturing "up" and "down," have the ability to insert round objects into a hole, and can find hidden objects but only in the first location. The behaviors of referring to oneself by pronoun and using future-oriented words such as "tomorrow" are seen in the preoperational stage of cognitive development.

What clinical manifestations should be observed in a 2-year-old child with hypotonic dehydration? (Select all that apply.) a. Thick, doughy feel to the skin b. Slightly moist mucous membranes c. Absent tears d. Very rapid pulse e. Hyperirritability

ANS: B, C, D Clinical manifestations of hypotonic dehydration include slightly moist mucous membranes, absent tears, and a very rapid pulse. A thick, doughy feel to the skin and hyperirritability are signs of hypertonic dehydration.

The clinic nurse is assessing a 6-month-old infant during a well-child appointment. The nurse should use which approaches to alleviate the infant's stranger anxiety? (Select all that apply.) a. Talk in a loud voice. b. Meet the infant at eye level. c. Avoid sudden intrusive gestures. d. Maintain a safe distance initially. e. Pick up the infant and hold him or her closely.

ANS: B, C, D The best approaches for the nurse to alleviate the infant's stranger anxiety are to talk softly; meet the infant at eye level (to appear smaller); maintain a safe distance from the infant; and avoid sudden, intrusive gestures, such as holding out the arms and smiling broadly. Talking in a loud voice and picking the infant up would increase the infant's anxiety.

What are sources of stress in preschoolers? (Select all that apply.) a. Shares possessions b. Damages or destroys objects c. May fear dogs or other animals d. Seems to be in perpetual motion e. May stutter or stumble over words

ANS: B, C, D, E Sources of stress in preschoolers include damaging or destroying objects, fearing dogs or other animals, in perpetual motion, and may stutter or stumble over words. Guarding possessions, not sharing, is a source of stress.

The school nurse is explaining to older school children that obesity increases the risk for which disorders? (Select all that apply.) a. Asthma b. Hypertension c. Dyslipidemia d. Irritable bowel disease e. Altered glucose metabolism

ANS: B, C, E Overweight youth have increased risk for a cluster of cardiovascular factors that include hypertension, altered glucose metabolism, and dyslipidemia. Irritable bowel disease and asthma are not linked to obesity.

The nurse is caring for a child with hypercalcemia. The nurse evaluates the child for which signs and symptoms of hypercalcemia? (Select all that apply.) a. Tetany b. Anorexia c. Constipation d. Laryngospasm e. Muscle hypotonicity

ANS: B, C, E Signs and symptoms of hypercalcemia are anorexia, constipation, and muscle hypotonicity. Tetany and laryngospasm are signs of hypocalcemia.

The nurse is teaching a group of parents at a community education program about introducing solid foods to their infants. Which recommendations should the nurse include? (Select all that apply.) a. Spoon feeding should be introduced after an entire milk feeding. b. It is best to introduce a wide variety of foods during the first year. c. As solid food consumption increases, the quantity of milk should decrease. d. Introduction of low-calorie milk and food should be done by the end of the first year. e. Introduction of citrus fruits, meats, and eggs should be delayed until after 6 months of age. f. Each new food item should be introduced at 5- to 7-day intervals.

ANS: B, C, E, F Teaching related to feeding an infant solid foods should include introducing a wide variety of foods because an infant has not developed a strong food preference as seen with a toddler. As solid food consumption increases, the amount of milk consumed should decrease to less than 1 L/day to prevent overfeeding. Introduction to citrus fruits, meats, and eggs should be delayed until after 6 months of age because of the potential to cause food allergies. New foods should be introduced at 5- to 7-day intervals to evaluate for food allergies. Spoon feedings should be introduced after a small ingestion of milk, not at the end of a milk feeding, to associate the activity with pleasure. In general, low-calorie milk and food should be avoided.

What are characteristics of dating relationships in early adolescence? (Select all that apply.) a. One-on-one dating b. Follow ritualized "scripts" c. Are psychosocially intimate d. Involve playing stereotypic roles e. Participating in mixed-gender group activities

ANS: B, D, E Early dating relationships typically follow highly ritualized "scripts" in which adolescents are more likely to play stereotypic roles than to really be themselves. Participating in mixed-gender group activities, such as going to parties or other events, may have a positive impact on young teenagers' well-being. One-on-one dating during early adolescence, however, with a lot of time spent alone, may lead to sexual intimacy before a teen is ready. Although teenagers may begin dating during early adolescence, these early dating relationships are not usually psychosocially intimate.

The nurse is caring for a child with hypokalemia. The nurse evaluates the child for which signs and symptoms of hypokalemia? (Select all that apply.) a. Twitching b. Hypotension c. Hyperreflexia d. Muscle weakness e. Cardiac arrhythmias

ANS: B, D, E Signs and symptoms of hypokalemia are hypotension, muscle weakness, and cardiac arrhythmias. Twitching and hyperreflexia are signs of hyperkalemia.

The nurse is caring for children on an adolescent-only unit. What growth and development milestones should the nurse expect from 11- and 14-year-old adolescents? (Select all that apply.) a. Self-centered with increased narcissism b. No major conflicts with parents c. Established abstract thought process d. Have a rich, idealistic fantasy life e. Highly value conformity to group norms f. Secondary sexual characteristics appear

ANS: B, E, F Growth and development milestones in the 11- to 14-year-old age group include minimal conflicts with parents (compared with the 15- to 17-year-old age group), a high value placed on conformity to the norm, and the appearance of secondary sexual characteristics. Self-centeredness and narcissism are seen in the 15- to 17-year-old age group along with a rich and idealistic fantasy life. Abstract thought processes are not well established until the 18- to 20-year-old age group.

A 17-month-old child should be expected to be in which stage, according to Piaget? a. Preoperations b. Concrete operations c. Tertiary circular reactions d. Secondary circular reactions

ANS: C A 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Concrete operations is the cognitive stage associated with school-age children. The secondary circular reaction stage lasts from about ages 4 to 8 months.

During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boy's birthday is close to the cut-off date, and he has not attended preschool. What is the nurse's best recommendation? a. Start kindergarten. b. Talk to other parents about readiness. c. Perform a developmental screening. d. Postpone kindergarten and go to preschool.

ANS: C A developmental assessment with a screening tool that addresses cognitive, social, and physical milestones can help identify children who may need further assessment. A readiness assessment involves an evaluation of skill acquisition. Stating the child should start kindergarten or go to preschool and postpone kindergarten does not address the father's concerns about readiness for school. Talking to other parents about readiness does not ascertain if the child is ready and does not address the father's concerns.

When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet is which? a. Lacking in protein b. Indicating they live in poverty c. Providing sufficient amino acids d. Needing enrichment with meat and milk

ANS: C A diet that contains vegetables, legumes, and starches may provide sufficient essential amino acids even though the actual amount of meat or dairy protein is low. Combinations of foods contain the essential amino acids necessary for growth. Many cultures use diets that contain this combination of foods. It is not indicative of poverty. A dietary assessment should be done, but many vegetarian diets are sufficient for growth.

The practitioner has ordered a liquid oral antibiotic for a toddler with otitis media. The prescription reads 1 1/2 tsp four times per day. What should the nurse consider in teaching the mother how to give the medicine? a. A measuring spoon should be used, and the medication must be given every 6 hours. b. The mother is not able to handle this regimen. Long-acting intramuscular antibiotics should be administered. c. A hollow-handled medication spoon is advisable, and the medication should be equally spaced while the child is awake. d. A household teaspoon should be used and the medicine given when the child wakes up, around lunch time, at dinner time, and before bed.

ANS: C A hollow-handled medication spoon allows the mother to measure the correct amount of medication. The order is written for four times a day; every 6 hours dosing is not necessary. There is no indication that the mother is not able to adhere to the medication regimen. She is asking for clarification so she can properly care for her child. Long-acting intramuscular antibiotics are not indicated. Household teaspoons vary greatly and should not be used.

When auscultating an infant's lungs, the nurse detects diminished breath sounds. What should the nurse interpret this as? a. Suggestive of chronic pulmonary disease b. Suggestive of impending respiratory failure c. An abnormal finding warranting investigation d. A normal finding in infants younger than 1 year of age

ANS: C Absent or diminished breath sounds are always an abnormal finding. Fluid, air, or solid masses in the pleural space all interfere with the conduction of breath sounds. Further data are necessary for diagnosis of chronic pulmonary disease or impending respiratory failure. Diminished breath sounds in certain segments of the lungs can alert the nurse to pulmonary areas that may benefit from chest physiotherapy. Further evaluation is needed in all age groups.

The nurse is talking to the parent of a 5-year-old child who refuses to go to sleep at night. What intervention should the nurse suggest in helping the parent to cope with this sleep disturbance? a. Establish a consistent punishment if the child does not go to bed when told. b. Allow the child to fall asleep in a different room and then gently move the child to his or her bed. c. Establish limited rituals that signal readiness for bedtime. d. Allow the child to watch television until almost asleep.

ANS: C An appropriate intervention for a child who resists going to bed is to establish limited rituals such as a bath or story that signal readiness for bed and consistently follow through with the ritual. Punishing the child will not alleviate the resistance problem and may only add to the frustration. Allowing the child to fall asleep in a different room and to watch television to fall asleep are not recommended approaches to sleep resistance.

Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Extended d. Binuclear

ANS: C An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." Which is the nurse's most appropriate answer? a. "I'm sure he'll be fine if you get a good babysitter." b. "You will need to stay home until Eric starts school." c. "Let's talk about the child care options that will be best for Eric." d. "You should go back to work so Eric will get used to being with others."

ANS: C Asking the mother about child care options is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. The other three answers are directive; they do not address the effect that her working will have on Eric.

During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner? a. Respond to name. b. React to loud noise with Moro reflex. c. Turn his or her head to side when sound is at ear level. d. Locate sound by turning his or her head in a curving arc.

ANS: C At 2 months of age, an infant should turn his or her head to the side when a noise is made at ear level. At birth, infants respond to sound with a startle or Moro reflex. An infant responds to his or her name and locates sounds by turning his or her head in a curving arc at age 6 to 9 months.

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, what should the nurse do? a. Set up a tray with equipment the same size as for adults. b. Apply EMLA to the puncture site 15 minutes before the procedure. c. Prepare the child for conscious sedation being used for the procedure. d. Reassure the parents that the test is simple, painless, and risk free.

ANS: C Because of the urgency of the child's condition, conscious sedation should be used for the procedure. Pediatric spinal trays have smaller needles than do adult trays. EMLA should be applied approximately 60 minutes before the procedure; the emergency nature of the spinal tap precludes its use. A spinal tap is not a simple procedure and does have associated risks; analgesia will be given for the pain.

At which age do most infants begin to fear strangers? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to infants' ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to their mothers. The infant at age 4 months is beginning the process of separation-individuation, which involves recognizing the self and mother as separate beings. Twelve months is too late; the infant requires referral for evaluation if he or she does not fear strangers by this age.

A female school-age child asks the school nurse, "How many pounds should I expect to gain in a year?" The nurse should give which response? a. "You will gain about 2.4 to 4.6 lb per year" b. "You will gain about 3.4 to 5.6 lb per year." c. "You will gain about 4.4 to 6.6 lb per year." d. "You will gain about 5.5 to 7.6 lb per year."

ANS: C Between the ages of 6 and 12 years, children will almost double in weight, increasing 2 to 3 kg (4.4 to 6.6 lb) per year.

What statement accurately describes physical development during the school-age years? a. The child's weight almost triples. b. Muscles become functionally mature. c. Boys and girls double strength and physical capabilities. d. Fat gradually increases, which contributes to children's heavier appearance.

ANS: C Boys and girls double both strength and physical capabilities. Their consistent refinement in coordination increases their poise and skill. 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/yr and gain 3 kg/yr. Their weight will almost double. Although the strength increases, muscles are still functionally immature when compared with those of adolescents. This age group is more easily injured by overuse. Children take on a slimmer look with longer legs in middle childhood.

A 7-year-old is identified as being at risk for skin breakdown. What intervention should the nursing care plan include? a. Massaging reddened bony prominences b. Teaching the parents to turn the child every 4 hours c. Ensuring that nutritional intake meets requirements d. Minimizing use of extra linens, which can irritate the child's skin

ANS: C Children who are hospitalized and NPO (taking nothing by mouth) for several days are at risk for nutritional deficiencies and skin breakdown. If NPO status is prolonged, parenteral nutrition should be considered. Massaging bony prominences can cause deep tissue damage. This should be avoided. Although parents can participate, turning the child is the nurse's responsibility. If the child is alert and can move, position shifts should be done more frequently. If the child does not move, the nurse should reposition every 2 hours. The number of linens is not an issue. The child should not be dragged across the sheet. Children should be lifted and moved to avoid friction and shearing.

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child's mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which intervention? a. Bring the child to the hospital for intravenous fluids. b. Alternate giving ORS and carbonated drinks. c. Continue to give ORS frequently in small amounts. d. Keep child NPO (nothing by mouth) for 8 hours and resume ORS if vomiting has subsided.

ANS: C Children who are vomiting should be given ORS at frequent intervals and in small amounts. Intravenous fluids are not indicated for mild dehydration. Carbonated beverages are high in carbohydrates and are not recommended for the treatment of diarrhea and vomiting. The child is not kept NPO because this would cause additional fluid losses.

With the National Center for Health Statistics criteria, which body mass index (BMI)-for-age percentiles should indicate the patient is at risk for being overweight? a. 10th percentile b. 75th percentile c. 85th percentile d. 95th percentile

ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits.

Physiologically, the child compensates for fluid volume losses by which mechanism? a. Inhibition of aldosterone secretion b. Hemoconcentration to reduce cardiac workload c. Fluid shift from interstitial space to intravascular space d. Vasodilation of peripheral arterioles to increase perfusion

ANS: C Compensatory mechanisms attempt to maintain fluid volume. Initially, interstitial fluid moves into the intravascular compartment to maintain blood volume. Aldosterone is released to promote sodium retention and conserve water in the kidneys. Hemoconcentration results from the fluid volume loss. With less circulating volume, tachycardia results. Vasoconstriction of peripheral arterioles occurs to help maintain blood pressure

What is a significant common side effect that occurs with opioid administration? a. Euphoria b. Diuresis c. Constipation d. Allergic reactions

ANS: 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.

What sign is one of the first to indicate overwhelming sepsis in a child with burn injuries? a. Seizures b. Bradycardia c. Disorientation d. Decreased blood pressure

ANS: C Disorientation in the burn patient is one of the first signs of overwhelming sepsis and may indicate inadequate hydration. Seizures, bradycardia, and decreased blood pressure are not initial manifestations of overwhelming sepsis.

After the acute stage and during the healing process, what is the primary complication from burn injury? a. Shock b. Asphyxia c. Infection d. Renal shutdown

ANS: C During the healing phase, local infection or sepsis is the primary complication. Respiratory problems, primarily airway compromise, and shock are the primary complications during the acute stage of burn injury. Renal shutdown is not a complication of the burn injury but may be a result of the profound shock.

What statement best describes fear in school-age children? a. Increasing concerns about bodily safety overwhelm them. b. They should be encouraged to hide their fears to prevent ridicule by peers. c. Most of the new fears that trouble them are related to school and family. d. Children with numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: C During the school-age years, children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. Parents and other persons involved with children should discuss children's fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding the fears does not end them and may lead to phobias.

Although a 14-month-old girl received a shock from an electrical outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of toddlers' inability to transfer remembering to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. This is typical behavior for a toddler, who is only somewhat aware of a causal relation between events. Her cognitive development is appropriate for her age

Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society? a. Race b. Culture c. Ethnicity d. Superiority

ANS: C Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity.

The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia? a. Hypertension b. Pain at the entry site c. Fever and general malaise d. Redness and swelling at the entry site

ANS: C Fever, chills, general malaise, and an ill appearance can be signs of bacteremia and require immediate intervention. Hypotension would be indicative of sepsis and possible impending cardiovascular collapse. Pain, redness, and swelling at the entry site indicate local infection.

The parent of 2-week-old infant asks the nurse if fluoride supplements are necessary because the infant is exclusively breastfed. What is the nurse's best response? a. "The infant needs to begin taking them now." b. "Supplements are not needed if you drink fluoridated water." c. "The infant may need to begin taking them at age 6 months." d. "The infant can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. Supplementation is not recommended before age 6 months regardless of whether the mother drinks fluoridated water. Infant cereal is not recommended at 2 weeks of age.

A child is in the intensive care unit after a motor vehicle collision. The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning care, the nurse recognizes that the indicated action is which? a. Give only an opioid analgesic at this time. b. Increase 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.

ANS: C For severe postoperative pain, a preventive around the clock (ATC) schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present, but it 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. Using a clock is counterproductive because it focuses the child's attention on how long he or she will need to wait for pain relief.

What is the required number of milliliters of fluid needed per day for a 14-kg child? a. 800 b. 1000 c. 1200 d. 1400

ANS: C For the first 10 kg of body weight, a child requires 100 ml/kg. For each additional kilogram of body weight, an extra 50 ml is needed. 10 kg ´ 100 ml/kg/day = 1000 ml 4 kg ´ 50 ml/kg/day = 200 ml 1000 ml + 200 ml = 1200 ml/day Eight hundred to 1000 ml is too little; 1400 ml is too much.

What organism is a parasite that causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C G. lamblia is a parasite that represents 10% of nondysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What should the nurse recommend? a. Heat only 8 oz or more. b. Do not heat a plastic bottle in a microwave oven. c. Leave the bottle top uncovered to allow heat to escape. d. Shake the bottle vigorously for at least 30 seconds after heating.

ANS: C If a microwave is being used, the bottle should be left uncovered. This will allow heat to escape. No more than 4 oz should be heated at any one time. Bottles can be heated safely in microwave ovens if safety guidelines are followed. The bottle should be inverted 10 times; vigorous shaking is not necessary.

The nurse is planning to counsel family members as a group to assess the family's group dynamics. Which theoretic family model is the nurse using as a framework? a. Feminist theory b. Family stress theory c. Family systems theory d. Developmental theory

ANS: C In family systems theory, the family is viewed as a system that continually interacts with its members and the environment. The emphasis is on the interaction between the members; a change in one family member creates a change in other members, which in turn results in a new change in the original member. Assessing the family's group dynamics is an example of using this theory as a framework. Family stress theory explains how families react to stressful events and suggests factors that promote adaptation to stress. Developmental theory addresses family change over time using Duvall's family life cycle stages based on the predictable changes in the family's structure, function, and roles, with the age of the oldest child as the marker for stage transition. Feminist theories assume that privilege and power are inequitably distributed based upon gender, race, and class.

In girls, what is the initial indication of puberty? a. Menarche b. Growth spurt c. Breast development d. Growth of pubic hair

ANS: C In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sexual characteristic development in girls is breast changes, a rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation (menarche), and abrupt deceleration of linear growth.

According to Piaget, a 6-month-old infant should be in which developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes stage is primarily during the first month of life. The primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. The fourth sensorimotor stage is coordination of secondary schemata, which occurs at ages 9 to 12 months. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

An infant weighed 8 lb at birth and was 18 inches in length. What weight and length should the infant be at 5 months of age? a. 12 lb, 20 inches b. 14 lb, 21.5 inches c. 16 lb, 23 inches d. 18 lb, 24.5 inches

ANS: C Infants gain 680 g (1.5 lb) per month until age 5 months, when the birth weight has at least doubled. Height increases by 2.5 cm (1 inch) per month during the first 6 months. Therefore, at 5 months the infant should weigh 16 lb and be 23 inches in length.

What is the purpose of a high-protein diet for a child with major burns? a. Promote growth b. Improve appetite c. Minimize protein breakdown d. Diminish risk of stress-induced hyperglycemia

ANS: C Initially after major burns, there is a hypometabolic phase, which lasts for 2 or 3 days. A hypermetabolic phase follows, characterized by increased body temperature, oxygen and glucose consumption, carbon dioxide production, glycogenolysis, proteolysis, and lipolysis. This response continues for up to 9 months. A diet high in protein and calories is necessary. Healing, not growth, is the primary consideration. Many children have poor appetites, and supplementation is necessary. Hypoglycemia, not hyperglycemia, can occur from the stress of burn injury because the liver glycogen stores are rapidly depleted.

The school nurse is teaching an adolescent about social networking and texting on phones. What statement by the adolescent indicates a need for further teaching? a. "Social networking can help me develop interpersonal skills." b. "I will have an opportunity to interact with people like myself." c. "My text messaging during class time in school will not cause any disruption." d. "I should be cautious, as the online environment can create opportunities for cyberbullying."

ANS: C Internet chatrooms and social networking sites have created a more public arena for trying out identities and developing interpersonal skills with a wider network of people, occasionally with anonymity. This can create opportunities for young people who have a limited access to friends (because of rural location, shyness, or rare chronic conditions) to interact with people like themselves. Both the online and text environment can create opportunities for cyberbullying, in which teens engage in insults, harassment, and publicly humiliating statements online or on cell phones. Text messaging and instant messaging via cell phones has become a common activity and can sometimes be disruptive during school. If the adolescent indicates it will not be disruptive, further teaching is needed.

A preschool child needs a dressing change. To prepare the child, what strategy should the nurse implement? a. Explain the procedure using medical terminology. b. Plan a 30-minute teaching session. c. Give choices when possible but avoid delay. d. Allow time after the procedure for questions and discussion.

ANS: C Involving children helps to gain their cooperation. Permitting choices gives them some measure of control. The other options would not be appropriate for a preschool child.

The nurse suspects fluid overload in an infant receiving intravenous fluids. What clinical manifestation is suggestive of water intoxication? a. Oliguria b. Weight loss c. Irritability and seizures d. Muscle weakness and cardiac dysrhythmias

ANS: C Irritability, somnolence, headache, vomiting, diarrhea, and generalized seizures are manifestations of water intoxication. Urinary output is increased as the child attempts to maintain fluid balance. Weight gain is usually associated with water intoxication. Muscle weakness and cardiac dysrhythmias are not associated with water intoxication.

Which heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1 and S2 b. S3 and S4 c. Murmur d. Physiologic splitting

ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 and S2 are normal heart sounds. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If it is heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

Several types of long-term central venous access devices are used. What is a benefit of using an implanted port (e.g., Port-a-Cath)? a. You do not need to pierce the skin for access. b. It is easy to use for self-administered infusions. c. The patient does not need to limit regular physical activity, including swimming. d. The catheter cannot dislodge from the port even if the child "plays" with the port site.

ANS: C No limitations on physical activity are needed. The child is able to participate in all regular physical activities, including bathing, showering, and swimming. The skin over the device is pierced with a Huber needle to access. Long-term central venous access devices are difficult to use for self-administration. The port is placed under the skin. If the child manipulates the device and plays with the actual port, the catheter can be dislodged.

The nurse is preparing to give acetaminophen (Tylenol) to a child who has a fever. What nursing action is appropriate? a. Retake the temperature in 15 minutes after giving the Tylenol. b. Place a warm blanket on the child so chilling does not occur. c. Check to be sure the Tylenol dose does not exceed 15 mg/kg. d. Use cold compresses instead of Tylenol to control the fever.

ANS: C Nurses must have an understanding of the safe dosages of medications they administer to children, as well as the expected actions, possible side effects, and signs of toxicity. The recommended doses of acetaminophen should never be exceeded.

What is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Stealing can occur because their sense of property rights is limited. c. Lying is used to meet expectations set by others that they have been unable to attain. d. Dishonesty results from the inability to distinguish between fact and fantasy.

ANS: C Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems. In this age group, children are able to distinguish between fact and fantasy.

A parent asks about whether a 7-year-old child is able to care for a dog. Based on the child's age, what does the nurse suggest? a. Caring for an animal requires more maturity than the average 7-year-old possesses. b. This will help the parent identify the child's weaknesses. c. A dog can help the child develop confidence and emotional health. d. Cats are better pets for school-age children.

ANS: C Pets have been observed to influence a child's self-esteem. They can have a positive effect on physical and emotional health and can teach children the importance of nurturing and nonverbal communication. Most 7-year-old children are capable of caring for a pet with supervision. Caring for a pet should be a positive experience. It should not be used to identify weaknesses. The pet chosen does not matter as much as the child's being responsible for a pet.

What is descriptive of the play of school-age children? a. They like to invent games, making up the rules as they go. b. Individuality in play is better tolerated than at earlier ages. c. Knowing the rules of a game gives an important sense of belonging. d. Team play helps children learn the universal importance of competition and winning.

ANS: C Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States but not in all cultures.

Parents are being taught how to feed their infant using a newly placed gastrostomy tube (G-tube). What is essential information for the parents to receive? a. Verify placement before each feeding. b. Use a syringe with a plunger to give the infant bolus feedings. c. Position the infant on the right side during and after the feeding. d. Beefy red tissue around the G-tube site must be reported to the practitioner.

ANS: C Positioning on the right side during and after feedings helps minimize the risk of aspiration. It is not necessary to verify placement before each feeing. G-tubes are inserted into the stomach and sutured in place. If the tube is through the skin, it is in the stomach. Feedings should be given by gravity flow. The plunger may be used to initiate the feeding, but then the formula should be allowed to flow. Beefy red tissue around the G-tube site is normal granulation tissue that is expected.

Using knowledge of child development, what approach is best when preparing a toddler for a procedure? a. Avoid asking the child to make choices. b. Plan for a teaching session to last about 20 minutes. c. Demonstrate on a doll how the procedure will be done. d. Show the necessary equipment without allowing child to handle it.

ANS: C Prepare toddlers for procedures by using play. Demonstrate on a doll but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure. In preparing a toddler for a procedure, the child is allowed to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it.

A 4-year-old child tells the nurse that she doesn't want another blood sample drawn because "I need all of my insides and I don't want anyone taking them out." What is the nurse's best interpretation of this? a. The child is being overly dramatic. b. The child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

ANS: C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at this age. She truly has fear. Body image is just developing in school-age children. Preschoolers do not have good understanding of their bodies.

The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. The child tells the nurse he does not want to lose his blood. What approach is best by the nurse? a. Explain that it will not be painful. b. Suggest to him that he not worry about losing just a little bit of blood. c. Discuss with him how his body is always in the process of making blood. d. Tell the child that he will not even need a Band-Aid afterward because it is a simple procedure.

ANS: C School-age children can understand that blood can be replaced. Explain the procedure to him using correct scientific and medical terminology. The venipuncture will be uncomfortable. It is inappropriate to tell him it will not hurt. Even though the nurse considers it a simple procedure, the boy is concerned. Telling him not to worry will not allay his fears.

What does the nurse understand about caloric needs for school-age children? a. The caloric needs for the school-age children are the same as for other age groups. b. The caloric needs for school-age children are more than they were in the preschool years. c. The caloric needs for school-age children are lower than they were in the preschool years. d. The caloric needs for school-age children are greater than they will be in the adolescent years.

ANS: C School-age children do not need to be fed as carefully, as promptly, or as frequently as before. Caloric needs are lower than they were in the preschool years and lower than they will be during the coming adolescent growth spurt.

What statement best describes the relationship school-age children have with their families? a. Ready to reject parental controls b. Desire to spend equal time with family and peers c. Need and want restrictions placed on their behavior by the family d. Peer group replaces the family as the primary influence in setting standards of behavior and rules

ANS: C School-age children need and want restrictions placed on their behavior, and they are not prepared to cope with all the problems of their expanding environment. Although increased independence is the goal of middle childhood, they feel more secure knowing that an authority figure can implement controls and restriction. In the middle school years, children prefer peer group activities to family activities and want to spend more time in the company of peers. Family values usually take precedence over peer value systems.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is which? a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child so that the child can then observe during the procedure. The nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety in asking how the blood pressure apparatus works, just requesting clarification of what will occur.

A 14-year-old adolescent is hospitalized with cystic fibrosis. What nursing note entry represents best documentation of his breakfast meal? a. Tolerated breakfast well b. Finished all of breakfast ordered c. One pancake, eggs, and 240 ml OJ d. No documentation is needed for this age child.

ANS: C Specific information is necessary for hospitalized children. It is essential to be able to identify caloric intake and eating patterns for assessment and intervention purposes. That he tolerated breakfast well only provides information that the child did not become ill with the meal. Even if he finished all his breakfast, an evaluation cannot be completed unless the quantity of food ordered is known. Nutritional information is essential, especially for children with chronic illnesses.

What dysfunctional speech pattern is a normal characteristic of the language development of a preschool child? a. Lisp b. Echolalia c. Stammering d. Repetition without meaning

ANS: C Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.

Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined? a. Ethnicity b. Racial variation c. Status d. Geographic boundaries

ANS: C Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Whereas racial grouping describes transmissible traits, culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined.

The nurse is teaching a group of female adolescents about toxic shock syndrome and the use of tampons. What statement by a participant indicates a need for additional teaching? a. "I can alternate using a tampon and a sanitary napkin." b. "I should wash my hands before inserting a tampon." c. "I can use a superabsorbent tampon for more than 6 hours." d. "I should call my health care provider if I suddenly develop a rash that looks like sunburn."

ANS: C Teaching female adolescents about the association between toxic shock syndrome and the use of tampons is important. The teaching should include not using superabsorbent tampons; not leaving the tampon in for longer than 4 to 6 hours; alternating the use of tampons with sanitary napkins; washing hands before inserting a tampon to decrease the chance of introducing pathogens; and informing a health care provider if a sudden high fever, vomiting, muscle pain, dizziness, or a rash that looks like a sunburn appears.

Which intervention is the most appropriate recommendation for relief of teething pain? a. Rub gums with aspirin to relieve inflammation. b. Apply hydrogen peroxide to gums to relieve irritation. c. Give the infant a frozen teething ring to relieve inflammation. d. Have the infant chew on a warm teething ring to encourage tooth eruption.

ANS: C Teething pain is a result of inflammation, and cold is soothing. A frozen teething ring or ice cube wrapped in a washcloth helps relieve the inflammation. Aspirin is contraindicated secondary to the risks of aspiration. Hydrogen peroxide does not have an anti-inflammatory effect. Warmth increases inflammation.

At what age is it safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving breast milk or iron-fortified commercial infant formula. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include? a. The child will continue to sleep and be pain free. b. Parents cannot administer additional medication with the button. c. The pump can deliver baseline and bolus dosages. d. There is a high risk of overdose, so monitoring is done every 15 minutes.

ANS: C The PCA prescription can be set for a basal rate for a continuous infusion of pain medication. Additional doses can be administered by the patient, parent, or nurse as necessary. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a 6-year-old child, the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button. Evidence-based practice 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.

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include? a. Send the child to his or her room if the child has one. b. A general rule for length of time is 1 hour per year of age. c. Select an area that is safe and nonstimulating, such as a hallway. d. If the child cries, refuses, or is more disruptive, try another approach.

ANS: C The area must be nonstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child's room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets.

A child has a central venous access device for intravenous (IV) fluid administration. A blood sample is needed for a complete blood count, hemogram, and electrolytes. What is the appropriate procedure to implement for this blood sample? a. Perform a new venipuncture to obtain the blood sample. b. Interrupt the IV fluid and withdraw the blood sample needed. c. Withdraw a blood sample equal to the amount of fluid in the device, discard, and then withdraw the sample needed. d. Flush the line and central venous device with saline and then aspirate the required amount of blood for the sample.

ANS: C The blood specimen obtained must reflect the appropriate hemodilution of the blood and electrolyte concentration. The nurse needs to withdraw the amount of fluid that is in the device and discard it. The next sample will come from the child's circulating blood. With a central venous device, the trauma of a separate venipuncture can be avoided. The blood sample will be diluted with either the IV fluid being administered or the saline.

The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse is aware that the new stepparent understands the teaching when which statement is made? a. "I am glad there will be no disruption in my lifestyle." b. "I don't think children really want to live in a two-parent home." c. "I realize there may be power conflicts bringing two households together." d. "I understand contact between grandparents should be kept to a minimum."

ANS: C The entry of a stepparent into a ready-made family requires adjustments for all family members. Power conflicts are expected, and flexibility, mutual support, and open communication are critical in successful relationships. So the statement that power conflicts are possible means teaching was understood. Some obstacles to the role adjustments and family problem solving include disruption of previous lifestyles and interaction patterns, complexity in the formation of new ones, and lack of social supports. Most children from divorced families want to live in a two-parent home. There should be continued contact with grandparents.

Which action should the nurse implement when taking an axillary temperature? a. Take the temperature through one layer of clothing. b. Add a degree to the result when recording the temperature. c. Place the tip of the thermometer under the arm in the center of the axilla. d. Hold the child's arm away from the body while taking the temperature.

ANS: C The thermometer tip should be placed under the arm in the center of the axilla and kept close to the skin, not clothing. The temperature should not be taken through any clothing. The child's arm should be pressed firmly against the side, not held away from the body. The temperature should be recorded without a degree added and designated as being taken by the axillary method.

Parents of a hospitalized toddler ask the nurse, "What is meant by family-centered care?" The nurse should respond with which statement? a. Family-centered care reduces the effect of cultural diversity on the family. b. Family-centered care encourages family dependence on the health care system. c. Family-centered care recognizes that the family is the constant in a child's life. d. Family-centered care avoids expecting families to be part of the decision-making process.

ANS: C The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child's life. The family should be enabled and empowered to work with the health care system and is expected to be part of the decision-making process. The nurse should also support the family's cultural diversity, not reduce its effect.

What is a strategy used to minimize scarring with burn injury in a child? a. Applying of drying agents on skin b. Use of loose-fitting garments over healing areas c. Limitation of period without pressure to areas of scarring d. Immobilization of extremities while healing is occurring

ANS: C Uniform pressure to the scar decreases the blood supply and forces the collagen into a more normal alignment. When pressure is removed, blood supply to the scar is immediately increased; therefore, periods without pressure should be brief to avoid nourishment of the hypertrophic tissue. Moisturizing agents are used with massage to help stretch tissue and prevent contractures. Compression garments, not loose-fitting garments, are indicated. Range of motion exercises are done to minimize contractures.

The nurse is testing an infant's visual acuity. By which age should the infant be able to fix on and follow a target? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months

ANS: C Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If an infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed.

What is the best method to verify the placement of a nasogastric tube before each use? a. Radiologic confirmation b. Auscultation of injected air c. Aspiration of stomach contents d. Verification of tape placement on tube

ANS: C Visual inspection and pH check of stomach contents is a reliable method of determining placement before each use. Radiologic examination should be obtained after initial placement but would be too cumbersome to do before each use. Auscultation is an unreliable method to confirm tube placement because of the similarity of sounds produced by air in the bronchus, esophagus, or pleural space. Verification of tape placement on the tube can be inaccurate if the tube has moved within the tape or become dislodged from the stomach.

The school nurse is presenting sexual information to a group of school-age girls. What approach should the nurse take when presenting the information? a. Put off answering questions. b. Give technical terms when giving the presentation. c. Treat sex as a normal part of growth and development. d. Plan to give the presentation with boys and girls together.

ANS: C When nurses present sexual information to children, they should treat sex as a normal part of growth and development. Nurses should answer questions honestly, matter-of-factly, and at the children's level of understanding. School-age children may be more comfortable when boys and girls are segregated for discussions.

Parents ask the nurse, "How should we deal with our toddler's regression since our new baby has come home?" The nurse should give the parents which response? a. "Introduce new areas of learning." b. "Use time-out as punishment when regression occurs." c. "Ignore the behavior and praise appropriate behavior." d. "Explain to the toddler that the behavior is not acceptable."

ANS: C When regression does occur, the best approach is to ignore it while praising existing patterns of appropriate behavior. It is advisable not to introduce new areas of learning when an additional crisis is present or expected, such as beginning toilet training shortly before a sibling is born or during a brief hospitalization. Time-out should not be used as a punishment, and the toddler does not have the cognitive ability to understand an explanation that the behavior is not acceptable.

The school nurse has been asked to begin teaching sex education in the fifth grade. What should the nurse recognize? a. Questions need to be discouraged in this setting. b. Most children in the fifth grade are too young for sex education. c. Sexuality is presented as a normal part of growth and development. d. Correct terminology should be reserved for children who are older.

ANS: C When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. They should be encouraged to ask questions. At 10 to 11 years old, fifth graders are not too young to speak about physiologic changes in their bodies. Preadolescents need precise and concrete information.

The nurse is explaining to an adolescent the rationale for administering a Tdap (tetanus, diphtheria, acellular pertussis) vaccine 3 years after the last Td (tetanus) booster. What should the nurse tell the adolescent? a. "It is time for a booster vaccine." b. "It is past the time for a booster vaccine." c. "This vaccine will provide pertussis immunity." d. "This vaccine will be the last booster you will need."

ANS: C When the Tdap is used as a booster dose, it may be administered earlier than the previous 5-year interval to provide adequate pertussis immunity (regardless of interval from the last Td dose). It is not time or past time for a booster because they are required every 5 years. Another booster will be needed in 5 years, so it is not the last dose.

The nurse is caring for a non-English-speaking child and family. Which should the nurse consider when using an interpreter? a. Pose several questions at a time. b. Use medical jargon when possible. c. Communicate directly with family members when asking questions. d. Carry on some communication in English with the interpreter about the family's needs.

ANS: C When using an interpreter, the nurse should communicate directly with family members when asking questions to reinforce interest in them and to observe nonverbal expressions. Questions should be posed one at a time to elicit only one answer at a time. Medical jargon should be avoided whenever possible. The nurse should avoid discussing the family's needs with the interpreter in English because some family members may understand some English.

The nurse is preparing to obtain a nasal washing from a child. What equipment should the nurse gather for the procedure? (Select all that apply.) a. Sterile water b. A sterile swab c. Syringe with tubing d. Sterile normal saline e. Tracheal suction catheter

ANS: C, D Nasal washings may be obtained to identify viral pathogens and guide therapy in some respiratory conditions. The child is placed supine, and 1 to 3 ml of sterile normal saline is instilled with a sterile syringe (without a needle) into one nostril. The contents are aspirated with a syringe with 5 cm (2 inches) of 18- to 20-gauge tubing. The saline is quickly instilled and then aspirated to recover the nasal specimen. A tracheal suction catheter would not trap the mucus. Normal saline is used, not sterile water. A sterile swab is used for a throat culture, not for nasal washings.

The nurse is teaching a parent of an 18-month-old about developmental milestones associated with feeding. What should the nurse include in the teaching? (Select all that apply.) a. The child will begin to use a fork. b. The child will be able use a straw and cup. c. The child will be able to hold a cup with both hands. d. The child will be able to drink from a cup with a lid. e. The child will begin to use a spoon but may turn it before reaching the mouth.

ANS: C, D, E An 18-month-old child can hold a cup with both hands, is able to drink from a cup with a lid, and begins to use a spoon but may turn it before reaching the mouth. Using a fork is a developmental milestone of a 36-month-old child. Using a straw and cup is a milestone seen at 24 months.

The nurse understands that traits of gifted children include what? (Select all that apply.) a. Fair memory skills b. Limited sense of humor c. Perfectionism as a focus d. Inquisitive; always asking questions e. Displays intense feelings and emotion

ANS: C, D, E Characteristics of gifted children include perfectionism as a focus; inquisitive, always asking questions; and displaying intense feelings and emotion. Memory skills are pronounced, and humor is exceptional.

A child receiving chemotherapy is experiencing mucositis. Which prescriptions should the nurse plan to administer for initial treatment? (Select all that apply.) a. Scope mouth rinse b. Listerine antiseptic mouth rinse c. Carafate suspension (Sucralfate) d. Nystatin oral suspension (Nystatin) e. Lidocaine viscous (Lidocaine hydrochloride solution)

ANS: C, D, E Initial treatment of stomatitis includes single agents (sucralfate suspension, nystatin, and viscous lidocaine). Scope and Listerine are plaque and gingivitis control mouth rinses that would have a drying effect and are not used with mucositis.

The nurse is teaching parents of a 4-year-old child about fine motor developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Can lace shoes b. Uses scissors successfully c. Builds a tower of nine or 10 cubes d. Builds a bridge with three cubes e. Adeptly places small pellets in a narrow-necked bottle

ANS: C, D, E The fine motor milestones of a 4-year-old child include building a tower of nine or 10 cubes, building a bridge with three cubes, and adeptly placing small pellets in a narrow-necked bottle. Lacing shoes and using scissors successfully are fine motor milestones seen at the age of 5 years.

The nurse is using the CRIES pain assessment tool on a preterm infant in the neonatal intensive care unit. Which are the components of this tool? (Select all that apply.) a. Color b. Moro reflex c. Oxygen saturation d. Posture of arms and legs e. Sleeplessness f. Facial expression

ANS: C, E, F Need for increased oxygen, crying, increased vital signs, expression, and sleeplessness are components of the CRIES pain assessment tool used with neonates. Color, Moro reflex, and posture of arms and legs are not components of the CRIES scale.

The nurse is developing a teaching pamphlet for parents of school-age children. What anticipatory guidelines should the nurse include in the pamphlet? a. At age 6 years, parents should be certain that the child is reading independently with books provided by school. b. At age 8 years, parents should expect a decrease in involvement with peers and outside activities. c. At age 10 years, parents should expect a decrease in admiration of the parents with little interest in parent-child activities. d. At age 12 years, parents should be certain that the child's sex education is adequate with accurate information.

ANS: D A 12-year-old child should have been introduced to sex education, and parents should be certain that the information is adequate and accurate and that the child is not embarrassed to talk about sexual feelings or other aspects of sex education. At age 6 years, a child does not need to be reading independently and usually still needs help with reading and enjoys being read to. At 8 years of age, parents should expect their child to show increased involvement with peers and outside activities and should encourage this behavior. A 10-year-old child exhibits increased feelings of admiration of parents, especially fathers, and parent-child activities should be encouraged.

At a seminar for parents with preschool-age children, the nurse has discussed anticipatory tasks during the preschool years. Which statement by a parent should indicate a correct understanding of the teaching? a. "I should be worried if my 4-year-old child has an increase in sexual curiosity because this is a sign of sexual abuse." b. "I should expect my 5-year-old to change from a tranquil child to an aggressive child when school starts." c. "I should be concerned if my 4-year-old child starts telling exaggerated stories and has an imaginary playmate, since these could be signs of stress." d. "I should expect my 3-year-old child to have a more stable appetite and an increase in food selections."

ANS: D A 3-year-old child exhibits a more stable appetite than during the toddler years and is more willing to try different foods. A 4-year-old child is imaginative and indulges in telling "tall tales" and may have an imaginary playmate; these are normal findings, not signs of stress. Also a 4-year-old child has an increasing curiosity in sexuality, which is not a sign of child abuse. A 5-year-old child is usually tranquil, not aggressive like a 4-year-old child.

The nurse needs to take the blood pressure of a preschool boy for the first time. What action would be best in gaining his cooperation? a. Tell him that this procedure will help him get well faster. b. Take his blood pressure when a parent is there to comfort him. c. Explain to him how the blood flows through the arm and why the blood pressure is important. d. Permit him to handle the equipment and see the cuff inflate and deflate before putting the cuff in place.

ANS: D A preschooler is at the stage of preoperational thought. The nurse needs to explain the procedure in simple terms and allow the child to see how the equipment works. This will help allay fears of bodily harm. Blood pressure measurement is used for assessment, not therapy, and will not help him get well faster. Although the parent will be able to support the child, he may still be uncooperative. Also, the assessment of blood pressure may be needed before the parent is available. Explaining to a preschooler how the blood flows through the artery and why the blood pressure is important is too complex.

What substance is released from the posterior pituitary gland and promotes water retention in the renal system? a. Renin b. Aldosterone c. Angiotensin d. Antidiuretic hormone (ADH)

ANS: D ADH is released in response to increased osmolality and decreased volume of intravascular fluid; it promotes water retention in the renal system by increasing the permeability of renal tubules to water. Renin release is stimulated by diminished blood flow to the kidneys. Aldosterone is secreted by the adrenal cortex. It enhances sodium reabsorption in renal tubules, promoting osmotic reabsorption of water. Renin reacts with a plasma globulin to generate angiotensin, which is a powerful vasoconstrictor. Angiotensin also stimulates the release of aldosterone.

Which is an accurate description of homosexual (or gay-lesbian) families? a. A nurturing environment is lacking. b. The children become homosexual like their parents. c. The stability needed to raise healthy children is lacking. d. The quality of parenting is equivalent to that of nongay parents.

ANS: D Although gay or lesbian families may be different from heterosexual families, the environment can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the parents and family, not the type of family. There is little evidence to support that children become homosexual like their parents.

Which characteristic best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily

ANS: D At age 5 months, the infant should be able to voluntarily grasp an object. The grasp reflex is present in the first 2 to 3 months of life. Gradually, the reflex becomes voluntary. The neat pincer grasp is not achieved until age 11 months. At age 12 months, an infant will attempt to build a tower of two cubes but will most likely be unsuccessful.

What characteristic best describes the language skills of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe an object according to its composition d. Talks incessantly regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3-year-old children are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old child asks lots of questions and can follow simple directional commands. A 6-year-old child can describe an object according to its composition.

The nurse is teaching parents about expected language development for their 6-month-old infant. The nurse recognizes the parents understand the teaching if they make which statement? a. "Our baby should comprehend the word 'no.'" b. "Our baby knows the meaning of saying 'mama.'" c. "Our baby should be able to say three to five words." d. "Our baby should begin to combine syllables, such as 'dada.'"

ANS: D By 6 months, infants imitate sounds; add the consonants t, d, and w; and combine syllables (e.g., "dada"), but they do not ascribe meaning to the word until 10 to 11 months of age. By 9 to 10 months, they comprehend the meaning of the word "no" and obey simple commands accompanied by gestures. By age 1 year, they can say three to five words with meaning and may understand as many as 100 words.

According to Piaget, adolescents tend to be in what stage of cognitive development? a. Concrete operations b. Conventional thought c. Postconventional thought d. Formal operational thought

ANS: D Cognitive thinking culminates in the capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. Concrete operations usually occur between ages 7 and 11 years. Conventional and postconventional thought refers to Kohlberg's stages of moral development.

What is true concerning the development of autonomy during adolescence? a. Development of autonomy typically involves rebellion. b. Development of autonomy typically involves parent-child conflicts. c. Parent and peer influences are opposing forces in the development of autonomy. d. Conformity to both parents and peers gradually declines toward the end of adolescence.

ANS: D During middle and late adolescence, the conformity to parents and peers declines. Subjective feelings of self-reliance increase steadily over the adolescent years. Adolescents have genuine behavioral autonomy. Rebellion is not typically part of adolescence. It can occur in response to excessively controlling circumstances or to growing up in the absence of clear standards. Parent and peer relationships can play complementary roles in the development of a healthy degree of individual independence.

What type of diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents? a. Osmotic b. Secretory c. Cytotoxic d. Dysenteric

ANS: D Dysenteric diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents such as Campylobacter, Salmonella, or Shigella organisms. Edema, mucosal bleeding, and leukocyte infiltration occur. Osmotic diarrhea occurs when the intestine cannot absorb nutrients or electrolytes. It is commonly seen in malabsorption syndromes such as lactose intolerance. Secretory diarrhea is usually a result of bacterial enterotoxins that stimulate fluid and electrolyte secretion from the mucosal crypt cells, the principal secretory cells of the small intestine. Cytotoxic diarrhea is characterized by the viral destruction of the villi of the small intestine. This results in a smaller intestinal surface area, with a decreased capacity for fluid and electrolyte absorption.

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. What food or beverage should be tolerated best? a. Clear fluids b. Carbonated drinks c. Applesauce and milk d. Easily digested foods

ANS: D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear fluids (e.g., fruit juices and gelatin) and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. In some children, lactose intolerance will develop with diarrhea, and cow's milk should be avoided in the recovery stage.

During the preschool period, the emphasis of injury prevention should be placed on what? a. Limitation of physical activities b. Punishment for unsafe behaviors c. Constant vigilance and protection d. Teaching about safety and potential hazards

ANS: D Education about safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Limitation of physical activities is not appropriate. Punishment may make children scared of trying new things. Constant vigilance and protection are not practical at this age because preschoolers are becoming more independent.

Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation? a. Palpate another area simultaneously. b. Ask the child not to laugh or move if it tickles. c. Begin with deeper palpation and gradually progress to superficial palpation. d. Have the child "help" with palpation by placing his or her hand over the palpating hand.

ANS: D Having the child "help" with palpation by placing his or her hand over the palpating hand will help minimize the feeling of tickling and enlist the child's cooperation. Palpating another area simultaneously will create the sensation of tickling in the other area also. Asking the child not to laugh or move will bring attention to the tickling and make it more difficult for the child. Superficial palpation is done before deep palpation.

What do the psychosocial developmental tasks of toddlerhood include? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that toddlers are concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age mates develops during the preschool and school-age years.

The nurse is assessing the Tanner stage in an adolescent male. The nurse recognizes that the stages are based on what? a. Hair growth on the face and chest b. Changes in the voice to a deeper timbre c. Muscle growth in the arms, legs, and shoulders d. Size and shape of the penis and scrotum and distribution of pubic hair

ANS: D In males, the Tanner stages describe pubertal development based on the size and shape of the penis and scrotum and the shape and distribution of pubic hair. During puberty, hair begins to grow on the face and chest; the voice becomes deeper; and muscles grow in the arms, legs, and shoulders, but these are not used for the Tanner stages.

A toddler sustains a minor burn on the hand from hot coffee. What is the first action in treating this burn? a. Apply burn ointment. b. Put ice on the burned area. c. Cover the hand with gauze dressing. d. Hold the hand under cool running water.

ANS: D In minor burns, the best method to stop the burning process is to hold the burned area under cool running water. Ointments are not applied to a new burn; the ointment will contribute to the burning. Ice is not recommended. Gauze dressings do not stop the burning process.

Adolescents often do not use reasoned decision making when issues such as substance abuse and sexual behavior are involved. What is this because of? a. They tend to be immature. b. They do not need to use reasoned decision making. c. They lack cognitive skills to use reasoned decision making. d. They are dealing with issues that are stressful and emotionally laden.

ANS: D In the face of time pressures, personal stress, or overwhelming peer pressure, young people are more likely to abandon rational thought processes. Many of the health-related decisions adolescents confront are emotionally laden or new. Under such conditions, many people do not use their capacity for formal decision making. The majority of adolescents have cognitive skills and are capable of reasoned decision making. Stress affects their ability to process information. Reasoned decision making should be used in issues that are crucial such as substance abuse and sexual behavior.

At an 8-month-old well-baby visit, the parent tells the nurse that her infant falls asleep at night during the last bottle feeding but wakes up when moved to the infant's crib. What is the most appropriate response for the nurse to make? a. "You should put your baby to sleep 1 hour earlier without the nighttime feeding but with a pacifier for soothing." b. "You could place rice cereal in the last bottle feeding of the day to ensure a longer sleep pattern." c. "You should have your partner give the last bottle of the day and observe whether your infant stays awake for your partner." d. "You could increase daytime feeding intervals to every 4 hours and put your baby in the crib while the baby is still awake."

ANS: D Increasing the daytime intervals to 4 hours and placing the baby in the crib while still awake are interventions for nighttime sleeping problems. Putting the baby to bed 1 hour earlier with a pacifier will not stop the need for the bedtime bottle; there is no research that rice cereal in the bottle helps to satisfy the baby longer at night, and switching partners does not guarantee that the baby will go to sleep better.

During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is which? a. Abnormal and requires further investigation b. Abnormal unless it occurs in conjunction with knock-knee c. Normal if the condition is unilateral or asymmetric d. Normal because the lower back and leg muscles are not yet well developed

ANS: D Lateral bowing of the tibia (bowlegged) is an expected finding in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African American children.

When assessing a preschooler's chest, what should the nurse expect? a. Respiratory movements to be chiefly thoracic b. Anteroposterior diameter to be equal to the transverse diameter c. Retraction of the muscles between the ribs on respiratory movement d. Movement of the chest wall to be symmetric bilaterally and coordinated with breathing

ANS: D Movement of the chest wall should be symmetric bilaterally and coordinated with breathing. In children younger than 6 or 7 years, respiratory movement is principally abdominal or diaphragmatic. The anteroposterior diameter is equal to the transverse diameter during infancy. As the child grows, the chest increases in the transverse direction, so that the anteroposterior diameter is less than the lateral diameter. Retractions of the muscles between the ribs on respiratory movement are indicative of respiratory distress.

What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)? a. Nausea, vomiting b. Weakness, fatigue c. Muscle hypotonicity d. Neuromuscular irritability

ANS: D Neuromuscular irritability is a clinical manifestation of hypocalcemia. Nausea and vomiting occur with hypercalcemia and hypernatremia. Weakness, fatigue, and muscle hypotonicity are clinical manifestations of hypercalcemia.

Parents of a preschool child ask the nurse, "Should we set rules for our child as part of a discipline plan?" Which is an accurate response by the nurse? a. "It is best to delay the punishment if a rule is broken." b. "The child is too young for rules. At this age, unrestricted freedom is best." c. "It is best to set the rules and reason with the child when the rules are broken." d. "Set clear and reasonable rules and expect the same behavior regardless of the circumstances."

ANS: D Nurses can help parents establish realistic and concrete "rules." The clearer the limits that are set and the more consistently they are enforced, the less need there is for disciplinary action. Delaying punishment weakens its intent. Children want and need limits. Unrestricted freedom is a threat to their security and safety. Reasoning involves explaining why an act is wrong and is usually appropriate for older children, especially when moral issues are involved. However, young children cannot be expected to "see the other side" because of their egocentrism.

The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which? a. 50th percentile b. 75th percentile c. 80th percentile d. 95th percentile

ANS: D Obesity in children and adolescents is defined as a body mass index at or greater than the 95th percentile for youth of the same age and gender.

What statement characterizes moral development in the older school-age child? a. Rule violations are viewed in an isolated context. b. Judgments and rules become more absolute and authoritarian. c. The child remembers the rules but cannot understand the reasons behind them. d. The child is able to judge an act by the intentions that prompted it rather than just by the consequences.

ANS: D Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rule violation is likely to be viewed in relation to the total context in which it appears. Rules and judgments become less absolute and authoritarian. The situation and the morality of the rule itself influence reactions.

The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by what? a. Allowing the child to eat citrus foods at bedtime b. A hereditary factor that cannot be prevented c. Poor fluoride supply in the drinking water d. Giving the child a bottle of juice or milk at naptime

ANS: D One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

A preterm infant has just been admitted to the neonatal intensive care unit. The infant's parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. What should the nurse's explanation be? a. Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli. b. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief. c. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences. d. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

ANS: D Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response. The pathways are sufficiently myelinated to transmit the painful stimuli and produce the pain response. Local and systemic pharmacologic agents are available to permit anesthesia and analgesia for neonates.

A nurse is observing children playing in the playroom. What describes parallel play? a. A child playing a video game b. Two children playing a card game c. Two children watching a movie on a television d. A child playing with blocks next to a child playing with trucks

ANS: D Parallel play is when a toddler plays alongside, not with, other children. A child playing with blocks next to a child playing with trucks is descriptive of parallel play. The child playing a video game is descriptive of solitary play. Two children playing cards is descriptive of cooperative play. Two children watching a television is descriptive of associative play.

Parents ask the nurse for strategies to help their toddler adjust to a new baby. What should the nurse suggest? a. Start talking about the baby very early in the pregnancy. b. Move the toddler to a new bed after the baby comes home. c. Tell the toddler that a new playmate will be coming home soon. d. Alert visitors to the new baby to include the toddler in the visit.

ANS: D Parents can minimize sibling rivalry by alerting visitors to the toddler's needs, having small presents on hand for the toddler, and including the child in the visits as much as possible. Time is a vague concept for toddlers. A good time to start talking about the new baby is when the toddler becomes aware of the pregnancy and the changes occurring in the home in anticipation of the new member. To avoid additional stresses when the newborn arrives, parents should perform anticipated changes, such as moving the toddler to a different room or bed, well in advance of the birth. Telling the toddler that a new playmate will come home soon sets up unrealistic expectations.

Parents of a preschool child tell the nurse, "Our child seems to have many imaginary fears." What suggestion should the nurse give to the parents to help their child resolve the fears? a. Ignore the fears; they will go away. b. Explain to your child the fears are not real. c. Give your child some new toys to allay the fears. d. Help your child to resolve the fears through play activities.

ANS: D Preschoolers are able to work through many of their unresolved fears, fantasies, and anxieties through play, especially if guided with appropriate play objects (e.g., dolls or puppets) that represent family members, health professionals, and other children. The fears should not be ignored because they may escalate. Preschoolers are not cognitively prepared for explanations about the fears. They gain security and comfort from familiar objects such as toys, dolls, or photographs of family members, so new toys should not be introduced.

What finding is the most reliable guide to the adequacy of fluid replacement for a small child with burns? a. Absence of thirst b. Falling hematocrit c. Increased seepage from burn wound d. Urinary output of 1 to 2 ml/kg of body weight/hr

ANS: D Replacement fluid therapy is delivered to provide a urinary output of 30 ml/hr in older children or 1 to 2 ml/kg of body weight/hr for children weighing less than 30 kg (66 lb). Thirst is the result of a complex set of interactions and is not a reliable indicator of hydration. Thirst occurs late in dehydration. A falling hematocrit would be indicative of hemodilution. This may reflect fluid shifts and may not accurately represent fluid replacement therapy. Increased seepage from a burn wound would be indicative of increased output, not adequate hydration.

Which best describes signs and symptoms as part of a nursing diagnosis? a. Description of potential risk factors b. Identification of actual health problems c. Human response to state of illness or health d. Cues and clusters derived from patient assessment

ANS: D Signs and symptoms are the cues and clusters of defining characteristics that are derived from a patient assessment and indicate actual health problems. The first part of the nursing diagnosis is the problem statement, also known as the human response to the state of illness or health. The identification of actual health problems may be part of the medical diagnosis. The nursing diagnosis is based on the human response to these problems. The human response is therefore a component of the nursing diagnostic statement. Potential risk factors are used to identify nursing care needs to avoid the development of an actual health problem when a potential one exists.

The parents of a 5-year-old child ask the nurse, "How many hours of sleep a night does our child need?" The nurse should give which response? a. "A 5-year-old child requires 8 hours of sleep." b. "A 5-year-old child requires 9.5 hours of sleep." c. "A 5-year-old child requires 10 hours of sleep." d. "A 5-year-old child requires 11.5 hours of sleep."

ANS: D Sleep requirements decrease during school-age years; 5-year-old children generally require 11.5 hours of sleep.

The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death? a. Preschoolers b. Young school age c. Middle school age d. Late school age and adolescents

ANS: D Suicide is the third leading cause of death in children ages 10 to 19 years; therefore, the age group should be late school age and adolescents. Suicide is not one of the leading causes of death for preschool and young or middle school-aged children.

The nurse is planning pain control for a child. Which is the advantage of administering pain medication by the intravenous (IV) bolus route? a. Less expensive than oral medications b. Produces a first-pass effect through the liver c. Does not need to be administered frequently d. Provides most rapid onset of effect, usually in about 5 minutes

ANS: D The advantage of pain medication by the IV bolus route is that it provides the most rapid onset of effect, usually in about 5 minutes. IV medications are more expensive than oral medications, and the IV route bypasses the first-pass effect through the liver. Pain control with IV bolus medication needs to be repeated hourly for continuous pain control.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. What is the most appropriate recommendation? a. Punish the child. b. Explain to child that this is wrong. c. Leave the child alone until the tantrum is over. d. Remain close by the child but without eye contact.

ANS: 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.

Examination of the abdomen is performed correctly by the nurse in which order? a. Inspection, palpation, percussion, and auscultation b. Inspection, percussion, auscultation, and palpation c. Palpation, percussion, auscultation, and inspection d. Inspection, auscultation, percussion, and palpation

ANS: D The correct order of abdominal examination is inspection, auscultation, percussion, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds. Auscultation is performed before percussion. The act of percussion can influence the findings on auscultation.

The school nurse is teaching a class on injury prevention. What should be included when discussing firearms? a. Adolescents are too young to use guns properly for hunting. b. Gun carrying among adolescents is on the rise, primarily among inner-city youth. c. Nonpowder guns (air rifles, BB guns) are a relatively safe alternative to powder guns. d. Adolescence is the peak age for being a victim or offender in the case of injury involving a firearm.

ANS: D The increase in gun availability in the general population is linked to increased gun deaths among children, especially adolescents. Gun carrying among adolescents is on the rise and not limited to the stereotypic inner-city youth. Adolescents can be taught to safely use guns for hunting, but they must be stored properly and used only with supervision. Nonpowder guns (air rifles, BB guns) cause almost as many injuries as powder guns.

What is a systemic response to severe burns in a child? a. Metabolic alkalosis b. Decreased metabolic rate c. Increased renal plasma flow d. Abrupt drop in cardiac output

ANS: D The initial physiologic response to a burn injury is a dramatic change in circulation. A precipitous drop in cardiac output precedes any change in circulating blood or plasma volumes. A circulating myocardial depressant factor associated with severe burn injury is thought to be the cause. Metabolic acidosis usually occurs secondary to the disruption of the body's buffering action resulting from fluid shifting to extravascular space. There is a greatly accelerated metabolic rate in burn patients, supported by protein and lipid breakdown. With the loss of circulating volume, there is decreased renal blood flow and depressed glomerular filtration.

The nurse is planning to bring a preschool child a toy from the playroom. What toy is appropriate for this age group? a. Building blocks b. A 500-piece puzzle c. Paint by number picture d. Farm animals and equipment

ANS: D The most characteristic and pervasive preschooler activity is imitative, imaginative, and dramatic play. Farm animals and equipment would provide hours of self-expression. Building blocks are appropriate for older infants and toddlers. A 500-piece puzzle or a paint by number picture would be appropriate for a school-age child.

A 16-year-old adolescent boy tells the school nurse that he is gay. The nurse's response should be based on what? a. He is too young to have had enough sexual activity to determine this. b. The nurse should feel open to discussing his or her own beliefs about homosexuality. c. Homosexual adolescents do not have concerns that differ from those of heterosexual adolescents. d. It is important to provide a nonthreatening environment in which he can discuss this.

ANS: D The nurse needs to be open and nonjudgmental in interactions with adolescents. This will provide a safe environment in which to provide appropriate health care. Adolescence is when sexual identity develops. The nurse's own beliefs should not bias the interaction with this student. Homosexual adolescents face very different challenges as they grow up because of society's response to homosexuality.

A parent asks the nurse about negativism in toddlers. What is the most appropriate recommendation? a. Punish the child. b. Provide more attention. c. Ask child not to always say "no." d. Reduce the opportunities for a "no" answer.

ANS: D The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to comply with requests not to say "no."

What do nursing interventions to promote health during middle childhood include? a. Stress the need for increased calorie intake to meet increased demands. b. Instruct parents to defer questions about sex until the child reaches adolescence. c. Advise parents that the child will need increasing amounts of rest toward the end of this period. d. Educate parents about the need for good dental hygiene because these are the years in which permanent teeth erupt.

ANS: D The permanent teeth erupt during the school-age years. Good dental hygiene and regular attention to dental caries are vital parts of health supervision during this period. Caloric needs are decreased in relation to body size for this age group. Balanced nutrition is essential to promote growth. Questions about sex should be addressed honestly as the child asks questions. The child usually no longer needs a nap, but most require approximately 11 hours of sleep each night at age 5 years and 9 hours at age 12 years.

The nurse is teaching parents about toilet training. What should the nurse include in the teaching session? a. Bladder training is accomplished before bowel training. b. The mastery of skills required for toilet training is present at 18 months. c. By 12 months, the child is able to retain urine for up to 2 hours or longer. d. The physiologic ability to control the sphincters occurs between 18 and 24 months.

ANS: D The physiologic ability to control the sphincters occurs somewhere between ages 18 and 24 months. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The mastery of skills required for training are not present before 24 months of age. By 14 to 18 months of age, the child is able to retain urine for up to 2 hours or longer.

Which is a consequence of the physical punishment of children, such as spanking? a. The psychologic impact is usually minimal. b. The child's development of reasoning increases. c. Children rarely become accustomed to spanking. d. Misbehavior is likely to occur when parents are not present.

ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake but rather out of fear of punishment. Spanking can cause severe physical and psychologic injury and interfere with effective parent-child interaction. The use of corporal punishment may interfere with the child's development of moral reasoning. Children do become accustomed to spanking, requiring more severe corporal punishment each time.

The nurse on a pediatric unit is writing guidelines for age-specific preparation of children for procedures based on developmental characteristics. What guideline is accurate? a. Inform toddlers about an upcoming procedure 2 hours before the procedure is to be performed. b. Inform school-age children about an upcoming procedure immediately before the procedure is scheduled to occur. c. Discourage parent presence during procedures on infants and toddlers. d. Use simple diagrams of anatomy and physiology to explain a procedure to a school-age child.

ANS: D To assist the school-age child in meeting Erickson's developmental stage of industry, using simple diagrams of anatomy and physiology to explain a procedure is the accurate guideline. Toddlers should be told about a procedure right before the procedure. School-age children should know about the procedure in advance, not right before, and parents should be present for procedures for infants and toddlers.

The parents of a 12-month-old child ask the nurse if the child can eat hot dogs as do their other children. The nurse's reply should be based on what? a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D To eat a hot dog safely, the child should be sitting down, and the hot dog should be cut into small, irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. Hot dogs are of a consistency, diameter, and shape that may cause complete obstruction of the child's airway if not cut into irregular, small pieces.

What factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates in toddlers are slower than those in infants. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have short, straight internal ear canals and large lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canals of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose toddlers to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

What should the nurse suggest to parents of preschoolers about sensitive questions regarding sex? a. Distract your child from the topic. b. Offer complete factual information. c. Dismiss the topic until the child is older. d. Find out what your child knows or thinks.

ANS: D Two rules govern answering sensitive questions about topics such as sex. The first is to find out what children know and think. By investigating the theories children have produced as a reasonable explanation, parents can not only give correct information but also help children understand why their explanation is inaccurate. Another reason for ascertaining what the child thinks before offering any information is to avoid giving an "unasked for" answer. The child should not be distracted from the topic. If parents offer too much information, the child will simply become bored or end the conversation with an irrelevant question. What matters is that parents are approachable and do not dismiss their child's inquiries.

Which parameter correlates best with measurements of total muscle mass? a. Height b. Weight c. Skinfold thickness d. Upper arm circumference

ANS: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold thickness is a measurement of the body's fat content.

The school nurse is discussing after-school sports participation with parents of children age 10 years. The nurse's presentation includes which important consideration? a. Teams should be gender specific. b. Organized sports are not appropriate at this age. c. Competition is detrimental to the establishment of a positive self-image. d. Sports participation is encouraged if the type of sport is appropriate to the child's abilities.

ANS: D Virtually every child is suited for some type of sport. The child should be matched to the type of sport appropriate to his or her abilities and physical and emotional makeup. At this age, girls and boys have the same basic structure and similar responses to exercise and training. After puberty, teams should be gender specific because of the increased muscle mass in boys. Organized sports help children learn teamwork and skill acquisition. The emphasis should be on playing and learning. Children do enjoy appropriate levels of competition.

The nurse is teaching a staff development program about levels of sedation in the pediatric population. Which statement by one of the participants should indicate a correct understanding of the teaching? a. "With minimal sedation, the patient's respiratory efforts are affected, and cognitive function is not impaired." b. "With general anesthesia, the patient's airway cannot be maintained, but cardiovascular function is maintained." c. "During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation." d. "During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation."

ANS: D When discussing levels of sedation, the participants should understand that during moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation, cognitive function is impaired, and respiratory function is adequate. In minimal sedation, the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected. In deep sedation, the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired, but cardiovascular function is maintained. With general anesthesia, the patient loses consciousness and cannot be aroused with painful stimuli, the airway cannot be maintained, and ventilation is impaired; cardiovascular function may or may not be impaired.

The parents of a young child report that the child is not eating well during mealtime. What information should the nurse ascertain to appropriately assess the eating concern? Select all that apply. Accessibility to food How the child snacks Which foods are provided What size dish the child uses Adequate time given to complete the meal

Accessibility to food Knowing if the child has easy access to food will help the nurse appropriately assess the eating concern. Limited access to food may lead to a problem with the child's nutrition. The nurse could assist the family in accessing resources. Correct How the child snacks Knowing how the child snacks will help the nurse appropriately assess the eating concern. Many children can fill up on snacks, then not want to eat their food at mealtime. Correct Which foods are provided Knowing what foods are provided will help the nurse appropriately assess the eating concern. There should be a variety of foods offered.

The mother of a newborn child enquires about having her child's hearing checked. What is the best response by the nurse? All newborns should be screened before 1 year of age. At 6 months you can return and we will screen your infant. Your newborn will be screened at the four-month well-baby visit. All newborns should be screened for hearing before one month of age.

All newborns should be screened for hearing before one month of age. Stating that the child will be screened for hearing before one month of age is accurate and therefore this is the best response for the nurse to make.

Which action by the nurse when caring for the preschool child is appropriate, given preschoolers' level of independence? Allowing the child to brush teeth alone Hand-feeding the child during mealtimes and snacks Explaining the entire procedure for ear tube surgery Allowing the child to put on the exam gown by him- or herself

Allowing the child to put on the exam gown by him- or herself The nurse should allow the child to undress him-/herself to put on the exam gown. Preschool children want to assert independence and undressing without assistance is appropriate given preschooler's level of independence.

A cephalocaudal pattern of growth is seen in which aspect of motor development? An infant will be able to roll front to back before he or she can crawl. An infant can use their upper limbs before he or she is able to use their lower limbs. An infant will be able to point to a moving object before they can bat the object. An infant will be able to lift the head before they demonstrate tripod sitting.

An infant can use their upper limbs before he or she is able to use their lower limbs. This aspect of motor development demonstrates a cephalocaudal pattern of growth.

Which can influence the development of both speech and language in infants? Select all that apply. Anatomical defects Genetics/family history Sociodemographic factors Lack of access to television and computers Quality of communication in the environment

Anatomical defects This can affect speech and language development. Children with cleft lip and palate for example may have difficulty reaching normal language milestones. Genetics/family history This factor can have an effect on speech and language development. Genetics and family histories will always be a consideration when evaluating a child's speech and language milestones. Sociodemographic factors Sociodemographic factors can have an effect on both speech and language development. Quality of communication in the environment This can affect speech and language development in infants, such as in a home where family members place a high value on education, with family members who are bilingual, or if the child has other siblings to converse with.

__________________________________ ________________________ refers to the best approach to prevention that uses teaching and counseling of parents and others about developmental expectations and that alerts parents to the issues that're most likely to arise at a given age.

Anticipatory guidance

The nurse is preparing to administer an IM injection to a 4-year-old patient who is afraid of needles. Which approach should the nurse use to engage the pediatric patient's cooperation in medication-administration procedures? Advise the child to view the injection. Ask the child if he would prefer a red or blue bandage afterward. Ensure that the needles are hidden from the child until the injection. Use restraints on the child's arm so it does not move during the injection.

Ask the child if he would prefer a red or blue bandage afterward. The nurse should develop a good rapport with the child and allow the child to have some control over the procedure by providing choices. The child can benefit from therapeutic play and participation.

The nurse is administering an injection to a 4-year-old patient who is fearful of the procedure. What can the nurse do to facilitate cooperation of the patient? Select all that apply. Ask the child to hold a toy. Explain in detail how the medication works. Tell the child they get a fun bandage after the injection. Tell the child how well she did after administering the injection. Tell the child she will receive a sticker of her choice after the procedure.

Ask the child to hold a toy. Providing a distraction, such as a favorite toy, helps the child accept the injection in a more favorable light. Tell the child they get a fun bandage after the injection. Adhesive bandages following an injection help the child feel better about receiving the medication because children of this age tend to think "magically." Therefore, the bandage will "make it all better." Correct Tell the child how well she did after administering the injection. Praising the child will help her feel good about herself and facilitate the child being less afraid of future injections. Correct Tell the child she will receive a sticker of her choice after the procedure. Rewarding good behavior will help the child focus on something positive and not what she is afraid of.

The nurse is preparing to administer an oral medication to a child who is reporting nausea and frequent vomiting. Which action should the nurse take to ensure successful delivery of the medication? Withhold the medication until the patient is no longer vomiting. Ask the health care provider to prescribe the medication for inhalation. Ask the health care provider to prescribe the medication rectally or by injection. Ask the health care provider to prescribe the medication as a topical application.

Ask the health care provider to prescribe the medication rectally or by injection. An alternative administration route such as rectal, intravenous, or intramuscular, should be requested so the patient doesn't go without the needed medication.

The nurse is teaching the parent of an infant how to administer medication using an oral syringe. In what order does the nurse describe the appropriate steps?

Assess the child's gag reflex and ability to swallow. Seat the infant in an upright or semi-upright position. Open the infant's mouth using gentle pressure to the chin or cheeks. Place the syringe along the side of the cheek. Gently dispense medication as the infant begins to suck. Correct Answer Exactly! The nurse should first assess the child's gag reflex and ability to swallow. Once it has been determined that the infant is able to safely ingest the medication orally, the infant should be held in an upright or semi-upright position. The nurse should then gently open the infant's mouth using gentle pressure and the syringe should be placed along the side of the cheek. With the syringe in this position the infant should be allowed to suck while the nurse gently dispenses the medication.

The nurse checks the newborn's pulse and records 140 beats/min. Which should be the nurse's next action? Obtain an electrocardiogram Assess the oxygen saturation Notify the health care provider Administer oxygen via nasal cannula

Assess the oxygen saturation A pulse of 140 beats/min is normal in a newborn. The nurse would continue the examination, and assessing the oxygen saturation is the next step in the examination.

Describe the concept of atraumatic care and list the 3 principles that provide a framework for its implementation

Atraumatic care is the provision of care that minimizes or eliminates psychologic and physical distress experienced by children and their families. 3 principles: prevent or minimize child's separation from family, promote a sence of control in the child and family & prevent or minimize bodily injury or pain

The nurse is assessing a 2-month-old patient. The nurse conducts which part of the assessment first? Palpation of abdomen Elicitation of the Moro reflex Evaluation of primitive reflexes Auscultation of the heart and lungs

Auscultation of the heart and lungs Auscultation of the heart and lungs should be performed first while the baby is quiet.

A 15-year-old patient is a member of the school's swim team. When educating on water safety, which water safety recommendation takes priority? Avoid drugs and alcohol Wear appropriate attire Attend practice regularly Refrain from playing around the pool

Avoid drugs and alcohol Avoiding drugs and alcohol is a water safety recommendation that would take priority. Drugs and alcohol can lower inhibitions and lead to an increased risk for injury in and around the water.

The parents of an overweight nine-year-old are concerned about their child's eating habits. Which recommendations can the nurse make for family-wide changes that may impact their child's food choices? Select all that apply. Eat meals quickly Avoid giving food for reward Increase the number of home-cooked meals Eat at least 10% of total daily calories as saturated fat Ensure the majority of the food eaten is grains over protein

Avoid giving food for reward Not using food as a reward is a recommendation that the nurse would make for family-wide changes to impact children's food choices. This recommendation focuses more on eating than nutrition. Correct Increase the number of home-cooked meals Increasing home-cooked meals and reducing the amount of fast food eaten is a recommendation that the nurse would make for family-wide changes to impact children's food choices. Fast food is high in calories and not nutritious.

Separation anxiety and stranger fear normally begin to appear by: A. 4 weeks B. 6 months C. 8 months D. 12 months

B. 6 months

After birth, maximum levels of immunoglobulin A, D, and E in humans are: A. reached during infancy B. attained in early childhood C. transferred from the mother D. reached before 9 months of age

B. attained in early childhood

Johnny spills his milk on the living room rug. his mother smacks him on the bottom and says "you are a messy bad boy johnny". which of the following discipline stretegies are used? (select all) a. consequence b. corporal punishment c. scolding d. behavior modification e. ignoring

B. corporal punishment C. scolding

Which of the following infant traits is most likely to contribute to shaken baby syndrome (traumatic brain injury)? A. laughing out loud B. crying C. soling the diaper D. pulling up to furniture

B. crying

A 4-month old infant who does not express vocalization such as cooing, gurgling, or laughing should be evaluated for: A. tongue-tied (ankloglossia) B. hearing impairment C. cleft palate D. vocal cord paralysis

B. hearing impairment

When introducing new food, the parents should not: A. decrease the quantity of the infant's milk B. mix food with formula to feed through a nipple C. introduce new foods in small amounts D. offer the new food by itself first

B. mix food with formula to feed through a nipple

Fine motor development is evaluated in the 10-month-old infant by observing the: A. ability to stack blocks B. pincer grasp C. righting reflexes D. tonic neck reflex

B. pincer grasp

According to Piaget's theory of cognitive development, the 3 crucial events of the sensorimotor phase are: A. trust, readjustment, and the regulation of frustration B. separation, object permanence, and mental representation C. imitation, personality development, and temperament D. ordering, comfort, and satisfaction with his or her body

B. separation, object permanence, and mental representation

The characteristic of the respiratory system that predisposes the infant to middle ear infection is the: A. short angled eustachian tube B. short, straight eustachian tube C. close proximity of the trachea to the bronchi D. size of the lumen of the eustachian tube

B. short, straight eustachian tube

The nurse is performing a thorough examination of a 5-year-old child. When assessing the warmth of the child's skin, the nurse uses which aspect of the hand? Palm Fingertips Finger pads Back surface

Back surface The back surface of the hand would be used to assess the temperature of the skin.

Question 4 of 6 Which developmental milestones are normal for a 10-year-old child? Select all that apply. Back-talking to parents Interest in the opposite sex Interest in getting a cell phone Unwillingness to venture too far from the home Being upset when artwork does not look like others

Back-talking to parents Rebellion is normal at age 9-11 and may include back-talking to parents as the child begins to assert independence. Correct Interest in the opposite sex At 9-11 years of age, boys tease girls, and girls may become interested in boys. Correct Interest in getting a cell phone 9-11-year-olds begin to talk to friends on the phone and may want to have their own cell phone. Being upset when artwork does not look like others By 9-11 years, children are critical of their own work and may be upset if they do not feel their work measures up to personal standards

The parent of an eight-year-old child is frustrated because the child constantly makes up reasons not to attend school. The child's health care provider ruled out any serious health issues. The nurse should suggest that the parent take which actions to address this behavioral problem? Select all that apply. Be firm in enforcing school attendance Encourage group activities with peers Discipline the child for wanting to leave school Rationally discuss the reasons the child wants to stay home Remove child from school any time they feel stressed or frightened

Be firm in enforcing school attendance The nurse should suggest the parent be firm in enforcing school attendance. Being firm does not allow the child to manipulate the situation. Encourage group activities with peers The nurse should suggest the parent should be encouraging group activities and emphasizing the positive aspects of school. Rationally discuss the reasons the child wants to stay home The child should be gently questioned about factors at school that cause worry or fear. Specific causes, such as a bully or an overly critical teacher, should be dealt with immediately.

Which are the major psychosocial developments that should occur during adolescence? Select all that apply. Becoming independent Determining gender identity Increasing desire to please others Developing a sense of industry Solidifying future plans for an occupation

Becoming independent Becoming independent is a major psychosocial development that should occur during adolescence. Correct Determining gender identity Determining sexual identity, including gender identity, is a major psychosocial development that should occur during adolescence. Solidifying future plans for an occupation Forming a vocational identity is a major psychosocial development that should occur during adolescence.

A mother of a male baby reported smoking occasionally while pregnant. She reports allowing the baby to sleep in the bed with her, on a firm mattress without any covers. Which factors put this baby at risk for SIDS? Select all that apply. Being a male baby Using a firm mattress Using no sleep covers in the crib Smoking occasionally in the house Allowing the baby to sleep in the bed

Being a male baby Male babies are at increased risk for SIDS and therefore this child would be more at risk than a female sibling. Smoking occasionally in the house Intrinsic risk factors such as smoking will increase the risk of SIDS and therefore this mother is putting her baby at risk. Correct Allowing the baby to sleep in the bed Bed sharing is not recommended since it can lead to injury in the child. An infant needs to sleep alone and without risk factors for asphyxiation.

Children learn role behavior and to perform in an expected way within the family at a very early age. One factor that influences the role each sibling is assigned within the family structure is the ________ _________

Birth order (p 53)

Match the period of cognitive development according to Piaget with the corresponding age group.

Birth-2 years Sensorimotor 2-7 years Preoperational thought 7-11 years Concrete operations 11 years-adulthood Formal operations

Which sentence best describes a healthy parent-infant attachment during the first month? Bonding is critical for normal development and survival. Bonding is critical but too much love can create a needy child. Bonding is important but meeting every emotional need will spoil the child. Bonding is necessary but the infant has built-in mechanisms to help if the child's needs are not met.

Bonding is critical for normal development and survival. This sentence best describes the relationship that needs to exist for normal development and survival in the infant during the first few months of life.

What contributes to helping an infant to fight infection within the first year of life? Select all that apply. Breast milk Vaccinations Fully functional respiratory system The mother's transplacental antibodies Bottle-fed cow's milk supplemented with Vitamins A, C, and D

Breast milk The breast milk contains IgA and proteins including lactoferrin, lysozyme, and serum albumin. The infant benefits from maternal IgA since the baby's immune system can only make 20% of the adult level. Vaccinations Vaccinations for diseases such as rotavirus and hepatitis B are given to infants, which helps them fight infection. The mother's transplacental antibodies Transplacental antibodies help supplement the infant's immune system until the infant is around 4 months of age. IgG is the most significant transplacental antibody.

Of the following characteristics of vision, the one that is developed at the earliest age is: A. binocularity B. stereopsis C. corneal reflex D. convergence

C. corneal reflex

Limit-setting and discipline should begin in: A. middle childhood or adolescence B. infancy, with voice tone and eye contact C. early infancy, with voice tone and eye contact D. infancy, with time-out in chair for misbehavior

C. early infancy, with voice tone and eye contact

The expected immaturity of the infant's functioning endocrine system will be demonstrated in the infant's: A. growth patterns B. thyroid levels C. homeostatic control D. immunoglobulin levels

C. homeostatic control

A formerly maltreated child who manifests behaviors such as limited eye contact and poor impulse control may be suffering from: A. separation anxiety B. stranger fear C. reactive attachment disorder D. spoiled child syndrome

C. reactive attachment disorder

transmission-based precautions

CDC precautions used in patients known or suspected to be infected with pathogens that can be transmitted by airborne, droplet, or contact routes; used in addition to standard precautions 1. airborn precautions (measles, varicella, tuberculosis) 2. droplet precautions (flu, meningitis, pneumonia, epiglotittis, , sepsis, plague, diphtheria, pertussis, strep, scarlettfever, mumps, rubella 3. contact precautionsGI, respiratory infection, wound infection, enteric infection, conjunctivitis

The pediatric intensive care unit (PICU) nurse is assessing a 7-year old-child, admitted after being struck by a car, for signs of pain. The child is lethargic but able to communicate. Which assessment tool is most appropriate for the PICU nurse to use? CRIES FACES FLACC COMFORT

COMFORT The COMFORT pain rating scale is most appropriate for infants and children in critical care settings.

The nurse is assessing pain experienced by a 1-month old infant with a burn on her arm. The nurse notes a persistent cry, tachycardia, irritability, an oxygen saturation of 91% with 2 L of oxygen administered via nasal cannula. Which pain assessment tool did the nurse most likely use? CRIES FACES FLACC COMFORT

CRIES The nurse likely used the CRIES scale, which assesses children between the ages of 0 and 6 months and evaluates the child's cry, use of oxygen, vital signs, expression, and sleeplessness.

When preparing a suspension or elixir that specifies dosage in milligrams (mg), what should the nurse do to ensure the patient receives the correct amount of the medication? Use a tablespoon to administer the oral medication. Weigh the bottle of liquid on a scale and then weigh the dose. Draw an amount of liquid equal to the number of milligrams prescribed. Calculate the dose based on the number of mg/mL in the suspension.

Calculate the dose based on the number of mg/mL in the suspension. Prescriptions will often state the dosage in mg—and not mL—for liquids; care must be given to calculate the correct liquid dose.

Which social/personal skills are milestones for the preschool child? Select all that apply. Caring for a doll Dressing oneself Personal hygiene Identifying the color blue Naming four familiar pictures

Caring for a doll Pretending that a doll is a baby and feeding, dressing, or caring for it is an important social/personal milestone for the preschool child. Dressing oneself Putting on an article of clothing is a critical social/personal milestone of the preschool child. Personal hygiene Washing and drying hands and brushing teeth with assistance are critical social/personal milestones of the preschool child.

Which directional pattern of growth is seen in early infant development? Dorsolateral Ventromedial Ventrolateral Cephalocaudal

Cephalocaudal Cephalocaudal describes head (cephalo) to tail (caudal) and is used to describe the pattern of normal growth and development in infancy. For example, a child learns to hold his or her head up before he or she learns to sit.

The nurse is performing patient teaching prior to discharge for a child with type I diabetes. What information should the nurse provide the child regarding administration of a subcutaneous insulin injection? Select all that apply. Change the site of injection Massage the site of injection Track the location of injection sites Injection of insulin should cause a bleb Administer the insulin injection in their abdomen

Change the site of injection The systematic rotation of injection site helps facilitate consistent drug absorption. Track the location of injection sites By encouraging the child to track injection locations the nurse helps to empower the child. Additionally, tracking helps the child perform injections in different sites regularly. Administer the insulin injection in their abdomen The abdomen is the preferred location for children who require frequent subcutaneous injections, like type 1 diabetics.

Developmental theory

Changes in the family over time are addressed, based on the predictable changes in the structure, function, and roles of the family, with the age of the oldest child as the marker for stage transition (p 47-48; table 3-1) The family and each individual member must achieve developmental tasks as part of each family life-cycle stage (p 47-48; table 3-1)

In order for toilet training to be successful, a toddler should demonstrate which signs of toilet training readiness? Select all that apply. Child can undress without assistance. Child removes a soiled diaper without assistance. Child sits through a movie without wetting a diaper. Child can self-feed using a fork and spoon at all meals. Child brings a diaper to the mother for a change when asked.

Child can undress without assistance. The child's ability to remove his or her own pants is a sign of readiness for toilet training. Child removes a soiled diaper without assistance. Dislike of wet or soiled diapers is a sign of readiness for toilet training. Child sits through a movie without wetting a diaper. Having dry periods of at least two hours is a sign of readiness for toilet training.

Match Freud's stage of psychosexual development to the corresponding activity.

Child is found playing with contents of diaper. Anal stage Child has an increased interest in genitals. Phallic stage Child's superego represses thoughts of sexuality. Latency stage Child experiences personal and family turmoil. Puberty stage

An 8-year-old pediatric patient was prescribed a topical medication. What steps should the nurse take to prepare for the application of the medication? Select all that apply. Cleanse the skin allow it to dry. Examine the skin for abnormalities. Teach the child to not touch treated areas. Assist the child in applying the medication. Use tie-down restraints to restrain the child.

Cleanse the skin allow it to dry. In preparing the skin for the application of a topical medication the skin should be cleansed to remove exudates, scales, and other residue. This preparation will allow proper penetration of the topical medication. Correct Examine the skin for abnormalities. The presence of bruises, abrasion, and irritation would affect the absorption of topical medications and, therefore, should not be present at the site of application. Correct Teach the child to not touch treated areas. The child should avoid manipulating the treated area once the topical medication has been applied. Manipulation of the treated area could alter the perfusion of the area, which would change the absorption characteristics of the medication. Correct Assist the child in applying the medication. Children should be involved in their own care as much as is appropriate for the child's development.

The parent of a five-year-old child is frustrated by the child's tendency to hit and pull hair when angry. The nurse assures the parent that this lack of impulse control can be normal for children and to address the problem in which ways? Select all that apply. Clearly define rules Enforce rules consistently Explain truthfully why the rule is set Spank the child when they engage in prohibited behavior Vary the type of discipline until you find one that works best

Clearly define rules Clearly defining rules and setting boundaries for the child can help the child learn self-confidence, self-control, and family expectations. Correct Enforce rules consistently The child must be consistently disciplined for acts that are destructive, socially unacceptable, or morally wrong. To prevent confusion and anxiety, the consequences of misbehavior should be articulated in advance and carried out immediately after misbehavior occurs. When the child is disciplined for misbehavior, a simple, truthful explanation of why the behavior was unacceptable should be given. Correct Explain truthfully why the rule is set When the child is disciplined for misbehavior, a simple, truthful explanation of why the behavior was unacceptable should be given. This will help the child understand the rules better.

A new parent reports that the infant cries incessantly in the evenings, often pulling the arms and legs into the body. The nurse understands that this may be due to which infant condition? Colic Cerebral palsy Night terrors Necrotizing enterocolitis

Colic Incessant crying and pulling the arms and legs into the body indicate a child with colic.

Which activity for play therapy would be most appropriate for the nurse to suggest for the hospitalized preschool child? Reading riddles and jokes Playing complex a card game Holding onto a push-pull toy Coloring with colored pencils

Coloring with colored pencils Coloring with colored pencils is the most appropriate activity for the hospitalized preschool child.

The public health nurse is teaching community nurses about factors affecting the health of infants. Which factors that may affect infant risk for dental caries should the nurse include in the lesson? Select all that apply. Coming from a low family income Using bottled water to mix formula Drinking after a mother with cavities Offering soda in a sippy cup to the baby Brushing with fruit flavored toothpaste

Coming from a low family income If the infant's family has a low income, the family is more likely to have inadequate resources to provide for adequate preventative dental care. Correct Using bottled water to mix formula Bottled water, unlike tap water, does not have fluoride added. Children who live in areas where they cannot drink fluoridated tap water often have more dental caries and it is recommended that they have fluoride supplementation. Correct Drinking after a mother with cavities If the infant's mother has dental caries, she is likely to transfer these germs to her child if they share saliva by drinking or eating after each other. Correct Offering soda in a sippy cup to the baby Sugary soda increases the risk for dental caries.

Match the student's behavioral problem with the relevant manifestation.

Complaint of feeling sick while at school School refusal Pushing another child to assert authority Peer victimization Drinking alcohol while home alone after school Problems associated with self-care

Structure

Composition of the family (p 49-51, 56-59, 63)

The nurse is caring for a 7-month-old infant with influenza. The nurse notes an axillary temperature of 103.7° F. Which action should the nurse take first? Place the child in an ice bath for 30 minutes Administer an oral antipyretic as prescribed Confirm accuracy and notify the health care provider Reassess the infant's temperature using a rectal thermometer

Confirm accuracy and notify the health care provider The provider should be notified of abnormal vital signs after the temperature has been verified using another route.

family structure

Consists of individuals each with a socially recognized status and position who interact with one another on a regular recurring basis in socially sanctioned ways, composition of family

The nurse is preparing to administer a narcotic medication to an 8-year-old patient. Which actions are necessary to ensure safe medication administration? Select all that apply. Consult with a second nurse. Review the patient's medication order. Verify the child's weight prior to administration. Obtain permission from the patient's caregivers. Ask the patient's name and check the patient's identification.

Consult with a second nurse. A nurse should ask a colleague to perform a second check of the medication, using the six rights, before dispensing it to the patient as required by agency policy (Institute for Safe Medication Practices). Review the patient's medication order. The nurse should ensure the six rights of medication administration prior to administration. Many medications can be given orally in liquid or pill forms, intravenously, subcutaneously, and so on. The nurse needs to make sure that if liquid is prescribed, that is what is given. Verify the child's weight prior to administration. Pediatric drugs are typically ordered according to weight to account for body mass and pharmacokinetic principles. The nurse should verify a weight-based dose prior to administration. Ask the patient's name and check the patient's identification. The nurse should review the six rights of medication administration. The nurse should ensure the medication was prepared for the right patient by asking the patient or caregiver the patient's name and checking the patient's ID. This will help avoid medication errors.

The nurse is preparing to administer amoxicillin to the pediatric patient who weighs 40 lbs. The dose required is 60 mg/kg/day BID. What should the nurse do first in order to begin dosage calculation? Convert the weight from pounds to kilograms. Multiply the child's weight by the dose prescribed. Administer the prescribed medication to the patient. Divide the total dose by the number of doses per day.

Convert the weight from pounds to kilograms. The nurse should convert the patient's weight from pounds to kilograms so that that the units are the same for performing dosage calculations.

Family stress theory

Crisis intervention strategies are used, with the focus on helping members with the challenging event (p 47-48; table 3-1) Concepts of basic attributes, resources, perception, and coping behaviors or strategies are used in assessing family crisis management (p 47-48; table 3-1)

The nurse is preparing to administer an ophthalmic solution to an 8-year-old patient who is refusing to open his eyes. How should the nurse respond to facilitate administration of the medication by the parents? Select all that apply. Demonstrate the administration for the parents. Allow the parents to practice prior to administration. Explain to the parents the necessity of the medication. Withhold the medication until the parents are available to assist. Encourage the parents to use a reward after administering the medication

Demonstrate the administration for the parents. The nurse should teach the parents how to deliver the medication so that they are confident in their approach. Correct Allow the parents to practice prior to administration. The parents should be allowed to practice administering the medication prior to actual administration to ensure confidence in both the parents and the child. Encourage the parents to use a reward after administering the medication The nurse should encourage the parents to use positive reinforcement to build trust and help reduce the fear that the child is feeling.

The parents of a preschooler report that their child will only go to bed at night if provided with a bottle of juice. Which consequences of this practice should the nurse describe to the parents? Select all that apply. Dental cavities Night terrors Strengthen teeth Interrupted sleep Malocclusion of permanent teeth

Dental cavities Sweets, especially if consumed at bedtime, can cause enamel erosion and lead to dental caries. Malocclusion of permanent teeth If deciduous teeth are lost early because of decay, the remaining teeth may drift out of position, blocking proper eruption of the permanent teeth and leading to malocclusion.

The nurse teaches the adolescent about engaging in risk-taking behaviors. In most states, the adolescent will be able to obtain care under the Minors' Consent Law for which issues? Select all that apply. Depression HIV exposure Prenatal care Alcohol abuse Contraception services Self-inflicted violence

Depression Mental health services are available to adolescents without consent. HIV exposure STI services are covered in most states without parental notification. Prenatal care Prenatal care and adoption is often available with parental consent. Abortion is covered in few states. Alcohol abuse Alcohol abuse and drug treatment is available in many states. Contraception services Contraception is available in most states without parental consent.

A nurse has been asked to administer an intramuscular injection to a 1-year-old child. How does the nurse choose the appropriate needle to use? Select all that apply. The nurse may contact a colleague to obtain information about the correct needle to use. Determine the shortest length needle according to the selected muscle. Choose the needle length by taking into account the amount of body fat on the child. Determine the appropriate gauge needle for the type of medication to be administered. Look up the last intramuscular injection that was given to see what size was used before.

Determine the shortest length needle according to the selected muscle. The nurse should choose the shortest-length needle for the administering of an IM injection based upon the selected muscle for administration. This will help prevent the injection from penetrating too deeply. Correct Choose the needle length by taking into account the amount of body fat on the child. The amount of body fat on the child would influence the correct needle choice by requiring a longer needle when the child is carrying a higher amount of body fat. Correct Determine the appropriate gauge needle for the type of medication to be administered. The nurse should choose the smallest-gauge needle, based on the site and viscosity of the medication, when administering an IM injection. Using the smallest-gauge needle will help reduce the pain associated with intramuscular injection and increase the child's cooperation during the procedure.

A three-year-old girl is brought to the emergency department with a third-degree burn on her hand. The mother is extremely distressed and says to the nurse: "My daughter is so active and curious—it is hard to predict her behavior." Why is it important for the nurse to discuss developmental milestones when advising this parent about safety measures? Select all that apply. Developmental milestones do not need to be discussed, since they are not related to this child's third-degree burn. Discuss the importance of keeping the child close at all times and preventing exploration and wandering to prevent injury. Discussing developmental milestones will help the mother prepare for the type of behavior the child will exhibit now and in the future. Discussing motor milestones, including increased motor capacity, explains why the child will be reaching and moving quickly, making the child more prone to accidents. Discussing cognitive milestones, including increased curiosity and the desire to explore without understanding the consequences of actions, will help the parent understand the need for child-proofing the home and close supervision of the child at this age.

Discussing developmental milestones will help the mother prepare for the type of behavior the child will exhibit now and in the future. Preparing for the future by providing anticipatory (ie, anticipatory guidance) is an important reason for the nurse to discuss developmental milestones when advising this mom. This can help to prevent injury in the future anticipate behavior associated with. Correct Discussing motor milestones, including increased motor capacity, explains why the child will be reaching and moving quickly, making the child more prone to accidents. Motor milestones are important for the nurse to discuss when advising this mother about safety measures. This will help the mother consider ways to make the child's environment safe (eg, keeping poisonous substances out of reach, restricting access to climbing hazards). Correct Discussing cognitive milestones, including increased curiosity and the desire to explore without understanding the consequences of actions, will help the parent understand the need for child-proofing the home and close supervision of the child at this age. Cognitive milestones are important for the nurse to discuss when advising a parent about safety measures. At this age, children do not have the capacity to anticipate consequences so they should be watched closely, and appropriate measures should be taken to make her environment as safe as possible.

A 7-year-old child is admitted to the hospital to receive an intravenous antibiotic. The child's parent is concerned about injury to the child's arm because this is the child's first IV infusion. How does the nurse ensure patient safety while placing the IV catheter? Select all that apply. Do not allow the parents to hold the child. Reduce pain using topical pharmacological agents. Have the parent leave the room during the IV insertion. Obtain help from a colleague to hold the child and the extremity. Tell the child to imagine his or her favorite activity while guiding the catheter.

Do not allow the parents to hold the child. The parents should be allowed to therapeutically hold the child during the IV insertion if they are comfortable with the position and the procedure. Correct Reduce pain using topical pharmacological agents. The use of EMLA cream will reduce the pain associated with the insertion of an IV catheter and encourage more cooperation from the child helping to prevent injury. Obtain help from a colleague to hold the child and the extremity. Therapeutic holding of a child may be a necessary step for the insertion of an IV catheter. Insertion of an IV catheter can be a traumatic event for a child. Restraint of the child will reduce the length of time the child is in the stressful situation. Correct Tell the child to imagine his or her favorite activity while guiding the catheter. The nurse should help the child imagine positive images when preparing them for the insertion of an IV catheter. This imagery will help the child feel in control of the situation and improve cooperation.

Which water safety guideline is a priority for children playing in a neighborhood pool? Jump head first Use a flotation device Do not dive into water Only run while wearing shoes

Do not dive into water Parents should always check any water in which the child will play. However, children should be instructed to only jump feet first, and not dive, to prevent potential neck injury.

The parents of a preschool-aged patient report that their child moans and screams during the night. The child's eyes are open, but the child does not remember anything the next morning. What should the nurse instruct the parents to do during these episodes? Do not wake the child. Call the primary health care provider. Comfort the child since they are in obvious emotional distress. Give the child a glass of water since these symptoms are a sign of dehydration.

Do not wake the child. The child is likely having a night terror. The parents should be advised not to wake or try to comfort the child, as the child will not remember the episode in the morning.

The nurse is caring for a pediatric patient and is implementing orders to infuse an IV medication at a rate of 50 mL/hr. The nurse returns to the room 15 minutes after initiating the IV medication and finds the pump set to 75 ml/hr. What action should the nurse take? Select all that apply. Double check the prescribed rate. Check the infusion site for edema. Disconnect the infusion and flush the site. Verify the medication that is to be infused. Stop the infusion and contact the health care provider.

Double check the prescribed rate. The nurse should verify the ordered rate of the IV medication. If it was administered incorrectly, stop the infusion and notify the health care provider. Correct Check the infusion site for edema. The nurse should check the IV site for signs of edema, infection, and infiltration, a medication instilled at an incorrect higher rate may cause edema or infiltration at the IV site. Correct Disconnect the infusion and flush the site. The nurse should stop the infusion and flush the site if the rate prescribed is not the same as the rate that is set on the infusion pump. This will prevent a continuing medication error. Stop the infusion and contact the health care provider. After stopping the infusion, the nurse contacts the health care provider to inform him or her of the increased rate of medication administration and to receive further orders.

Identify fine motor capabilities for the toddler. Select all that apply. Drawing a circle Stacking blocks or toys Drinking from a sippy cup Using a spoon without difficulty Drawing a person with several body parts

Drawing a circle Drawing loops and lines (scribbling) is a fine motor skill capability of the toddler. Stacking blocks or toys Building a tower of blocks is a fine motor skill capability of the toddler. Drinking from a sippy cup By 12-18 months, the toddler should have mastered the use of a sippy cup and can use an adult cup without much spilling.

Which motor skills should be developed in the preschool child? Select all that apply. Playing hopscotch Cutting paper using safety scissors Drawing a picture of his or her home and pets Balancing on each foot for one second Riding a bicycle without training wheels

Drawing a picture of his or her home and pets Drawing objects that resemble familiar objects is a motor skill that should be developed in the preschool child. Correct Balancing on each foot for one second Balancing on each foot for one second is a motor skill that should be developed in the preschool child. Playing hopscotch The preschool child can hop on one foot and jump forward, two skills used in hopscotch.

The parents of a preschool-aged child are distressed by the child's inability to speak smoothly. The parents explain that the words seem to get stuck as they leave the child's mouth and that the child seems to have trouble putting words together. The nurse explains that this may be a form of which common speech problem in children? Echolalia Dysarthria Dysfluency Verbal impulse disorder

Dysfluency Dysfluency describes stammering and stuttering often experienced by preschool-aged children. Dysfluency may be more frequent during times of excitement, when formulating long and complex sentences, or when trying to think of a particular word. Most children grow out the problem.

Match the situation with the type of cognitive development.

Early adolescent abstract thinking Understanding bad grades will harm chances of getting into college Late adolescent abstract thinking Comprehending the importance of community recycling Adolescent logical reasoning Analyzing career paths and taking pre-emptive action

The parents of a two-and-half-year-old-patient are frustrated by their child's preference for only chicken nuggets. The nurse suggests which action(s) to help their child appreciate new tastes and encourage the consumption of a variety of foods? Select all that apply. Eat a wide variety of foods as a family. Make the child eat everything on the plate. Create routine by serving the same foods daily. Talk with the child about the foods they like most. Serve only the foods the child will agree to eat.

Eat a wide variety of foods as a family. Eating a wide variety of foods as a family will expose the child to a variety of different foods with different tastes and textures and will encourage the consumption of well-rounded diet. Talk with the child about the foods they like most. Parents should talk about different foods they enjoy eating to encourage a sense of curiosity and willingness to try a variety of foods. Parents should avoid discussing food aversions with their child.

Question 1 of 3 The nurse is preparing to administer a subcutaneous injection to a pediatric patient. Which skin abnormality would cause the nurse to avoid that site? Select all that apply. Scarring Excess fat Ecchymosis An open wound Presence of body hair

Ecchymosis Bruising at the site of injection would alter the vascular bed and would be contraindicated for subcutaneous injection. An open wound An infection at the site of injury would alter the vascular bed and would be contraindicated for subcutaneous injection. Scarring Scarring at the site of injection would indicate increased connective tissue, which would impair circulation. Impaired circulation would reduce the diffusion of the medication into the circulatory system and limit its effectiveness by decreasing the concentration in the blood.

Match the period of cognitive development with the appropriate characteristic.

Egocentric view of the world. Sensorimotor Thinking is magical and dominated by perception. Preoperational Thinking becomes logical. Concrete operational Situations can be analyzed. Formal operational

Which one of the following developmental characteristics explains why a toddler frequently uses the words me, I, and mine? Animism Ritualism Negativism Egocentrism

Egocentrism Egocentrism is when a toddler views everything in relation to self and is unable to consider another's point of view, and it explains why the predominant words in the toddler's language are me, I, and mine.

Which important anticipatory guidance would parents need to learn prior to the development of the infant's pincer grasp (around 9 months of age)? Select all that apply. Electrical outlets should be covered with socket safety panels. Parents should place stove pot handles away from the child's reach. Parents should keep unsafe objects locked out of reach of the infant. The infant's food items should be cut into small, manageable pieces. Parents should place hand protectors on the child to help protect them from injury.

Electrical outlets should be covered with socket safety panels. Six-month-old infants grasp objects with all their fingers in a raking motion, but 9-month-olds use their thumbs and forefingers which allows them to grab potentially harmful things, putting them at risk for electrical injury. Correct Parents should place stove pot handles away from the child's reach. This would be good anticipatory guidance to give a parent with a child who is 9 months old since the child will be reaching for dangerous objects when in the kitchen. Correct Parents should keep unsafe objects locked out of reach of the infant. Infants will need to be watched closely, and since they are growing in both cognitive development and motor development, this ability provides them with a wider view of the world and creates new ways to play, but this may put them in danger. Correct The infant's food items should be cut into small, manageable pieces. Nine-month-olds use their thumbs and forefingers in a fine motor skill called the pincer grasp, which allows them to grab potentially harmful things and place them in their mouth, which creates a choking hazard.

Match the Tanner stage of male sexual development with the appropriate physical description

Enlarged, pink scrotum with long straight pubic hair Tanner stage 2 Slightly curly, brown pubic hair with a penis slightly larger than a child's Tanner stage 3 Dark scrotum and enlarged glans penis Tanner stage 4 Pubic hair on inner thighs Tanner stage 5

A mother has brought in her infant for the infant's 6-month well-child checkup. You notice the infant's left eye intermittently not aligning with the right eye and an inability to focus both eyes on the same spot. What is the appropriate response? Select all that apply. Ensure the infant's "red reflex" is normal. Place the infant in isolation as this can be a sign of conjunctivitis. Do nothing, as infants do not gain extraocular eye coordination until 9 months of age. Stress the importance of eye exercises to help prevent worsening of the condition. Notify the child's provider, as extraocular eye alignment should be achieved by 6 months of age.

Ensure the infant's "red reflex" is normal. This is an important part of any pediatric eye exam. Notify the child's provider, as extraocular eye alignment should be achieved by 6 months of age. Infants under 3 to 4 months of age often lack eye coordination and alignment but should achieve proper coordination by age 4 to 6 months. By 3 months, infants should be able to track and reach for objects as their eye-hand coordination begins to develop.

The nurse is administering oral medication to a pediatric patient. How does the use of an oral syringe facilitate safe medication delivery? Ensures accurate dosing. Calculates correct dosing. Ensures complete delivery. Allow less frequent dosing.

Ensures accurate dosing. Oral syringes are calibrated for accurate dosing of oral medications and are made to look different than IV syringes.

Limit-setting

Establishment of the rules or guidelines for behavior (p 49-51, 56-59, 63)

__________ ____________ _____________ involves questioning why something is effective and whether a better approach exists. The concept also involves analyzing and translating published clinical research into the everday practice of nursing

Evidence-based practice

Which is an example of a negative influence affecting a school-aged child's food choices? Eating snacks after school Involvement in food preparation Exposure to fast food commercials Eating a wide variety of food choices at home

Exposure to fast food commercials Fast food commercials provide a negative influence affecting a school-aged child's food choices.

Which newly acquired cognitive/language milestones are achieved by the adolescent? Select all that apply. Understanding conservation Arguing a hypothesis Reversing a math problem Expressing abstract concepts Planning for college

Expressing abstract concepts The ability to think and reason abstract concepts is a cognitive/language milestone that is achieved by the adolescent. Planning for college Becoming future-oriented is a cognitive/language milestone that is achieved by the adolescent. Arguing a hypothesis Hypothesizing several solutions to a problem is a cognitive/language milestone that is achieved by the adolescent.

The nurse is assessing a 7-year-old patient who reads at a first-grade level. Which tool would the nurse use to assess the patient's pain? APPT FACES FLACC COMFORT

FACES The FACES tool is used with children older than 3 years who can understand simple phrases.

The nurse is assessing a 7-year-old. List the body systems in the order in which they would likely be assessed.

Face Neck Chest Abdomen Extremities Genitals

What is a child at the concrete operational stage able to understand? Fact vs. fiction Socialized thinking Abstract thinking Far past and far future events

Fact vs. fiction During the period of concrete operations, the child is no longer bound by perceptions and can distinguish fact from fantasy. The concept of time becomes increasingly clear during this stage, although far past and far future events remain obscure. Although reasoning powers increase rapidly during this stage, the child cannot deal with abstractions or with socialized thinking.

Blended family

Family situation that includes at least one stepparent, stepsibling, or half sibling (p 49-51, 56-59, 63)

What consequences may result if an infant's needs are ignored by the parent? Feelings of insecurity Emotional resilience An early development of independence Inappropriate survival mechanism development

Feelings of insecurity If the infant's needs are not met, the child will develop feelings of insecurity at an early age, which can continue throughout life, along with a feeling of dissatisfaction.

Why would an adolescent engage in "sexting"? Select all that apply. Fit in with peers. Attract a partner. Decrease sexual activity. Delay having sex with a partner. Make himself feel more important.

Fit in with peers. Engaging in sexting may be a way that adolescents attempt to fit in with a peer group. Correct Attract a partner. Adolescents may use sexting may as a way to gain a potential partner. Make himself feel more important. Engaging in sexting allows the adolescent to make himself feel more important. This shows they are doing something that makes them stand out.

Which characteristics are typical of the toddler's physical appearance? Select all that apply. Leaner Knees curved inward Flattened plantar arch Inward curve of the spine Mature abdominal muscles

Flattened plantar arch Toddler's feet seem flat because of a plantar fat pad that disappears around 2 years of age. This is typical of a toddler's appearance. Inward curve of the spine An exaggerated lumbar curve is typical of a toddler's appearance. Leaner Loss of adipose (fat) tissue as the toddler becomes more active is typical of a toddler's appearance.

The nurse is taking a detailed history of a preschool aged patient. Which factors are noted by the nurse as possibly affecting the growth and development of the child? Select all that apply. Family history of intestinal disorders Follows a strict gluten-free, vegan diet Attends preschool in a church built in 1932 Maternal diagnosis of type 2 diabetes during pregnancy Family living in a two-bedroom home with central air and radiant heat

Follows a strict gluten-free, vegan diet A vegetarian diet limits the amount of protein and can affect the child's physical growth. Correct Attends preschool in a church built in 1932 Old buildings are often a source of lead exposure from old paint and pipes. Exposure to lead can cause developmental delays and permanent neurologic damage. Correct Maternal diagnosis of type 2 diabetes during pregnancy Maternal history of diabetes may affect the child's growth and development.

Which person is most important to the identity development of an adolescent? Friend Sibling Mentor Parent

Friend Friends are most important to the adolescent's development of identity because peers validate acceptable behavior.

The parents of a three-year-old toddler report that the child refuses to eat dinner and will only eat once or twice a day. Which responses by the nurse are most appropriate? Select all that apply. Gather the child's weekly food history. Ask parents if child has a snack before dinner. Advise parents to offer smaller portions at mealtime. Encourage parents to offer only the child's favorite foods. Advise parents to make child sit at the table until all food has been consumed.

Gather the child's weekly food history. Nutritional consumption in children tends to balance out over a week. Advise parents to offer smaller portions at mealtime. Toddlers typically consume only two to three tablespoons at one sitting. Offering smaller portions may prevent the child from becoming overwhelmed by the food presented.

Multifactorial birth defects result because of a combination of which two factors? Genetics Economic Environment Physiological Psychological

Genetics Genetics is one of the most important factors involved in the development of multifactorial birth defects. Genetic counseling is available for parents concerned about disorders that run in families. Environment Environment is an important factor involved in understanding multifactorial birth defects. Environmental factors can play a role in prenatal and postnatal development.

A father asks the nurse for advice on caring for the teeth of his five-month-old infant who just cut the first two. Which recommendations should the nurse make? Select all that apply. Use fluoride toothpaste twice daily. Avoid sugary foods, sodas, and candy. Visit the dentist regularly for cleanings. Gently brush the teeth with a wet cloth. Do not put your baby to bed with a bottle.

Gently brush the teeth with a wet cloth. Gently brushing the teeth can help prevent tooth decay and gum disease in infants. It is important for the parent to use a soft cloth with water to rub gently while cleaning the infant's teeth. Do not put your baby to bed with a bottle. This recommendation can help reduce dental caries. If the baby is left in the crib with a bottle, the milk can coat the teeth and allow bacteria to form a biofilm and erode the tooth enamel overnight.

A parent reports concern that his or her preschool child has difficulty following directions. The nurse should recommend which actions by the parent to help the child with this task? Giving the child specific direction Telling the child he or she could do it better next time Explaining the directions in more detail next time Reminding the child that good children always listen

Giving the child specific direction The nurse should recommend the parent give specific direction because preschool children are often unable to follow directions unless they are given one step at a time.

Grading of Heart Murmurs

Grade 1 very faint, often not heard if child sits up grade 2 usually readily heard, slightly louder than grade 1. audible in all positions grade 3 - loud but not accompanied by a thrill grade 4 - loud accompanied by thrill grade 5 - loud enough to be heard with a stethoscope barely touching the chest, acconpanied by athrill grade 6 - loud enough to be heard with the stethoscope not touching the chest, often heard with a human ear close to the chest, accompanied by a thrill

The nurse is performing an initial assessment on a 4-year-old child. Before beginning the assessment, what should the nurse do? Ask the parent to hold the child Ask the parent to leave the room Have the child sit beside the parent Place the child supine on the examination table

Have the child sit beside the parent Having the child sit next to the parent during the examination allows for proper visualization and enlists the parent's help in keeping the child calm and still during the examination.

What information does the nurse need to know in order to calculate body surface area (BSA) for the pediatric patient receiving chemotherapy? Select all that apply. Age Height Weight Temperature Body mass index

Height The height of the child is required in order for the nurse to properly calculate the BSA using a nomogram. Weight The weight of the child is required in order for the nurse to properly calculate the BSA using a nomogram.

The parents of an 11-month-old infant are inquiring as to the foods they should avoid feeding their infant. The nurse should instruct the parent to avoid which foods? Select all that apply. Fish Honey Potatoes Strawberries Whole grapes

Honey Honey should be avoided until age 12 months due to the risk of botulism. Whole grapes Whole grapes should be avoided due to the risk for choking. Parents should be taught to cut all foods into small bitesize pieces.

Which fire safety recommendation is a priority for school-aged children, as it takes advantage of their developing cognitive abilities? Not to panic How to stop, drop, and roll How to use appliances safely Be familiar with fire alarm sound

How to use appliances safely How to safely use appliances is a fire safety recommendation that is priority for school-aged children. At this age, they are becoming interested in helping with chores.

When educating a caregiver about personal safety for a preschooler, which information would the nurse indicate as most important for the child to learn? The ability to run How to verbalize dissent Identification of a dangerous person Alerting other children to the danger

Identification of a dangerous person Distinguishing a stranger from a well-intentioned person is challenging and often difficult for the preschooler. Strangers are often portrayed as evil, and may not appear as such in a real-life situation. Therefore, it is appropriate to teach "stranger danger."

Which two influences on growth and development increase the risk of occurrence of multifactorial birth defects? If the child is female, the risk for multifactorial birth defects will increase. If one close relative has a severe form of the defect, then the risk for multifactorial birth defects increases. A risk for multifactorial birth defects increases if the mother has gestational diabetes. If several close relatives have the defect, whether mild or severe, it will increase the risk for multifactorial birth defects. If the mother is exposed to harmful chemicals during pregnancy, then the child is at increased risk for multifactorial birth defects.

If one close relative has a severe form of the defect, then the risk for multifactorial birth defects increases. The existence of a severe form of the defect is an important factor that will increase the risk of multifactorial birth defects in the developing fetus. If several close relatives have the defect, whether mild or severe, it will increase the risk for multifactorial birth defects. If the child has several close relatives with the defect, this is going to increase the risk of occurrence of multifactorial defects.

An adolescent reports feeling fatigued and unable to focus during the day. Which lifestyle changes can the nurse recommend for this patient? Select all that apply. Taking a nap after school Implementing a sleep routine Eating a full meal before bed Avoiding caffeine before bed Discontinuing use of electronic devices at least one hour before bedtime

Implementing a sleep routine Implementing a sleep routine can help improve sleep because it prepares the body for sleep, promotes relaxation, and helps maintain a regular sleep/wake cycle. Avoiding caffeine before bed Avoiding drinking caffeine before bed can help improve sleep. Caffeine is a stimulant and will interrupt or delay sleep. Correct Discontinuing use of electronic devices at least one hour before bedtime Discontinuing the use of electronic devices at least one hour before bedtime is a lifestyle change that the nurse can suggest to improve the patient's sleeping habits. The light from electronic devices is stimulating and interferes with melatonin release, which helps set sleep/wake cycles.

Which environmental factors may negatively affect the health of a pediatric patient? Select all that apply. Impure drinking water Limited amount of clothing Inadequate sewage facilities Disruptive sleeping conditions Damaged electrical wiring and outlets

Impure drinking water Impure drinking water can cause illness and developmental delays. Inadequate sewage facilities Inadequate sewage facilities can lead to disease as a result of exposure to feces and other contaminants. Correct Disruptive sleeping conditions Disruptive sleeping conditions can lead to sleep deprivation and delayed growth and development. Correct Damaged electrical wiring and outlets Damaged electrical wiring and outlets can lead to injuries resulting from contact with electricity or fires.

Which physical changes are experienced by boys during the adolescent years? Select all that apply. Thelarche Increased height Growth of sexual organs Increased fat deposits Growth of pubic hair

Increased height Boys experience a growth spurt beginning between ages 10½ and 16 years and ending between 13½ and 17½ years, resulting in increased height. Growth usually ceases between 18 and 20 years of age. Growth of sexual organs The growth of sexual organs, specifically the penis and testicles, occurs during adolescence. Growth of pubic hair Like adolescent girls, adolescent boys experience a growth of pubic hair.

A mother of a 10-month-old comes to the nurse concerned that her child has had two upper respiratory infections in one month and asks if something is wrong with her child. How can the nurse respond? To prevent infection the infant will need prophylactic antibiotics. Infants have an immature immune system, which makes them susceptible to infections. An infant's immune system should be developed by 6 months and so the child needs further evaluation. The infant's infections are a sign that the child will develop asthma.

Infants have an immature immune system, which makes them susceptible to infections. Telling the parent that the child has an immature immune system, making them more susceptible to infection, will be the best explanation for the nurse to give the parent. The nurse can explain to the parent that the airways are small and collapsible, making it easier for pathogens to cause an infection.

At which age should infants achieve proper eye coordination? Infants should achieve proper eye coordination by 2 weeks to 1 month. Infants should achieve proper eye coordination by 1-2 months. Infants should achieve proper eye coordination by 2 to 4 months. Infants should achieve proper eye coordination by 4 to 6 months.

Infants should achieve proper eye coordination by 4 to 6 months. Infants under 3-4 months of age often lack eye coordination and alignment but should achieve proper coordination by 4 to 6 months. By 3 months infants should be able to track and reach for objects as their eye-hand coordination begins to develop.

A mother presents to the nurse and states, "just recently my child has developed a positive, 'can-do' attitude towards all of her tasks." Based on this comment the child has recently reached which stage of psychosocial development according to Erikson? Initiative vs guilt Trust vs mistrust Identity vs role confusion Autonomy vs shame and doubt

Initiative vs guilt The initiative vs guilt stage happens during the preschool years and is a time when a child will present with a "can-do" attitude.

The nurse is assessing a 4-year-old child with a cough. After noting the child's vital signs, which action would the nurse take? Palpate the face Inspect the chest Percuss the thorax . Auscultate the lungs

Inspect the chest Chest inspection is an important assessment and would need to be performed after the child's vital signs have been determined

Place the steps of the chest examination in the order in which they are performed.

Inspection Palpation Percussion Auscultation

How does Erickson's theory of child development influence pediatric nursing? It provides a rationale for appropriate punishment of children. It provides a theoretical basis for teaching children life skills for the future. It provides a theoretical basis for the emotional care required for nursing. It provides feedback for thoroughly understanding why children may get sick.

It provides a theoretical basis for the emotional care required for nursing. Erikson's main contribution to the study of human development lies in his outline of a universal sequence of phases of psychosocial development influences. This information aids pediatric nursing by providing a framework for how to work with children of different ages and developmental levels.

Which cognitive skills are milestones for the preschool child? Select all that apply. Being able to tell time on a clock Naming five different colors correctly Knowing what tired and hungry mean Knowing what a fork and blanket are used for Speech being understandable 15% of the time

Knowing what tired and hungry mean Understanding the meaning of two adjectives is a critical cognitive milestone of the preschool child. Knowing what a fork and blanket are used for Knowing the use of two objects is a critical cognitive milestone of the preschool child.

A girl in Tanner stage 3 would be expected to exhibit which characteristics regarding breast development? Select all that apply. Breast mound elevation Mature nipple projection Lack of contour separation Areola forming secondary mound Breast and areola enlargement

Lack of contour separation A 13-year-old girl is expected to be in Tanner stage 3 of breast development, which includes no contour separation of the breast and areola. Breast and areola enlargement A 13-year-old girl is expected to be in Tanner stage 3 of breast development, which includes enlarged breast and areola.

What factors make children more vulnerable to environmental exposures? Select all that apply. Small body surface area Large body surface area Increased metabolic rate and growth Slow and gradual developing tissue in many body systems Immature and rapidly developing tissue in multiple body systems

Large body surface area Children have a larger body surface area which puts them at risk for harm caused by environmental exposures. Increased metabolic rate and growth An increase in metabolic rate and growth will make children more vulnerable to environmental exposures. Immature and rapidly developing tissue in multiple body systems Rapidly developing tissue in multiple body systems will make a child more vulnerable to environmental exposures.

A child prefers to be with friends rather than with parents. The child is demonstrating which of Kohlberg's levels of morality? The level of premorality (stage 1) The level of premorality (stage 2) Level of conventional role conformity Level of self-accepted moral principles

Level of self-accepted moral principles This is a stage that reflects a time when a child is social and will want to be with friends. The individual will develop a conscience at this stage. This stage is usually experienced by adolescents who will be social and want to spend time with friends rather than with parents.

The health care facility supplies the nurse with which tools to prevent medication errors in the pediatric population? Select all that apply. Limiting variations in drug preparation by using standardized doses. Universal procedures for drug administration facilitates proper usage. Use of kilograms for weight in all dose calculations and medical records. Dose-range software programs to provide alerts for potentially incorrect doses. Eliminating use of bar-coding technology for medications that require a nurse perform a second check.

Limiting variations in drug preparation by using standardized doses. The standardization of pediatric medications will reduce medication errors by limiting the variations in drug preparation. Correct Universal procedures for drug administration facilitates proper usage. The establishment of universal procedures for drug administration facilitates proper usage and reduces the risk of medication errors by providing a standard mechanism that is followed by all health care providers. Correct Use of kilograms for weight in all dose calculations and medical records. The use of kilogram weight in children for prescriptions, dose calculations, medical records, and staff communication will standardize communication procedures and reduce the risk of medication errors. Correct Dose-range software programs to provide alerts for potentially incorrect doses. The use of software programs to alert about incorrect doses is a protocol that will help catch medication errors.

The nurse is creating safety brochures about the prevention of poisoning for different population groups. The nurse identifies which recommendations to include for parents and caregivers of infants? Select all that apply. Lock all medication cabinets. Place all houseplants out of reach. Avoid exposure to cigarette smoke. Remove all toys made prior to 1970. Evaluate your home for lead sources.

Lock all medication cabinets. Medications should always be kept out of reach and locked to prevent accidental poisoning of infants and children. Correct Place all houseplants out of reach. Placing houseplants out of reach will prevent the ingestion of common toxic houseplants by the infant or child. Evaluate your home for lead sources. The home should be evaluated for sources of lead. High blood lead levels are associated with neurological disorders in children. Lead in old pipes and in some paint can be a source of lead in older homes.

Which statement below describes one of the ways that male physical development differs from females? Males develop increased muscle mass. Males develop increased adipose tissue. Males experience height increase of 3.15 in (8 cm)/year. Males experience an increase in body mass index.

Males develop increased muscle mass. Male physical development during adolescence differs from females by an increase in muscle mass

A nurse is aware that an antibiotic medication can be nephrotoxic. What should the nurse do to decrease the risk of toxic drug levels from developing in an 18-month-old patient? Select all that apply. Manage the hydration level of the child. Monitor antibiotic peak and trough levels. Evaluate the glomerular filtration rate daily. Examine the child for paradoxical symptoms. Ask the parents about the child's cognitive state.

Manage the hydration level of the child. Children become easily dehydrated. In a dehydrated state a drug can very easily reach toxic concentrations in a child. Monitor antibiotic peak and trough levels. The medication levels must be monitored to verify that they remain within the therapeutic range. Evaluate the glomerular filtration rate daily. The nurse should evaluate the glomerular filtration rate (GFR) of the child daily. If the GFR increases suddenly, the drug may have reached toxic levels. Ask the parents about the child's cognitive state. Parents are usually the first to notice that their child is acting "differently." If a parent reports a change in the condition of their child it could mean that the drug has reached toxic levels in the child.

A child who feels guilty about stealing a toy is demonstrating which of Kohlberg's stages of moral development? Select all that apply. Preconventional morality (stage 1) Preconventional morality (stage 2) Morality of conventional role conformity (stage 3) Morality of conventional role conformity (stage 4) Morality of self-accepted moral principles (stage 5)

Morality of conventional role conformity (stage 3) A child will start to have feelings of guilt at this stage, as they are starting to become socially sensitive. Morality of conventional role conformity (stage 4) This stage is when the child starts to have a concern for social order and begins to show respect for authority. This is exhibited by school-age children who would feel guilty about stealing a toy. Morality of self-accepted moral principles (stage 5) This reflects a time when there is a concern for what is good for all. The individual will develop a conscience at this stage.

Encourage the toddler to walk because he or she will fall down when running. Keep the toddler in a crib until 3 years of age, even if he or she tries to climb out. As motor development increases, allow the toddler to use a toothbrush unsupervised. Motor development in this age group is far ahead of development of judgment and perception.

Motor development in this age group is far ahead of development of judgment and perception. This difference in timing of the development of different skills increases the risk for injury.

Match the parental activity with the learning it fosters when preparing a child for preschool.

Motor skills Putting together a birdhouse Reading readiness Visiting a library during story time General knowledge Visiting a wildlife refuge Intellectual development Making a scrapbook

A pediatric patient cannot swallow pills. The medication order is for an enteric-coated medication. How should the nurse proceed? Notify the health care provider. Crush tablet for administration. Ask the child to chew the tablet. Administer the medication as a liquid.

Notify the health care provider. The nurse should notify the ordering provider and request the medication be changed to a different form. Medication that is enteric-coated cannot be crushed or chewed without hindering the effectiveness of the medication.

Which statement describes how nurses can use Piaget's theories in a pediatric setting? Select all that apply. Nurses can use the theories to develop teaching plans for children. Nurses can use the theories to predict health outcomes in children. Nurses can use the theories to understand the cognitive basis of fears. Nurses can use the theories to understand the physiological basis for disease. Nurses can use the theories to understand psychosexual stages of development.

Nurses can use the theories to develop teaching plans for children. With the use of Piaget's theories, nurses can understand the cognitive development of children at specific ages, which can help to educate children in an age-appropriate and developmentally appropriate way. Nurses can use the theories to predict health outcomes in children. Nurses can use Piaget's theories to understand a child's ability to cope and therefore can help to predict health outcomes in children. Nurses can use the theories to understand the cognitive basis of fears. This statement describes how nurses can use Piaget's theories to help children in a pediatric setting. Because the theories help to explain a child's thought processes, they can help the nurse understand the child's cognitive basis of fears.

The nurse is caring for an 11-month-old infant who has been diagnosed with human immunodeficiency virus (HIV). When the nurse is obtaining vital signs for the child, which actions are appropriate? Select all that apply. Obtain the temperature rectally. Observe for signs of respiratory distress. Measure apical heart rate for 60 seconds. Use a manual cuff to measure blood pressure. Auscultate lung sounds. Observe respiratory rate while the child is at play.

Observe for signs of respiratory distress. While the child is at rest, the nurse should observe for signs of respiratory distress while obtain the vitals. Measure apical heart rate for 60 seconds. Measuring apical heart rate is an important part of the assessment of a patient younger than 2 years. Use a manual cuff to measure blood pressure. Using a manual cuff while auscultating is important for obtaining an accurate blood pressure reading in a child.

An 8-year-old is seen in a clinic for a sore throat and cough. The nurse has orders to assess vital signs, auscultate lung sounds, assess the child's weight, and obtain a throat culture. Why would the nurse perform the culture last? Obtaining a throat culture is optional Obtaining a throat culture is uncomfortable Obtaining a throat culture can change the vital signs Obtaining the throat culture may change lung sounds

Obtaining a throat culture is uncomfortable The throat culture would be obtained last because it will likely be uncomfortable for the child.

Order the stage of psychosexual development as they occur in chronological order.

Oral Stage—infancy Anal Stage—toddlerhood Phallic Stage—pre-school Latency Stage—school-age Puberty—adolescence During the Oral Stage, the infant takes in and explores during the oral passive substage (first half of infancy); infant may also strike out with teeth during oral aggressive substage (latter half of infancy). During the Anal Stage, the toddler's sexual interest in the anus and control of body functions is a major feature. The Phallic Stage happens during the pre-school years. During this time, the child's genitals become the focus of sexual curiosity; superego (conscience) develops; feelings of guilt emerge. Latency is the next stage, characterized by a period of sexual repression happening during the years leading up to puberty. Finally, the Puberty Stage occurs in adolescence and is characterized by increasing hormone levels; sexual energy wells up in full force, resulting in personal and family turmoil.

Which developmental changes are expected in females beginning with menarche? Select all that apply. Regular periods Budding of breasts Ovulation Increase in progesterone Increase in estrogen

Ovulation Ovulation is expected in females beginning with menarche as reproductive maturity is achieved. Increase in estrogen An increase in estrogen is expected in females beginning with menarche as reproductive maturity is achieved.

The nurse is preparing a community program to decrease the incidence of water-related accidents and deaths. The nurse should plan to implement teaching about water-safety issues in which ways? Select all that apply. Prepare handouts with parent education about home water safety precautions. Promote education about life jacket use on boats among summer camp populations. Organize community outreach sessions and material on swimming classes for children and water safety programs. Perform inspections at community pools and condo associations to check for pool safety issues. Provide pamphlets with information on preventing drowning deaths to community pool locations.

Prepare handouts with parent education about home water safety precautions. Handouts are a good way to provide water safety recommendations. The nurse can inform parents of simple in-home water safety precautions, including guidelines such as installing toilet lid locks and never allowing a child to bathe unattended. Correct Promote education about life jacket use on boats among summer camp populations. The nurse can target certain populations, such as summer camps and other communities where children are at a higher risk for water-related accidents, to provide educational materials to address this risk. Correct Organize community outreach sessions and material on swimming classes for children and water safety programs. The nurse can plan outreach education about swimming and water safety classes. The nurse can recommend certain organizations, such as the American Red Cross and the YMCA, for assistance. Provide pamphlets with information on preventing drowning deaths to community pool locations. Providing education to those using community pools will work to decrease the rates water-related injury.

Which physical changes are normally seen as an infant transitions into a toddler? Cherub appearance A cherub appearance, resulting from excess adipose stores, is typical of an infant. This physical attribute disappears as the infant transitions into the toddler and the baby fat disappears. Correct Protruding abdomen Increased adipose tissue Excessive curve of the back Wide gap between knees when standing erect

Protruding abdomen A potbellied abdomen due to immature abdominal muscles is a normal physical change as an infant transitions into a toddler. Excessive curve of the back An exaggerated lumbar curve is a normal physical change as an infant transitions into a toddler. Correct Wide gap between knees when standing erect A gap between the knees is the result of short, bowed legs, which are a normal physical change as an infant transitions into a toddler.

The nurse is caring for a four-year-old child who drinks approximately 24 ounces of milk per day. Which nutrition recommendations below would be appropriate? Select all that apply. Provide fresh fruit Provide fresh vegetables Offer a wide variety of foods Increase the amount of red meat Decrease milk consumption to 16 ounces per day or less

Provide fresh fruit Fresh fruit would be recommended because it provides vitamins and fiber. Provide fresh vegetables Fresh vegetables provide a lot of vitamins and fiber. Healthy snacks at this age include vegetables, such as carrot sticks. Offer a wide variety of foods Offering meals and snacks that have different textures and colors helps to encourage the consumption of a wide variety of foods. Decrease milk consumption to 16 ounces per day or less Excessive intake of milk decreases consumption of other foods, with children frequently experiencing iron deficiency anemia. Decreasing milk intake should be coupled in increased water intake.

The parents of a toddler ask the nurse how to ensure their child eats a well-rounded diet. Which mealtime practices does the nurse suggest to help encourage the toddler to try a variety of new foods? Select all that apply. Spoon-feed the child. Provide whole milk daily. Offer large servings of tasty foods. Provide small portions every two to three hours. Offer varieties of a single type of food.

Provide whole milk daily. Offering 12 to 16 oz per day of whole milk provides toddlers with needed calcium, fat, and other nutrients. This approach can contribute to the consumption of a well-rounded diet. Provide small portions every two to three hours. Providing small portions is a practice that encourages toddlers to try new foods without pressure. This can contribute to the consumption of a well-rounded diet.

List five functions of play in the hospital

Provides diversion; brings about relaxation; helps child feel secure; helps lessen stress; provides a means for tension release; encourages interaction; helps develop positive attitudes; acts as an expressive outlet; provides a means for accomplishing therapeutic goals; places child in active role; gives more control and choices to the child

The parent of an eight-year-old reports that the child has trouble getting to sleep at night. Which practices should the nurse recommend to promote sleep? Delaying bedtime Reading before bed Watching a movie in the bed Keeping the room dark and quiet Limiting media exposure prior to bedtime

Reading before bed Reading before bed is a practice the nurse should recommend to promote sleep. Reading allows the child to relax and unwind. Keeping the room dark and quiet Keeping the room dark and quiet is a practice the nurse should recommend to promote sleep. Dark sleeping environments promote the release of melatonin, which helps with sleep onset. Correct Limiting media exposure prior to bedtime Limiting media exposure prior to bedtime is a practice the nurse should recommend to promote sleep. Limiting media exposure will avoid stimulating content.

How can the parent-infant attachment be strengthened immediately after birth? The mother needs to have time alone to ensure she does not overwhelm the child. A mother should cuddle with the baby but allow the child to cry alone if the baby is upset. The mother should give the infant some space to allow for natural biological development. Reciprocal interactions that include holding the child, touching the child, and speaking gently to the child.

Reciprocal interactions that include holding the child, touching the child, and speaking gently to the child. This is an example of how the parent-infant interaction can be strengthened after birth and therefore a lot of positive physical and emotional interactions between the parent and child should be encouraged.

The nurse has to give the 6-year-old patient with diabetes a dose of insulin. Which statement(s) describes what the nurse should do before administering the medication? Select all that apply. Record the time. Verify the dosage calculation and the order. Ask another nurse to double-check the medication. Administer the insulin as soon as the dose is prepared. Confirm the six rights of medication administration after receiving the medication order.

Record the time. As part of the six rights of medication administration, the nurse must ensure the patient is receiving medication at the appropriate time. The nurse must document this Correct Verify the dosage calculation and the order. The dosage calculation of the drug should be performed before administering any medication. The nurse should discuss any discrepancies in calculations with the prescribing health care provider and pharmacist. Correct Ask another nurse to double-check the medication. Insulin is a drug that requires a second nurse to check before administration, as defined by the Institute for Safe Medication Practices.

Time-out

Refinement of the practice of "sending the child to his or her room"; based on the premise of removing the reinforcer and using the strategy of unrelenting consequences (p 49-51, 56-59, 63)

Which behavior is commonly exhibited by young children experiencing a stressful situation such as hospitalization? Regression Repression Sublimation Rationalization

Regression Regression is a reaction where a child reverts to an earlier form of behavior due to a stressful situation.

A child is brought to the allergist's office for frequent congestion and watery eyes. The health care provider orders a series of allergens to be administered subcutaneously to determine the child's allergies. When the nurse administers these subcutaneous injections, which steps should be taken? Select all that apply. Massage the site of injection. Release the tissue and inject the medication. Gently pinch the subcutaneous tissue from the muscle. Insert the needle at a 45-degree angle with the bevel up using a dart motion. Apply gentle pressure to the site using dry gauze after removing the needle.

Release the tissue and inject the medication. Releasing the tissue before injecting the medication will remove pressure from the tissue allowing the medication to be safely injected. Correct Gently pinch the subcutaneous tissue from the muscle. The nurse should pinch the child's skin to raise the subcutaneous tissue from the muscle underneath. This will help prevent the needle from being inserted too deeply into the patient. Correct Insert the needle at a 45-degree angle with the bevel up using a dart motion. Inserting the needle at a 45-degree angle with the bevel up is used for subcutaneous injections in most cases. The nurse would use a dart-like motion to decrease the time of skin penetration, thereby reducing the pain felt by the patient with a subcutaneous injection. Correct Apply gentle pressure to the site using dry gauze after removing the needle. Applying gentle pressure will help stimulate clotting and prevent the medication from leaking out of the needle site.

The nurse is teaching the mother of a newborn about the prevention of infant asphyxiation. Which priority strategy does the nurse recommend the parents implement even before the infant is mobile? Remove crib decorations and fluffy bedding. Place the crib mattress at the lowest setting. Keep the baby away from any cigarette smoke. Make sure the crib slats are at least six inches apart.

Remove crib decorations and fluffy bedding. Crib decorations and fluffy bedding should be removed to reduce the risk of infant asphyxiation.

Coping strategies

Resources for dealing with stress, such as community services, social support, and the adoption of a future orientation (p 49-51, 56-59, 63)

Which task demonstrates the school-age child has progressed from intuitive thought to concrete operational stage? Retracing steps without getting lost Guessing the answer after a few tries Stating the sidewalk caused the accident Chooses favorite toy as a gift for another child

Retracing steps without getting lost Retracing steps, or reversibility, demonstrates the school-age child has progressed from intuitive thought to concrete operational stage.

An infant is in the clinic for a six-month well visit. Height and weight are in the 50th percentile. The infant can sit and shows an interest in food. Which foods should the nurse recommend the parents introduce at this stage? Yogurt mixed with bananas or mango Chopped steamed broccoli and carrots Canned chicken and beef mixed with broth Rice cereal mixed with breast milk or formula

Rice cereal mixed with breast milk or formula The nurse should recommend the parents introduce iron-fortified rice cereal mixed with breast milk or formula. This is an ideal first food that is gentle on the stomach and nutritious.

Match the safety recommendation with the activity for which it is most important.

Ride on the right side of the road with traffic Bicycle Walk across intersections Inline skates Limit to areas with no traffic Scooter Do not ride on gravel roads Skateboard

A 10-year-old with braces recently joined the soccer team. The nurse recommends use of a mouth guard for which reasons? Select all that apply. Comfort Safeguards the braces Provides barrier for teeth Enhanced functionality of braces Protection from soft tissue damage

Safeguards the braces Protection of braces is a reason the nurse would recommend wearing a mouth guard over braces. Provides barrier for teeth Protection of teeth is a reason the nurse would recommend wearing a mouth guard over braces. Protection from soft tissue damage Protection from soft tissue damage is a reason the nurse would recommend wearing a mouth guard over braces.

When caring for a toddler in the hospital, which nursing intervention is most developmentally appropriate? Not allowing the child to have a pacifier while in the hospital. Allowing the child to decide if the nurse can perform a procedure. Asking the parents to leave the room when performing an assessment. Scheduling evening medications to follow the toddler's bedtime routine.

Scheduling evening medications to follow the toddler's bedtime routine. The toddler may experience distress when a routine is not followed. The nurse can provide care in the hospital that helps support routines, if possible

A child who insists on staying home from school because they fear that something will happen to make him/her look bad in front of the other children is exhibiting which common school-age behavioral problem? Bullying Family stress School refusal Social isolation

School refusal School refusal is a common school-age behavioral problem in which a child insists on staying home instead of attending school.

Which statement can the nurse use to educate the parent on leaving a child who shows emotional distress when having to leave the parent? Separations should be accomplished swiftly without dwelling on the separation. The mother should reciprocate and show the child that she too is emotionally a bit upset. Separations should not be done too fast as this can create emotional turmoil in the child. Separations should be accomplished swiftly, and with repeated emphasis on reassuring the child that the mother will return shortly

Separations should be accomplished swiftly without dwelling on the separation. This statement suggesting the parent leave swiftly, yet with care, would help the parent-child interaction where the child is upset at leaving the mothe

The nurse makes which recommendation(s) to the parents of a three-year-old who throws a tantrum every night at bedtime? Select all that apply. Set appropriate limits. Establish a regular bedtime routine. Set a behavior expectation plan. Allow the tantrums as a sign of autonomy. Identify the triggers for the tantrums.

Set appropriate limits. Appropriate limit-setting will help the toddler better understand the boundaries with regard to his or her behavior. Correct Establish a regular bedtime routine. A regular bedtime routine will be predictable and thereby make the transition from waking to sleeping time smoother. Correct Set a behavior expectation plan. Having a behavior expectation plan in place will help the parents respond in a consistent manner to the tantrums. It shows what behaviors the parents will not tolerate and the expected consequences. Identify the triggers for the tantrums. It is important for the parents to identify specific triggers for the toddler's tantrums (eg., sleepiness) so that they can be addressed. Prevention is the best intervention

Childhood Injuries: Risk Factors

Sex—Preponderance of males; difference mainly the result of behavioral characteristics, especially aggression Temperament—Children with difficult temperament profile, especially persistence, high activity level, and negative reactions to new situations Stress—Predisposes children to increased risk taking and self-destructive behavior; general lack of self-protection Alcohol and drug use—Associated with higher incidence of motor vehicle injuries, drownings, homicides, and suicides History of previous injury—Associated with increased likelihood of another injury, especially if initial injury required hospitalization

Preschool and/or daycare programs provide a structured environment to develop which skills necessary to promote the prevention of future behavioral problems in school? Select all that apply. Sharing Reading Socialization Time management

Sharing Sharing is a skill provided by preschool or daycare programs to prevent future behavioral problems in school. Learning how to share the attention of an adult is a particularly relevant skill that daycare can impart to young children. Socialization Preschool/daycare offers a structured environment in which children can begin to learn to play with other children.

Match the crib feature with the relevant safety recommendation

Slats Must be <2 3/8 inches (6 cm) apart Surface No lead based paint Drop side Child proof Decoration Not recommended

The nurse is providing patient teaching to the family of a young child with asthma. The nurse would instruct the parents on the correct use of which piece of equipment to increase the effectiveness of a metered-dose inhaler? Mask Spacer Nebulizer Flutter valve

Spacer The use of a spacer can increase the effectiveness of administration with a metered dose inhaler because it allows the child time to deeply inhale the medication.

The father of an eight-month-old reports that the infant cries and clings to its mother when new friends or unfamiliar relatives visit the home. The nurse explains that this reaction is most likely caused by which? Colic Sleepiness Stranger anxiety Anxiety disorder

Stranger anxiety Stranger anxiety is the most likely cause for this infant behavior. By six to seven months of age, infants develop a fear of unfamiliar people, and this peaks around seven to nine months and often resurfaces again during toddlerhood.

The mother of an infant reports that her husband smokes but only smokes outside. She also states that the infant sleeps in a co-sleeper, with a light blanket and a stuffed bear. The nurse identifies which risk factor(s) for SIDS as high priority? Select all that apply. Smoking Co-sleeper Light blanket Stuffed animals Baby sleeping prone

Stuffed animals Nothing plush should be in the baby's sleeping area because of the risk of becoming trapped in the soft material and being unable to breathe or free themselves. Baby sleeping prone Infants should not be allowed to sleep on their abdomen. Sleeping supine, on their backs reduces the risk of SIDS.

The nurse is caring for a pediatric patient who is to receive oral pain medication. The patient's parents indicate that the patient has had trouble swallowing capsules in the past. Which forms of medication may the nurse request? Select all that apply. Elixir Tablet Injection Suspension Chewable tablet Sprinkle (powder)

Suspension If a child is unable to swallow a capsule, then a suspension is an acceptable alternative form for medication administration. A suspension is a liquid form of medication which is easily swallowed. Chewable tablet If a child is unable to swallow a capsule, then a chewable tablet is an acceptable alternative form for medication administration. Chewable tablets allow the child to break down the medication into a size that may be swallowed. Sprinkle (powder) If a child is unable to swallow a capsule, then a sprinkle (powder) is an acceptable alternative form for medication administration. A powder can be placed in a food such as applesauce, which will allow the child to ingest the medication. Elixir If a child is unable to swallow a capsule, then an elixir is an acceptable alternative form for medication administration. An elixir is a liquid and is easily swallowed compared with a capsule.

Match the infant age with the most appropriate developmental action.

Takes one or two naps 12 months old Can begin to self-soothe Four months old Sleeps 16 hours per day Newborn Consistently sleeps all night Six months

The nurse is teaching the mother of a toddler about safety precautions necessary to prevent accidents and injuries. The nurse determines that the teaching has been effective when the mother identifies which situation(s) as requiring close supervision? Select all that apply. Taking a nap Taking a bath Taking medicine Climbing a tree Helping to cook in the kitchen

Taking a bath Infants, toddlers, and young children should be watched closely throughout their baths to prevent drowning. It takes only seconds to drown in only one inch of water. Correct Taking medicine Taking medicine is a situation that warrants close supervision. Children should be given medicine by a parent or another responsible adult. In addition, parents should be sure all medications and poisonous items are kept securely in a locked medicine box or cabinet. Correct Climbing a tree Toddlers should be watched closely when they are climbing. Toddlers are curious and as their gross motor skills increase, they are often eager to climb, making them prone to falls. Providing effective supervision is an excellent way to let children grow and explore yet keep them safe. Correct Helping to cook in the kitchen Helping prepare food is a situation that warrants close supervision. Toddlers and small children should not be left alone in the kitchen or around hot water to prevent thermal injuries such as scalds and burns.

The nurse is teaching first time parents about techniques to soothe infant irritability. Which suggestions should the nurse include? Select all that apply. Feeding the infant formula Taking the baby for a car ride Swinging the baby in an infant swing Engaging the infant in an educational TV show Carrying the infant in a front pack close to the parent's chest

Taking the baby for a car ride Taking the baby for a car ride may soothe infant irritability. Infants are often soothed by constant motion. Swinging the baby in an infant swing Swinging the baby in an infant swing may help soothe infant irritability. Infants are often soothed by constant motion. Carrying the infant in a front pack close to the parent's chest Carrying the infant in a front pack close to the parent's chest may help soothe infant irritability. Infants are often soothed by constant motion as well as being close to the parent.

While taking a history from an adolescent with behavioral problems, the nurse learns that the adolescent has a fondness for violent activities and physical punishment is used at home. Which safety recommendation takes priority when addressing the adolescent's violence risk? Teach alternatives to physical punishment. Restrict movies and shows with adult content. Minimize time allowed playing shooting sports. Eliminate computerized games featuring fighting.

Teach alternatives to physical punishment. Exposure to violence in the house not only puts the adolescent in danger, but increases the likelihood that the adolescent will be violent. Changing this pattern is the priority recommendation.

A preschooler left alone in the kitchen wants to help their mother cook. The child ignites the stove, which results in a small fire. Which simple rules relating to fire safety can prevent injury in this situation? Select all that apply. Teach the child about smoke alarms and sounds. Teach the child to stop, drop, and roll if clothes catch on fire. Adult chores such as ironing and cooking are not to be performed by the preschooler. Allow the child to only observe rather than participate in the kitchen when doing the cooking. Adult chores such as ironing and cooking can be performed by the preschooler as long as the heat is kept to a low level.

Teach the child about smoke alarms and sounds. Teaching a preschooler about smoke alarms and their sounds is an important action that can help prevent injuries in a fire. Teach the child to stop, drop, and roll if clothes catch on fire. Teaching a preschooler how to stop, drop, and roll is an important action that can help prevent injuries in a fire. Adult chores such as ironing and cooking are not to be performed by the preschooler. In order to help prevent injuries a preschooler should not be permitted to iron or cook.

Which role does the nurse play in toilet training? Select all that apply. Explaining Piaget's and Freud's stages of development Teaching parents the importance of physical readiness Providing the parents with one-on-one toilet training coaching Making home visits to ensure the child is reaching appropriate milestones Teaching the parents about developmental signs of toilet training readiness

Teaching parents the importance of physical readiness There are physical and psychological signs of readiness that the nurse can explain to the parents, such as voluntary control of the bladder and bowel and recognition of the need to void. This will help the parents determine when their child is ready and will decrease frustration. Teaching the parents about developmental signs of toilet training readiness The nurse can inform the parents of physical and psychological signs of readiness, such as the child showing interest in the toilet or the child disliking a wet or soiled diaper.

The parents of a six-month-old infant report excessive drooling, fussiness, and loss of appetite. Which practices should the nurse recommend that may relieve these symptoms? Select all that apply. Popsicles Hard candy Teething ring Frozen bagels Clean wet washcloth

Teething ring A teething ring may be soothing to a teething infant. The cold is likely soothing to inflamed gums. Correct Frozen bagels Providing frozen foods can help relieve a child's discomfort by soothing inflamed gums. Ensure parents avoid foods that might be choking hazards. Correct Clean wet washcloth A clean wet washcloth may provide relief to a teething infant. Often chewing is soothing for teething infants.

Which instructions could the nurse provide to parents to encourage self-esteem of the school-age child? Select all that apply. Complete her homework so she can get good grades. Tell her "I love you" and give her a hug before leaving. Give her a chore chart with things she can do each day. Encourage her to do better by pointing out all mistakes. Allow her to solve problems and make responsible choices.

Tell her "I love you" and give her a hug before leaving. Instructing the parents to provide demonstrative love is important to encouraging self-esteem of the school-age child. Correct Give her a chore chart with things she can do each day. Giving her chores she can accomplish develops a sense of industry and is important to encouraging self-esteem of the school-age child. Allow her to solve problems and make responsible choices. Allowing the child to solve problems and make responsible choices are important to encouraging self-esteem of the school-age child.

Which approach should the nurse use when engaging a pediatric patient in the medication administration process? Select all that apply. Tell the child if a medication may have an unpleasant taste. Describe how long an injection site might be uncomfortable. Leave injection sites uncovered so the child can see the skin. Describe how the child can help during medication administration. Offer words of support and encouragement to the child for any cooperative behaviors.

Tell the child if a medication may have an unpleasant taste. The child should be told what to expect from an oral medication. This knowledge should include how the medication will taste. The nurse should be truthful with the child to gain their trust. Describe how long an injection site might be uncomfortable. The nurse should explain if the procedure will be painful. The nurse should use familiar words such as "pinching" or "stinging" to describe what the child will feel. The nurse should be truthful with the child to gain his or her trust. Describe how the child can help during medication administration. The child should be involved in the medication delivery process. This will help the child feel in control of the situation. Offer words of support and encouragement to the child for any cooperative behaviors. Praising, cuddling, and offering rewards after procedures are beneficial.

The parent of a two-and-a-half-year-old with 19 teeth reports that they do not have fluoridated city water at home and do not have access to a dentist for preventative care. Which actions should the nurse take? Tell the parents to apply a topical fluoride varnish daily. Tell the parents to apply a topical fluoride varnish every six months. Recommend that the parents give the child an oral supplement of 0.5 mg of fluoride daily. Recommend that the parents give the child an oral supplement of 0.25 mg of fluoride daily. Recommend that the parents give the child and oral supplement of 0.5 mg of fluoride every six months.

Tell the parents to apply a topical fluoride varnish every six months. The application of fluoride varnish should be every three to six months during early childhood if the child does not have access to a dentist. Recommend that the parents give the child an oral supplement of 0.25 mg of fluoride daily. A supplement containing 0.25 mg of fluoride is recommended for children without access to fluoridated water.

The parent of a toddler reports that the two-year-old sometimes screams and hits himself in the head with a toy when it is close to bedtime. How would the nurse describe this behavior? Acting out Temper tantrum Tourette's syndrome Developmental disability

Temper tantrum This child is having a temper tantrum, which is a common behavior pattern seen in toddlers. Children of this age lack the verbal ability to express themselves well or to reason with parents and often resort to tantrums and aggressive outbursts.

A pre-adolescent male can expect physical changes to occur in which order?

Testicular enlargement Growth of pubic hair Penile enlargement Deeper voice Axillary hair Facial hair Boys first experience testicular enlargement, followed in approximately 1 year by penile enlargement. Pubic hair precedes the growth of the penis. The voice begins to deepen in Tanner stage 3 and 4, after penile enlargement. Axillary hair develops followed by facial hair.

The nurse administers acetaminophen to a group of pediatric patients. Which patient will experience the therapeutic effects of the medication last? The 3-month-old infant experiencing colic pain. The 10-month-old infant with constipation and nausea. The 16-month-old infant who just finished a cup of milk. The 6-month-old infant with gastroesophageal reflux disease (GERD).

The 3-month-old infant experiencing colic pain. Gastric emptying in infants tends to be intermittent and unpredictable causing the drug to reach the intestinal absorption site slowly when compared to other age groups, pancreatic enzyme activity tends to be unreliable, and gastric acidity tends to be more alkaline. Combined, these factors cause the drug to be absorbed more slowly and take effect more slowly.

The nurse is administering medication to a group of pediatric patients. The nurse recognizes that which patient is at the highest risk of experiencing a medication-related adverse event? The 4-month-old infant admitted for diarrhea and vomiting. The 3-year-old child admitted for mononucleosis and fever. The 16-month-old child admitted for strep throat and enlarged tonsils. The 4-year-old child admitted with failure-to-thrive and malnutrition.

The 4-month-old infant admitted for diarrhea and vomiting. Dehydration in a child this young is a serious risk factor for medication-related adverse events because the drugs will be very concentrated. The child is both losing fluid and unable to take in fluid. In such a small child, fluid loss quickly becomes dangerous.

Which situation best describes a 6-month-old's ability to maintain a standing position? The 6-month-old will kick slightly to avoid bearing weight. The 6-month-old will stand on his or her own and bear full weight. The 6-month-old can bear significant weight when held in a standing position. The 6-month-old's knees will bend and they will bear no significant weight.

The 6-month-old can bear significant weight when held in a standing position. At 6 months the baby's muscles are developing and have reached a point where they are strong enough to allow the baby to bear significant weight when held in the standing position.

How does the ability for a 24-month-old to build a two-block tower demonstrate a toddler's fine motor development? The ability to stack one block on top of another demonstrates an improvement in the toddler's balance. The ability to stack one block on top of another demonstrates an improvement in the toddler's autonomy. The ability to stack one block on top of another demonstrates an improvement in the toddler's visual acuity. The ability to stack one block on top of another demonstrates an improvement in a toddler's hand-eye coordination.

The ability to stack one block on top of another demonstrates an improvement in a toddler's hand-eye coordination. An improvement in a toddler's hand-eye coordination is typical at this stage and stacking blocks demonstrates development of fine motor skills.

An adolescent reports following the juicing diet in order to lose weight. The adolescent complains about being hungry even after juicing. What should the nurse tell the adolescent about their hunger? The body is trying to adjust. The body needs more calories. The adolescent should juice more often to satiate hunger. The body needs more protein during the juicing process.

The body needs more calories. The adolescent needs more calories because of their accelerated growth. The nurse should educate about healthy eating practices, including adding more healthy calories to the diet to address the hunger.

Why is an understanding of motor development important for keeping a child safe when an infant's mobility increases around 10 months of age? Select all that apply. The child has no understanding of consequences. The child has a clear understanding of boundaries. The child now has an increased ability to move about. The child now has a naturally increased level of curiosity. The child now has an increased ability to reach for objects

The child now has an increased ability to move about. An increased ability to move about, reach objects, and explore their world places infants at great risk for accidents and injury. The child now has a naturally increased level of curiosity. Now that they child can grab at objects, heavy containers will become a hazard. An increased ability to move about, reach objects, and explore their world places infants at greater risk for accidents and injury. The child now has an increased ability to reach for objects. They now have the ability to grasp things and an increased ability to move about, reach objects, and explore their world, placing infants at greater risk for accidents and injury. The child has no understanding of consequences. An increased level of curiosity without the cognitive ability to understand consequences puts the infant at great risk for accidents and injury.

The pediatric nurse is teaching a new nurse how to recognize signs that a toddler is ready for toilet training. The nurse includes which indicators as signs of readiness for toilet training? Select all that apply. The child shows an interest in toilets and putty chairs. The child is able to pull up and remove his or her pants. The child is eager to please the parents with a dry diaper. The child notices his or her own wet diaper and may try to remove it. When placed on the toilet, the child will sit for a short time.

The child shows an interest in toilets and putty chairs. It is a sign of readiness when the toddler shows an interest in the toilet and how it works. This shows that the child may be ready to learn about the process and practice of using the toilet or potty chair. Correct The child is able to pull up and remove his or her pants. This demonstrates physical maturation and is one sign of readiness for toilet training. Correct The child is eager to please the parents with a dry diaper. This scenario reflects readiness for toilet training, since the child is showing signs of psychological maturation as well as the physical ability to hold their urine for a while. Correct The child notices his or her own wet diaper and may try to remove it. This reflects readiness for toilet training because the child understands the difference between being wet and dry and shows a preference for being clean and dry.

Which behavior observed by the nurse represents normal social development of the preschool child? Select all that apply. The child steals a toy from another child. The child is playing a game with another child. The child is arguing about the rules of the game. The child blames a mess on an imaginary friend. Plays alone, away from other children in the group.

The child steals a toy from another child. Although preschoolers may begin to play with other children, they are still primarily egocentric and have difficulty understanding the morality of right and wrong. The child is playing a game with another child. Cooperative play is a normal social development of the preschool child. The child is arguing about the rules of the game. Arguing about the rules of a game represents normal social development of the preschool child because preschool children will become more argumentative as they become secure in their group. The child blames a mess on an imaginary friend. Imaginary friends are common to preschool-aged children. The preschooler often uses imaginary friends to take the blame for misbehavior.

Which aspect of ear development leads to increased susceptibility to ear infections during the first two years of life? The eustachian tube is short and horizontal. The external acoustic meatus is short and vertical. The auricle is narrow and can block the eustachian tube. The outer tympanic membrane is porous and not highly vascularized.

The eustachian tube is short and horizontal. The eustachian tube is short and horizontal in children, making them more prone to infection. The eustachian tube connects to the middle ear and provides air and drains fluid, which helps to fight infection.

Which statement reflects the consequence of a mother suffering from postpartum depression in regard to an infant's psychosocial development? The child will not be affected by the mother's depression. The infant will develop empathy and respond to the mother's sadness. The infant will develop a preference for other caregivers and may avoid eye contact until two years of age. The infant will struggle to develop the basic sense of trust that the infant's needs will be met and instead develop a sense of suspicion or mistrust.

The infant will struggle to develop the basic sense of trust that the infant's needs will be met and instead develop a sense of suspicion or mistrust. The child needs to develop a sense of trust with the mother and the mother's depression will interfere in the positive reciprocal process that enables psychosocial development in the infant.

A mother calls the clinic and states that upon giving her 18-month-old child a prescribed medication, the child has become hyperactive. Her older child takes the same medication and it makes her sleepy. Which physiological mechanism(s) describes the differences in the children's responses to the medicine? Select all that apply. The liver's metabolism of drugs can differ by age. The medication is able to access the brain of the older child faster. Plasma proteins are higher in concentration in a young child because of the smaller blood volume. The body fluid of older children is a larger percentage of body weight resulting in drug dilution. The development of the nervous system is not complete, resulting in different reactions in children of different ages.

The liver's metabolism of drugs can differ by age. The metabolic enzyme systems in the liver are immature in young children, which can lead to differences in the metabolism of the medication. In a young child, all of the drug may not be metabolized resulting in a higher concentration of the drug in the blood. The development of the nervous system is not complete, resulting in different reactions in children of different ages. The immaturity of the infants' and toddlers' nervous system can lead to paradoxical effects in infants and toddlers compared to the same drug's effects in older children.

A young child explains to the nurse that her uncle often hits her on the bottom when she misbehaves. Which information is the most important for the nurse obtain from the child before action is taken? The age of the uncle How well the child knows the uncle The timing and frequency of physical contact The nature and circumstances of the physical contact

The nature and circumstances of the physical contact Preventing sexual abuse begins with teaching children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior. A spanking, while not encouraged, should be distinguished from sexual contact.

The nurse is assessing a newborn and notes that the head circumference is 13 inches and the chest circumference is 11 inches. What conclusion can be made by the nurse about this ratio? The newborn has a cardiovascular anomaly. The newborn is presenting with a normal growth pattern. The newborn is at risk of having microcephaly and neuro referral is needed. The child may have a developmental delay as the head should be at least 17 inches at birth. .

The newborn is presenting with a normal growth pattern. The chest circumference of newborns is often smaller than the head circumference and therefore this is a normal presentation at birth.

The nurse is administering medications to a group of pediatric patients. The nurse recognizes that which child is at the highest risk for experiencing an adverse medication reaction? The 6-month-old infant being treated with topical cortisone. The 2-month-old infant receiving a dose of oral acetaminophen. The premature newborn receiving a dose of intravenous amoxicillin. The 18-month-old child being injected with a newly developed vaccine.

The premature newborn receiving a dose of intravenous amoxicillin. Smaller, younger babies do not metabolize drugs in the same manner as older infants, children, or adults due to differences in physiology. These differences are most striking in the premature newborn.

A mother brings her 5-month-old infant to the clinic and is concerned that the child does not seem to smile as much as her niece, who is the same age. How will the nurse respond? This is normal as you can expect to see a smile at 6 months of age. All children start to smile at a different age, so be patient. There is no need to worry. This is a concern since the child should be showing a social smile by no later than 1 month of age. This is a concern since the child should be showing a social smile by no later than 3 months of age.

This is a concern since the child should be showing a social smile by no later than 3 months of age. Since the child should be showing a social smile by no later than 3 months, this is the correct response that the nurse should make to this parent.

Which behaviors are expected in the toddler? Select all that apply. Throwing tantrums Crying when the toddler's parent leaves for work Developing a sense that bad behavior is punished Insisting on same book being read every morning Feeling guilty when they steal a toy from another child

Throwing tantrums Negativism, or saying "no" to requests, is an expected behavior in toddlers and is a way that they can test their independence and boundaries. In extreme cases, it can lead to screaming, kicking, hitting, biting, or breath-holding. Crying when the toddler's parent leaves for work Crying when a parent leaves, or separation anxiety, is an expected behavior in the toddler. Developing a sense that bad behavior is punished Controlling behavior to avoid punishment is an expected behavior in the toddler. Insisting on same book being read every morning Reading the same book, or ritualism, is an expected behavior in the toddler.

Why are age-appropriate growth parameters (height, weight, head circumference) measured and plotted at each well-child visit? Select all that apply. To help monitor neurological development To help evaluate basal metabolic rate (BMR) To predict the amount of fat cells gained yearly To calculate body mass index (BMI) in children over 2 years of age To monitor changes in growth rates, which can indicate an underlying health problem

To help monitor neurological development Head circumference in children less than 2 years of age is used to assess the growth of the skull as it accommodates the growing brain. To help evaluate basal metabolic rate (BMR) Evaluating a child's basal metabolic rate can help in understanding his or her growth and development. To calculate body mass index (BMI) in children over 2 years of age Calculating body mass index can be a helpful indicator for health status in children and adolescence. Height and weight measurements for children over the age of 2 are used in the BMI calculation to assess for the child being underweight, overweight, or obese. To monitor changes in growth rates, which can indicate an underlying health problem Since a child's growth is expected to follow certain milestones, a failure to meet these milestones can be an indicator of a long-term or chronic underlying health problem.

Why is a booster seat recommended for preschool aged children rather than car seatbelts? To provide a better view So the parent can see the child To minimize harm to the child To keep the child upright while asleep in the vehicle

To minimize harm to the child The booster seat places the child in a position where the safety belt is not around the face, neck, or midabdomen. Without it, the seatbelt is improperly placed and can cause harm to the child.

The parents of a four-year-old patient are concerned about their child's stuttering. The nurse should advise the parents to take which actions to address this problem? Talk for the child Encourage the child not to speak Correct the stutter whenever it occurs Try to focus on the child's ideas, not the stutter

Try to focus on the child's ideas, not the stutter The nurse should advise the parents to try to focus on the child's ideas, not the stutter. This helps to minimize the stress.

Which safety recommendation for burn prevention is the most important to provide to the parents of an active three-year-old? Keep the household water lukewarm. Monitor the barbecue grill closely while cooking. Use a fireplace screen when you have a fire in the fireplace. Turn pot handles toward the center of the stovetop when you are cooking.

Turn pot handles toward the center of the stovetop when you are cooking. Turning pot handles inward toward the center of the stovetop will reduce the likelihood of a toddler reaching up to grab a heated pot and injuring himself or herself. This is a common source of injury. This recommendation is the most important because it most directly prevents burns and scalding in toddlers.

An infant is prescribed nasal drops by the primary health care provider. Which actions should the nurse take to ensure proper delivery of the medication? Select all that apply. Hold the infant in a semi-upright position. Use a calm voice to help the infant relax. Obtain assistance in restraining the child. Remove any excess mucus with a bulb syringe. Hold the infant's nose after administration to ensure adequate delivery.

Use a calm voice to help the infant relax. Using a calm voice helps the baby know how to react to a disturbing event and can increase the likelihood that the infant remains still during administration. Correct Obtain assistance in restraining the child. The restraining of a child is not always necessary, but may be necessary if efforts getting the child to cooperate fail. Correct Remove any excess mucus with a bulb syringe. The removal of excess mucus from the nares is essential for preparing an infant to receive nasal medication because it will allow the medication access to the mucus membranes.

The nurse is providing safety teaching in an infant care class for pregnant first-time mothers and their partners. Which safety recommendation is the priority to include? Use a rear-facing infant car seat Place a lock on every toilet bowl Lock medications out from reach Install covers on electrical sockets

Use a rear-facing infant car seat The highest priority recommendation is to use a rear-facing infant car seat with a three or five-point harness, which should be placed in the back seat. This will be needed immediately upon leaving the hospital.

Which safety recommendation is a priority for the adolescent who reports previously drinking alcohol at a party? Use a ride-home agreement Drive slowly on secondary roads Do not use the phone while driving Call parents on arrival to the destination

Use a ride-home agreement A ride-home agreement is a priority safety recommendation for the adolescent who has previously used alcohol at a party. A ride-home agreement assures the adolescent may get home safely without fearing parental punishment.

The mother of a six-month-old infant states that she puts the baby to bed in a crib under a single blanket on a firm mattress and offers a pacifier. She indicates that the baby often rolls over to prone position once asleep. What should the nurse identify as the unsafe sleeping practice for this infant? Use of a blanket in the crib Offering a pacifier for sleep Sleeping on a firm mattress Rolling to prone positioning

Use of a blanket in the crib The nurse should identify having a blanket in the crib as an unsafe sleeping practice for this infant. There is a potential of suffocation or rebreathing decreased oxygen levels if the blanket were to cover the infant's face.

The nurse is teaching new parents about motor vehicle safety recommendations for their new baby. Place the safety recommendations in chronological order, starting with those necessary for a newborn.

Use the back seat with a three point seat belt. Use a rear-facing car seat with three or five-point harness. Use a front-facing car seat with three or five-point harness. Use a forward facing car or booster seat in the back seat. The first recommendation is to use a rear-facing car seat with three or five-point harness until age 24 months or until the child outgrows the seat. Children should use a car seat with harness until they reach the upper limits of the manufacturers' recommendations, then remain in a booster seat as long as possible. Children under the age of 13 years should not sit in the front seat if there is a passenger airbag, due to risk of injury.

A nurse is ordered to administer oral pain medication to a 5-year-old patient who is newly admitted after a vehicle accident. Which action is least likely to help the nurse prevent medication errors? Use the medication calculations provided by the pharmacy. Describe in detail the medication procedure to the child's caregivers. Ask the patient's caregivers which medications the child typically takes at home. Administer high-risk medications after verifying the prescribed dose with another nurse.

Use the medication calculations provided by the pharmacy. The nurse should always perform an independent double-check of the medication calculations to ensure accuracy and should not rely on calculations provided by the pharmacy. The nurse should discuss any discrepancies with the healthcare provider or pharmacist.

The nurse is preparing to administer prescribed oral medication to a 3-month-old patient. How should the nurse administer this medication? Place the infant on his or her back prior to administering medication. Hold the infant with the dominant hand to ensure the child does not move. Using a nipple, wait for the infant to begin sucking before adding the medication. Using a teaspoon, place the medication into the mouth along the side of the cheek.

Using a nipple, wait for the infant to begin sucking before adding the medication. The infant should be encouraged to begin sucking the empty nipple and only afterward should the medication be added. By waiting until the infant is sucking the nurse can ensure that the infant is able to feed.

A new mother reports that the baby is sleeping next to her own bed in a bassinet with a small pillow. She reports laying the baby on the back to sleep and says she has banned cigarette smoking in the house. The nurse identifies which practice as putting the baby at risk for SIDS? Banning smoking in the house Sleeping in the room with mom Using a small pillow in the bassinet Placing the baby on the back to sleep

Using a small pillow in the bassinet Using a pillow in the bassinet places the baby at risk. There should not be anything soft or loose in the crib with the baby.

A nurse receives an order that specifies IV bolus for a medication. What is the first step the nurse should take to administer this medication? Verify the administration rate for the medication. Verify the medication can safely be given as an IV bolus. Verify the medication compatibility with the IV solution being used. Verify the amount of flush needed following administration of the medication.

Verify the medication can safely be given as an IV bolus. The first step the nurse should take is to verify that the medication can be safely administered as an IV bolus. Some medications delivered via IV can be delivered as a bolus or intermittent infusion. It is important that the nurse verify the method of administration.

The nurse receives orders to administer eye drops to a young patient. What is the correct order for the steps involved?

Wash hands and don gloves. Gently wipe the child's eye with a sterile gauze pad. Shake the medication. Instill drops into the conjunctival sac. Correct Answer Exactly! The nurse should first perform hand hygiene and don gloves. Next the nurse should remove any exudates from the child's eye with a sterile gauze pad. The nurse should use a different pad for each eye and move from the inner to outer canthus when wiping the eye. The suspensions should be mixed well before applying to eye. Finally, the eye drops will be instilled into the conjunctival sac of the child's eye.

biologic development of toddlers

Weight gain slows to 4 to 6 pounds per year Birth weight should be quadrupled by 2½ years of age Height increases about 3 inches per year Growth is "steplike" rather than "linear" specific taste and texture preferences develop voluntary elimination acidity of Gi increases learns to control body temp. can maintain it, shiver production of antibodies is established

A newborn is placed under a radiant heat warmer. The nurse knows that thermoregulation presents a problem for newborns because __________. their renal function is not fully developed, and heat is lost in the urine their small body surface area favors more rapid heat loss than does an adult's body surface area they have a relatively thin layer of subcutaneous fat that provides poor insulation their normal flexed posture favors heat loss through perspiration

Well, interim history The well, interim history is conducted when the patient has no current complaints to gather data about occurrences since the last checkup.

When helping parents select activities for the convalescing hospitalized child, the nurse should recommend: a. simpler activities than would normally be chosen. b. new toys and games to help distract the child. c. challenging new games to keep the child engaged. d. games that can be played with adults.

When helping parents select activities for the convalescing hospitalized child, the nurse should recommend: a. simpler activities than would normally be chosen. b. new toys and games to help distract the child. c. challenging new games to keep the child engaged. d. games that can be played with adults. a. simpler activities than would normally be chosen. often don't have energy to cope with more challenging activities

Which are the best resources to find an appropriate growth chart in assessing growth for a 1-year-old child? Food and Drug Administration growth chart American Academy of Pediatrics growth chart Center for Disease Control (CDC) growth charts for this age group World Health Organization (WHO) growth standards for this age group

World Health Organization (WHO) growth standards for this age group The CDC recommends that health care providers use the World Health Organization (WHO) growth standards to monitor growth for infants and children ages 0 to 2 years of age and the CDC growth charts for children age 2 years and older. The reason is that the data collected for the WHO growth charts represent infants and children who were breastfed during their first year of life, and this is considered to be the optimal standard of measurement for comparison.

A student nurse is learning the best way to measure the head circumference of an infant. Which is the appropriate advice? Measure across the pinna and over the broadest part of the parietal bone Wrap a no-stretch measuring tape above the supraorbital ridges and over the most prominent part of the occiput Wrap a no-stretch measuring tape around the forehead, across the temporal bone, and over the least prominent part of the occiput Wrap a no-stretch measuring tape across the widest part of the zygomatic arch and around the least prominent part of the occiput

Wrap a no-stretch measuring tape above the supraorbital ridges and over the most prominent part of the occiput If a student nurse is learning about the correct way to measure an infant's head, this would be the correct advice to give them. An infant's head is measured with a no-stretch measuring tape wrapped above the supraorbital ridges and over the most prominent part of the occiput.

What are potential adverse effects when adolescents do not use sunscreen? Select all that apply. Wrinkles Melanoma Facial acne Facial scars Contact dermatitis

Wrinkles Sun damage in the form of wrinkles (premature aging) is an adverse effect that can result when adolescents do not use sunscreen. Correct Melanoma Melanoma (among other skin cancers) is an adverse effect of long-term sun damage.

The nurse is caring for an 8-month-old patient who has had surgery. Why is repeated pain assessment important for this patient? Younger children hide their pain well. Younger children do not express pain externally. Young children are most at risk for receiving insufficient pain medications. Younger children experience pain more frequently than older children and adults.

Young children are most at risk for receiving insufficient pain medications. Young children cannot verbalize pain; thus pain management may be insufficient. This is why a repeated pain assessment is needed.

A mother questions the nurse about motor skills she should expect to see in her 9-year-old child. Which response by the nurse is appropriate? There are no new motor skills you should expect. It is normal for your child to need help zipping a jacket. Your child has fine motor control similar to an adult. School-age children have trouble with hand-eye coordinatio

Your child has fine motor control similar to an adult. This is the appropriate response because 8-11-year-olds have fine motor control similar to adults.

single parent family

a family in which only one parent is present to care for the children

extended family

a household that includes at least one parent and child as well as other members (related or not) like grandparents, aunts, uncles, and cousins relations may be adoptive, biologic, step, foster

Two basic concepts in philosophy of family-centered nursing care are: a) enabling and empowerment b) empowerment and bias c) enabling and curing d) empowerment and self-control

a) enabling and empowerment

At Sara's next well-baby visit, what information will be most important to document in the chart? a) written evidence of progress toward outcomes b) the standard plan of care c) broad-based goals d) interventions applicable to patients like Sara

a) written evidence of progress toward outcomes

The best example of adequate documentation of a child's food intake would be: a. "Child ate one bowl of cereal with milk." b. "Child ate an adequate breakfast." c. "Child ate 80% of the breakfast served." d. "Parent states that child ate an adequate breakfast."

a. "Child ate one bowl of cereal with milk."

During the physical examination of a child, which of the following physical findings could be consistent with excess carbohydrate nutrition? a. Caries. b. Skin elastic and firm. c. Hair stringy, friable, dull, and dry. d. Enlarged thyroid.

a. Caries.

Growth and development during middle adolescence includes which one of the following a. Characeterized by a transition to a dominant peer orientation b. Characterized by the changes of puberty and the responses to those changes c. Characterized by the taking on of adult roles d. Characterized by excellent conflict resolution over parental control

a. Characeterized by a transition to a dominant peer orientation

Which one of the following behavioral pain measures includes five categories of behavior and uses a scoring system to quantify pain behaviors, with 0 being no pain behaviors and 10 being the most possible pain behaviors? a. FLACC Pain Assessment Tool (Facial expression, Leg movement, Activity, Cry, and Consolability). b. Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). c. COMFORT scale. d. All of the above.

a. FLACC Pain Assessment Tool (Facial expression, Leg movement, Activity, Cry, and Consolability).

The nurse is assessing the mouth and throat of 7-month-old Alex. Which of the following is recognized as a normal finding? a. Membranes are bright pink, smooth, and glistening. b. White curdy plaques are located on the tongue. c. Redness and puffiness are present along the gum line. d. Tip of the tongue extends to the gum line.

a. Membranes are bright pink, smooth, and glistening.

Tommy is brought in by his father for his yearly physical. On examination, the nurse notes that since last year Tommy has developed pubic hair, testicular enlargement, and related scrotal changes. In planning anticipatory guidance, the nurse recognizes that which one of the following subjects would best be discussed with Tommy as soon as possible? a. Nocturnal emission b. sexually transmitted infection prevention c. pregnancy prevention d. hygiene needs

a. Nocturnal emission

When parents are divorced, who is eligible to consent to medical treatment of the child? a. Usually, the custodial parent consents. b. Only the noncustodial parent may consent. c. Both parents must consent. d. The child is the responsible party.

a. Usually, the custodial parent consents. nonemergent care only requires one parental consent; if divorced should be custodian

All of the following techniques for medication administration in the infant are acceptable except: a. adding the medication to the infant's formula. b. allowing the infant to sit in the parent's lap during administration. c. allowing the infant to suck the medication from a nipple. d. inserting a needleless syringe into the side of the mouth while the infant nurses.

a. adding the medication to the infant's formula. don't add to formula bc bb might refuse

Changes in family structure and parent employment have resulted in: a. adolescents having more time unsupervised by adults b. adolescents having more time for communication and intimacy with parents c. adolescents having less time to spend with peers d. adolescents requiring more supervision by outside family members

a. adolescents having more time unsupervised by adults

which of the following minority groups experience the highest income gap in the US a. african americans b. latino c. asians d. native americans

a. african american

which of the following is NOT a description of the use of time out as a discipline? a. allows the reinforcer to be maintained b. involves no physical punishment c. offers both parents and child cooling off time d. facilitates the parents ability to consistently apply the punishment

a. allows the reinforcer to be maintained

On auscultation of 8-year-old Tammie's lung field, the nurse hears inspiratory sounds that are louder, longer, and higher pitched than on expiration. These sounds are heard over the chest, except over the scapula and sternum. These sounds are: a. at the left medclavicular line and fourth intercoastal space b. lateral to the left midclavicular line and fifth intercostal space c. over the pulmonic valve d. over the aortic valve

a. at the left medclavicular line and fourth intercoastal space

to understand and deal effectively with families in a multicultural community, nurses should: a. be aware of their own attitudes and values b. learn about different cultural beleifs to manipulate them c. learn how to change longstanding health beleifs d. recognize that all cultures are very similar to one another

a. be aware of their own attitudes and values

The anesthetic EMLA is used: a. before invasive procedures. b. as preoperative oral sedation. c. for chronic cancer pain. d postoperatively.

a. before invasive procedures.

When administering intravenous medication to an infant, the nurse should: a. check site for patency before each dose. b. administer medications along with blood products. c. combine antibiotics to avoid fluid overload. d. use the maximum dilution of the drug permitted by the manufacturer.

a. check site for patency before each dose. * most IV require minimum dilution specified, never mix meds with blood products, only one AB at a time best for kids with poor absorption, drugs requiring high serum concentration, resistant infection, around the clock pain relief, emergency tx

child misbehavior requires parental implementation of appropriate disciplinary action. identify which one of the following would NOT be an appropriate guideline for implementing discipline? a. focus on the child and the misbehavior by using you messages rather than I messages b. maintain consistency with disciplinary action c. make sure all caregivers maintain unity by agreeing on the plan and being familiar with details before implementation d. maintain flexibility by planning disciplinary actions appropriate to the child age, temperament, and severity of misbehavior

a. focus on the child and the misbehavior by using you messages rather than I messages

The most ideal way to support parents when they first visit the child in the intensive care unit is: a. for the nurse to accompany them to the bedside. b. to use picture books of the unit in the waiting area. c. to limit the visiting hours so that parents are encouraged to rest. d. to expect parents to stay with their child continuously.

a. for the nurse to accompany them to the bedside. * provide emo support and ready to answer questions emphasize family visitation, family-centered rounds, family presence during invasive procedures, and family conferences

The best strategy to use when performing venipuncture on a toddler is to: a. give simple instructions for the child to hold still. b. extend the neck and maintain head alignment to expose the jugular vein. c. place the child prone with legs in a frog position to expose groin the area. d. hold the child's upper body to prevent movement.

a. give simple instructions for the child to hold still. femoral venipuncture = supine + frog position legs + cover groin in case he pees extremity venipuncture = straddling parent lap and facing them + parent hugging upper body bone marrow biopsy: - if posterior iliac crest; prone - infants may use tibia

Internet chatrooms and social networking: a. have allowed adolescents a more public arena for developing interpersonal skills b. have decreased the amount of bullying in the school setting c. have increased the development of multitasking and longer attention spans in adolescent d. have decreased adolescents' risk-taking behaviors

a. have allowed adolescents a more public arena for developing interpersonal skills

Mr. Alls brings his 12-month-old son, Keith, in for his regular well-infant examination. The nurse knows that the best approach to the physical examination for this patient will be to: a. have the infant sit in the parent's lap to complete as much of the examination as possible. b. place the infant on the examination table with parent out of view. c. perform examination in head-to-toe direction. d. completely undress Keith and leave him undressed during the examination.

a. have the infant sit in the parent's lap to complete as much of the examination as possible

During the chill phase of the febrile state: a. heat is generated and conserved. b. the temperature stabilizes at a higher range. c. a crisis of the temperature is occurring. d. the temperature is greater than the set point.

a. heat is generated and conserved. febrile state: shivering, vasoconstriction, new set point to conserve heat

Indications for the nurse to conduct a comprehensive family assessment include which of the following? i. Children with developmental analysis. ii. Children with history of repeated accidental injuries. iii. Children with behavioral problems. iv. Children receiving comprehensive well-child care. a. i, ii, iii, and iv. b. ii, iii, and iv. c. i, ii, and iii. d. ii and iii.

a. i, ii, iii, and iv.

language during the preschool years: a. includes telegraphic speech b. is simple and concrete c. uses phrases, not sentences d. includes the ability to follow complex commands

a. includes telegraphic speech

The rectal route of medication administration is used in children when the child: a. is not responding to oral antiemetic preparations. b. needs a reliable route of administration. c. is constipated. d. all of the above

a. is not responding to oral antiemetic preparations. if rectum is not empty at insertion, absorption may be delayed * is less reliable

Compared with childhood peer groups, adolescent peer groups are: a. more likely to include peers from the opposite sex b. less autonomous c. less likely to influence members' socialization roles d. more likely to require parental supervision

a. more likely to include peers from the opposite sex

When assessing 4-year-old Gail's chest, the nurse should expect: a. movement of the chest wall to be symmetric bilaterally and coordinated with breathing. b. respiratory movements to be chiefly thoracic. c. anteroposterior diameter to be equal to the transverse diameter. d. retraction of the muscles between the ribs on respiratory movement.

a. movement of the chest wall to be symmetric bilaterally and coordinated with breathing

To prepare a breast-fed infant physically for surgery, the nurse would expect to: a. permit breastfeeding up to 4 hours before surgery. b. withhold breastfeeding from midnight the night before surgery. c. permit breastfeeding up to 6 hours before surgery. d. replace breast milk with formula and permit feeding up to 2 hours before surgery

a. permit breastfeeding up to 4 hours before surgery.

The assessment method that the nurse expects to provide the most reliable evaluation about the physical growth pattern of a pre-school-age child is: a. recording height and weight measurement of the child and comparing growth measurements over time. b. keeping a flow sheet for height, weight, and head circumference increase. c. obtaining a history of sibling growth patterns. d. measure the height, weight, and head circumference of the child.

a. recording height and weight measurement of the child and comparing growth measurements over time.

A toddler is most likely to react to short-term hospitalization with feelings of loss of control that are manifested by: a. regression. b. withdrawal. c. formation of new superficial relationships. d. self-assertion and anger.

a. regression.

According to Erikson, a key to identity achievement in adolescence is: a. related to the adolescent's interactions with others and serves as a mirror reflecting information back to the adolescent b. linked to the role the adolescent plays within the family c. related to the adolescent's acceptance of parental guidelines d. related to the adolescent's ability to complete his or her plans for future accomplishments

a. related to the adolescent's interactions with others and serves as a mirror reflecting information back to the adolescent

The Visual Analog Scale (VAS): a. requires a higher degree of abstract thought. b. is recommended for children who understand the value of numbers. c. does not offer an option for "no pain." d. is recommended for children under 3 years of age.

a. requires a higher degree of abstract thought.

The adolescent with body art: a. seeks body art as an expression of personal identity and style and to mark significant life events b. is at lower risk for scarring if the piercing was done on the ear or nose because of the poor blood supply c. should be advised to have the professional use a piercing gun for all piercings d. should be advised that complications of piercing include infection and bleeding, but rarely keloid formation, which occurs most often with tattoos

a. seeks body art as an expression of personal identity and style and to mark significant life events

Factors that best promote adolescent health and well-being include: a. the ability of the adolescent to adapt to new persons and situations b. the ability of the adolescent to have universal access to the Internet c. interventions that focus the responsibility for adolescent health to one person or setting d. health promotion efforts aimed at identification of adolescent needs

a. the ability of the adolescent to adapt to new persons and situations

To best affect adolescent health promotion activity, the nurse should incorporate which one of the following in the plan? a. the adolescent's definition of health b. the adolescent's past health promotion activities c. a complete assess of the adolescent's past medical treatment d. a complete physical examination

a. the adolescent's definition of health

The most accurate method for determining the safe dosage of a chemotherapy medication for a child is to use: a. the body surface area formula. b. Clark's rule. c. Wright's rule. d. milligrams per kilogram

a. the body surface area formula. less precise will use mg/kg

In assessing pain in children with chronic illness and complex pain, the nurse understands that: a. the most important aspect is the relationship that develops between the child and the family. b. the most important aspect is the relationship that develops between the family and the nurse. c. the assessment should occur when the child is in pain. d. the assessment should occur when the child is pain free.

a. the most important aspect is the relationship that develops between the child and the family.

To prevent a child with diarrhea from becoming dehydrated the nurse should: a. use gentle persuasion. b. force fluids. c. awaken the child to offer fluids. d. allow only high-quality, nutritious liquids.

a. use gentle persuasion. * play techniques also effective loss of appetite most common s/sx, forcing food may cause N/V or rebellion if used as power tactic child may desire empty calories, but serve because they may provide necessary fluids/calories take advantage of hungry periods by offering high quality food or breakfast drinks, encourage home foods

which of the following is a correct interpretation in the use of reasoning as a form of discipline? a. used for older children when moral issues are involved b. used for younger children to see the other side of an issue c. used only in combination with scolding and criticism d. used to allow children to obtain length explanations and a greater degree of attention from parents

a. used for older children when moral issues are involved

To prevent an ostomy pouch from being pulled off, a young child may need to: a. wear one-piece outfits. b. use an alcohol-based skin sealant. c. use a rubber band to help the appliance fit.

a. wear one-piece outfits. avoid rubber bands to prevent choking

the nurse is planning to adivce a school age childs parents about appropriate physical activity for their child which fact does the nurse include?

activities that promotes coordination in the school age child includes running and skipping rope

Communicating with children

allow children to feel comfortable avoid sudden movements, broad smiles, extended eye contacts talk to the parent initially if child is shy communicate through transition objects give older children opportunity to talk withput the parents present assume the position that is at the same level as the child speak in quiet, unhurried, voice speak clearly, be specific, use simple words state directions and suggestions positively offer a choice only when one exists be honest with children allow children to express their concern and fear

ear meds to give to kids

allow med to warm up prone or supine position head turned to the appropriate side children younger than 3 yo pinna down and straight back older than 3 yo - pinna upward and back drop should fall against the side of the ear canal lying on unaffected side for few min after gently massage the area immediately anterior to the ear to fascilitate the netry of drops

permissive

allows children to regulate their own activity; sees the parenting role as a resource rather than a role model

determining the site for IM

amount and viscosity of the medication amount and general condition of the muscle mass frequency and number of injection type of medication factors that may impede access to or cause contamination of the site child's ability to assume the required position safely 1 ml max dose to administer in a single IM site to small children and older infants

During the evaluation phase, which one of the following responses by Sara's mother would indicate that the expected outcomes have been met? a) "I will have to go through all the boys' things when we get home to be sure there aren't any other small objects that could hurt Sara." b) "I had forgotten how curious babies are. It has been many years since the boys were babies, and they didn't have an older child's toys around." c) "I will have to start to discipline Sara now so that she knows not to play with the older children's belongings." d) "I am afraid she cannot receive her immunizations. She had a fever after her last one."

b) "I had forgotten how curious babies are. It has been many years since the boys were babies, and they didn't have an older child's toys around."

The incidence of accidental drowning is highest in both boys and girls in what age-group? a) <1 year b) 1-4 years c) 5-14 years d) 15-24 years

b) 1-4 years

According to "Healthy People 2020," strategies that address leading health indicators for the nation would include all of the following EXCEPT: a) decreasing tobacco use b) increasing innovative Tx for cancer c) decreasing substance abuse d) increasing immunization rates

b) increasing innovative treatment for cancer

Which one of the following statments about injuries in childhood is FALSE? a) developmental stage partially determines prevalence of injuries at a given age b) most fatal injuries occur in children <9 years old c) developmental stage helps to direct preventative measures d) children aged 5-9 years are at greatest risk for bicycle fatalities

b) most fatal injuries occur in children <9 years old

Which of the following words or phrases is considered nonthreatening to a small child? a. "A little stick" b. "An owie" c. Die d. Deaden

b. "An owie" "medicine under the skin" special medicine make sleepy hug your arm (BP), see how warm you are (BP), TV (monitor), special opening (cut), puffiness (edema)

Adolescent egocentrism may lead to a pattern of personal fable. An example of a personal fable is: a. "everyone is coming to the play just to see me." b. "Mary Sue got pregnant, but it won't happen to me." c. "I hate taking my clothes off for gym class because everyone stares at me." d. "Mary is very envious of how I dress."

b. "Mary Sue got pregnant, but it won't happen to me

Separation anxiety would be most expected in the hospitalized child at age: a. 3 to 6 months. b. 12 to 24 months. c. 3 to 6 years d. 7 to 12 years.

b. 12 to 24 months. *seen in children 6-30 months; early childhood without separation, tremendous ability to withstand other stressors

The development of a personal value system or value autonomy during adolescence usually occurs by what age? a. 14-16 years b. 18-20 years c. 13 - 14 years d. 16-18 years

b. 18-20 years

Mrs. Green has brought her daughter Karen to the clinic where you work as a nurse. Karen, age 12 years, is a new patient and needs a physical examination so that she can play volleyball. Which of the following techniques would not be helpful to establish effective communication during the interview process? a. You introduce yourself and ask the name of all family members present. b. After the introduction, you are careful to direct questions about Karen to Mrs. Green, since she is the best source of information. c. After the introduction and explanation of your role, you begin the interview by saying to Karen, "Tell me about your volleyball team." d. You choose to conduct the interview in a quiet area with few distractions.

b. After the introduction, you are careful to direct questions about Karen to Mrs. Green, since she is the best source of information.

Which one of the following factors, according to Craft's 1993 framework, would be considered most likely to negatively influence the reactions of siblings to the hospitalized child? a. The sibling is an adolescent. b. Care providers are not relatives. c. The sibling has received information about the ill child. d. The ill child is cared for in the home.

b. Care providers are not relatives. sibling illness has greater impact if younger and experiencing many changes being cared for outside of home without relatives little info received perception of being treated differently by parents compared to before the ill child's hospitalization

___________ is the capacity to understand what another person is feeling by experiencing the situation from that person's frame of reference. a. Sympathy. b. Empathy. c. Reassurance. d. Encouragement.

b. Empathy.

Which one of the following findings for growth is cause for potential concern and should be followed closely? a. Height and weight fall above the 5th percentile on the growth chart. b. Height and weight fall below the 5th percentile on the growth chart. c. Height and weight fall below the 95th percentile on the growth chart. d. Height and weight fall within the 50th percentile on the growth chart.

b. Height and weight fall below the 5th percentile on the growth chart.

Which one of the following is an acute manifestation of pain in the neonate? a. Increased transcutaneous oxygen saturation. b. Increased heart rate, rapid and shallow respirations. c. Decreased muscle tone and increased vagal nerve tone. d. Increased skin dryness, decreased blood pressure, hyperglycemia.

b. Increased heart rate, rapid and shallow respirations.

In pediatric examinations, the normal sequence of head-to-toe direction of often altered to accommodate the patient's developmental needs. The nurse identifies which of the following goals as least likely to guide the examination process? a. Minimizing the stress associated with the assessment of body parts. b. Recording the findings according to the normal sequence. c. Fostering a trusting nurse-child relationship. d. Preserving the essential security of the parent-child relationship.

b. Recording the findings according to the normal sequence.

While inspecting Mary's abdomen you should recognize which of the following as an normal finding a. peristaltic waves b. Silvery whiteish lines when the skin is stretched out c. Bulging at that umbilicus d. Protruding abdomen with skin pulled tight

b. Silvery whiteish lines when the skin is stretched out

Infants and children experience a substantial amount of pain due to routine immunizations. Based on current research, which of the following statements is false? a. The child should be positioned upright, either sitting or being held by the caregiver during the immunization. b. The caregiver and the nurse should use verbal reassurance, empathy, and apology during the immunizations. c. The nurse should administer the least painful vaccine first when administering multiple vaccines. d. The nurse should administer the vaccines rapidly and without aspiration.

b. The caregiver and the nurse should use verbal reassurance, empathy, and apology during the immunizations.

In working with children, nurses include family members in the care plan. Which of the family statements does the nurse recognize as false when planning nursing interventions for the family? a. A complete family assessment is needed to discover family dynamics, family strengths, and family weaknesses b. There is no expectation for parents to participate in their child's care when using the systems theory c. The intervention used with families depends on the nurse's view of the theoretic model of the family d. The level of assistance a family needs depends on the type of crisis, factors affecting family adjustment, and the family's level of functioning

b. There is no expectation for parents to participate in their child's care when using the systems theory (p 48-49)

Which of the following statements about temperature measurement in children is true? a. Rectal site is preferred in children under 1 month of age. b. Tympanic artery thermometry for children older than 2 years of age and temporal artery thermometry in all age groups is recommended. c. Ear (tympanic) temperature is a precise measurement of core body measurement. d. Oral temperature is a better indicator of rapid changes in core body temperate and accuracy and is the preferred method when the patient is under 5 years of age.

b. Tympanic artery thermometry for children older than 2 years of age and temporal artery thermometry in all age groups is recommended.

In eliciting the chief complaint, the nurse identifies which one of the following techniques as not appropriate? a. Limiting the chief complaint to a brief statement restricted to one or two symptoms. b. Using labeling-type questions such as "How are you sick?" to facilitate information exchange. c. Recording the chief complaint in the child's or parent's own words. d. Using open-ended neutral questions to elicit information.

b. Using labeling-type questions such as "How are you sick?" to facilitate information exchange.

When considering the impact of culture on the pediatric patient, the nurse recognizes that culture: a. is synonymous with race. b. affects the development of health beliefs. c. refers to a group of people with similar physical characteristics. d. refers to the universal manner and sequence of growth and development.

b. affects the development of health beliefs

For postoperative or cancer pain control, analgesics should be administered: a. whenever needed. b. around the clock. c. before the pain escalates. d. after the pain peaks.

b. around the clock.

The most appropriate way to prevent firearm injury among adolescents is: a. teaching the adolescent proper use of firearms b. counseling the adolescent on nonviolent ways to resolve conflict c. passing laws to prevent parents from having guns d. telling parents to keep guns and ammunition in separate locations within the house

b. counseling the adolescent on nonviolent ways to resolve conflict

To collect a blood culture specimen from a central venous line or peripheral lock, research suggests that the nurse: a. use the first sample of blood. b. discard the first sample of blood. c. irrigate the device with D5W first. d. use a heparinized collection tube.

b. discard the first sample of blood.

To safely administer 1 teaspoon of medication at home, the parent should use the: a. household soup spoon. b. disposable calibrated syringe. c. hospital's molded plastic cup. d. household teaspoon

b. disposable calibrated syringe. measuring <1tsp with a medicine cup almost impossible droppers highly unrelieable b/c depends on the viscosity of the liquid

After mouth or lip surgery, the nurse would choose to restrain the small child using: a. arm and leg restraints. b. elbow restraints. c. a jacket restraint. d. a mummy restraint.

b. elbow restraints. mitts and holding onto baby not a restrain behavioral restraints must be ordered q1hr if <9y.o.; q2hr if 9-17y.o. nonbehavioral restraints reordered q1d mummy restraint is short-term for exam/tx involving head/neck; if used for tx, not restraint jacket restraint for chairs arm/leg restraints should be observed for signs of impaired circulation

Strategies used to minimize the hospitalized child's feelings of loss of control include attempts to: a. alter the child's schedule to match the hospital schedule. b. establish a daily schedule for the hospitalized child. c. eliminate rituals that have been used at home. d. perform all of the above.

b. establish a daily schedule for the hospitalized child. promote freedom of movement and self-care parent-child contact during times requiring restraint or during physical write any changes in the schedule down on a calendar; anticipatory preparatio

Assessment of family interactions and roles, decision making and problem solving, communication, and expression of feelings and individuality is known as assessment of: a. family structure. b. family function. c. family composition. d. home and community environment.

b. family function.

The transform patch Duralgesic may be used: a. in infants for acute pain management. b. for patients who are opioid tolerant. c. as a safe and effective medication for children of all ages. d. to provide prolonged pain relief for more than 96 hours.

b. for patients who are opioid tolerant.

The nurse, in working with special groups of adolescents, recognizes which of the following statements is true? a. effective health promotion programs for minority adolescents must contain culturally competent information and must be provided by health care professionals with the same cultural background as the adolescent b. gay and lesbian adolescents programs aimed at "reparative therapy" or treatment designed to alter sexual orientation show no evidence of effectiveness but do show evidence of psychological harm c. nurses should encourage all gay and lesbian adolescents to disclose their sexual orientation to their families immediately to help eliminate the stress of keeping secret d. rural adolescents' access to health care is the same as for urban areas because of the advantages of Medicaid and incentives offered to physicians to work in these areas

b. gay and lesbian adolescents programs aimed at "reparative therapy" or treatment designed to alter sexual orientation show no evidence of effectiveness but do show evidence of psychological harm

Susan, age 15, comes to the school-based clinic and complains to the nurse practitioner about a vaginal discharge. After the nurse has established a trusting and confidential relationship, Susan confides that she has been sexually active with three different partners within the past 6 months. She thinks they used condoms every time, but she is not sure. Susan's last period was 4 weeks ago, and she has never had a Pap test. What tests would the nurse assisting the nurse practitioner expect to prepare for? i. pap test ii. gonorrhea test iii. chlamydia test iv. HIV test v. pregnancy test vi. syphilis test a. ii, iii, iv, v, and vi b. i, ii, iii, iv, v, and vi c, ii, iii, iv, and vi d. i and v

b. i, ii, iii, iv, v, and vi

The Adolescent Pediatric Pain Tool (APPT): a. is used in children over 6 years of age. b. is grouped by sensory, affective, and evaluative qualities. c. uses a straight line. d. uses to scale of 0 to 10 to rate the degree of pain.

b. is grouped by sensory, affective, and evaluative qualities.

To instill eye drops in an infant whose eyelids are clenched shut, the nurse should: a. apply finger pressure to the lacrimal punctum. b. place the drops in the nasal corner where the lids meet and wait until the infant opens the lid. c. administer the eye drops before nap time. d. use any of the above techniques.

b. place the drops in the nasal corner where the lids meet and wait until the infant opens the lid. place supine, one hand to pull lower lid down and the other rests on forehead to delivery med pressure at lacrimal punctum to prevent nasopharynx taste give eyedrops first, wait 3 minutes, then ointments administer ointments before nap because of temporary blurriness

because of the preschoolers egocentric thought, the best approach for effective communication is through: a. speech b. play c. drawing d. actions

b. play

To prepare a toddler for an invasive procedure, the best strategy for the nurse to use would be to: a. give one direction at a time. b. prepare the child a day in advance. c. set up the equipment while the child watches. d. expect the child to sit still and cooperate.

b. prepare the child a day in advance. older children may want more advance notice

which of the following statements about the preshoolers physical proportions is true? a. preschoolers have a squat and potbellied frame b. preschoolers have a slender but sturdy frame c. The muscle and bones of the preschooler have matured d. sexual characteristics can be differentiated in the preschooler

b. preschoolers have a slender but sturdy frame

To prevent skin injuries from shear, the nurse should avoid: a. using sheepskin over the elbows. b. pulling the patient up in bed without a lift sheet. c. pulling the patient up in bed with a lift sheet. d. using Montgomery straps

b. pulling the patient up in bed without a lift sheet.

Effective health education and health care for adolescents does not include which one of the following? a. recognizes that adolescents, as they progress through adolescence, can assume additional responsibility for their own health b. recognizes that the need to maintain privacy and confidentiality decreases as the adolescent ages c. should meet the physical and emotional needs of the adolescent d. recognizes that parents need to respect their teenagers' independence and move more toward the role of health consultant

b. recognizes that the need to maintain privacy and confidentiality decreases as the adolescent ages

Limit setting and discipline are positive, necessary components of childrearing. Which one of the following best describes how these functions help children? a. reduce the need for children to have limits set b. support children's ability to test their limits of control c. allow unresctricted freedom to ensure children's grpwth potential d. reassure children that they are able to protect themselves from harm

b. support children's ability to test their limits of control

The most effective method of preoperative preparation for a child is: a. consistent supportive care. b. systematic preparation at specific stress points. c. offering parents the option of attending the induction of anesthesia. d. a single session of preparation

b. systematic preparation at specific stress points. rehearse forthcoming events, systematic prep of more than a single session tour, videam with demonstrations/explanations, a mask to practice with, calls to coach parents

A 14-year-old boy is admitted to the ER and placed on a suicide watch, as he told his mother he would kill himself if she went out drinking again. This is his second or third threat in as many weekends, and the ER staff is acquainted with the family situation. The adolescent is placed in a locked room with a nonbreakable glass window in the wood door. A hospital security guard is positioned at the door. The practitioner asks the nurse if he thinks body restraints are necessary to protect the child. The nurse's priority intervention would be to: a. immediately place the boy in a Posey vest. b. talk with the boy and assess his mental status with focus on risk for self-harm. c. ask the mother for permission to administer sedation to the adolescent to prevent him from harming himself. d. None of the above would be appropriate.

b. talk with the boy and assess his mental status with focus on risk for self-harm.

When preparing a child for a procedure, the nurse should: a. use abstract terms. b. teach based on the child's developmental level. c. use phrases with dual meanings. d. introduce anxiety-laden information first.

b. teach based on the child's developmental level. sensory-procedural info and help child develop coping skills ID what they know and correct the younger the child, the closer the explanation should be to the actual procedure

Which of the following statements about adolescents and school is true? a. transition from elementary to middle school has no negative effects on adolescents b. teenagers whose grades fall below average spend more time in perceived negative environment and feel alienated from school c. students who repeat one or more grades are more likely to bring weapons to school d. students with above-average grades have been identified as more likely to engage in suicide attempts

b. teenagers whose grades fall below average spend more time in perceived negative environment and feel alienated from school

When necessary, suprapubic aspiration may be used: a. to access the bladder through the urethra. b. to obtain a sterile urine specimen from an infant. c. even though it may increase the risk for contamination. d. to prevent complications associated with urinary catheterization.

b. to obtain a sterile urine specimen from an infant. is a painful procedure can be assumed if pt hasn't voided for >1hr or the bladder can be palpated above the symphysis pubis

adolescent develop the social cognition change of mutual role-taking. Which one of the following is the best description of this ability? a. heightened sense of self-consciousness b. understanding the perspectives of others and that actions can influence others c. beliefs that are more abstract and rooted in ideologic principles d. realization that others have thoughts and feelings

b. understanding the perspectives of others and that actions can influence others

In regard to behavioral and physiologic responses to pain, children: a. remain consistent from age to age. b. vary widely in their responses. c. exhibit typical behaviors at each developmental stage. d. are unaffected by temperament.

b. vary widely in their responses.

You are preparing Mary for a physical examination. You know that during the examination, Mary, as an adolescent, will likely: a. prefer her parents to be present during the entire exam. b. wish to undress in private and feel more comfortable when provided with a gown. c. prefer that traumatic procedures such as ear and mouth examinations be performed last. d. need to have heart and lungs auscultated first.

b. wish to undress in private and feel more comfortable when provided with a gown.

When choosing the pain medication for use in children less than 6 months old: a. use the weight and height to determine the exact dosing. b. younger than 6 months of age and not mechanically ventilated, use one fourth to one third the recommended starting dose of opioids for older children. c. use smaller doses because tolerance develops slowly. d. increase the dose for moderate pain by 75% if pain relief is inadequate.

b. younger than 6 months of age and not mechanically ventilated, use one fourth to one third the recommended starting dose of opioids for older children

Adequate Intake (AI)

based on estimates of nutrient intake by healthy individuals

to assist school age children in coping with stress in their lives the nurse should

be able to recognize signs that indicate the child is undergoing stress ------ teach the child how to recognize signs of stress in herself or himself ------ help the child plan a means for dealing with any stress through problem solving

mrs jones is a single mother caring for her 10 year old son james. at an office appointment for james his mother asks the nurse how to prevent her son from becoming invloved in gang violence. the best response is which one of the following

becomes aware of any gang related activities in your community and become acquainted with your sons friends

The nurse reads Tina as story about an event similar to her own from a book and asks her to retell the story

bibliotherapy

What is false in regard to toilet training?

bowel training is usually accomplished after bladder training

communicating with adolescents

build a foundation: - spend time together - encourage expression of ideas - respect their views - tolerate differences - praise good points - respect their privacy - set a good example communicate effectively: - give undivided attention - listen, listen, listen - be corteous, calm, honest - try not to overreact - avoid jusging and criticizing - avoid thrid degree questioning - choose important issue when taking a stand

which of the following statements related to bullying is correct

bullying usually occurs in school hallways and playgrounds where supervision is minimal but peers are present to witness the attack

mary's mother is apprehensive about her daughters condition and asks you whether it is serious. Which of the following is your best response a. Mary has appendicitis and will need to have surgery immediately b. You will have to ask the doctor about her condition c Mary has some abdominal pain that is not normal. We are watching very carefully and we'll be able to tell you more about the provider examinesHer and that laboratory test are completed d. Mary should be able to go home as soon as the doctor finishes with the examination and the laboratory tests are completed

c Mary has some abdominal pain that is not normal. We are watching very carefully and we'll be able to tell you more about the provider examinesHer and that laboratory test are completed

Case Study: Marisa Gutierrez arrives with her infant, Sara, in the well-baby clinic. Sara, who is 15 mos old, is the youngest of 3 children. Her mother has brought her to the clinic for well-child care. Sara's 2 bros, who are 7 and 8, have come as well. As the nurse interviews the mother, Sara explores the exam room. She reaches for her older brother' coins and put one in her mouth. After organizing the data into similar categories, the nurse correctly makes which one of the following decisions? a) no dysfunctional health problems are evident b) high risk for dysfunctional health problems exists c) actual dysfunctional health problems are evident d) potential complications are evident

c) actual dysfunctional health problems are evident

An example of atraumatic care would be to: a) eliminate all traumatic procedures b) restrict visiting hours to adults only c) allow parents to "room in" with the child d) remove parents from the room during painful procedures

c) allow parents to "room in" with the child

Which of the following differences is seen when infant death rates are categorized according to race? a) disparities among races have continued to increase dramatically in the USA b) infant mortality for Hispanic infants is much higher than for any other groups c) infant mortality for African-Americans is 2x the rate of Caucasians d) infant mortality for Caucasian infants is the same as for other races

c) infant mortality for African-Americans is 2x the rate of Caucasians

The role of the nurse in the parent-professional partnership is to: a) decide what is most important for the family b) decide what is most important for the child c) strengthen the family's ability to make informed choices d) manipulate the available resources

c) strengthen the family's ability to make informed choices

As the movement for providing care based on evidence continues, nurses will be using methods to evaluate research such as: a) Agency for Health Care Policy and Research (AHCPR) guidelines in place of guidelines developed locally b) guidelines that are based on traditional practice c) the GRADE criteria d) guidelines that reflect current research but decrease job satisfaction

c) the GRADE criteria

Julie, 12 years old, is brought to the nurse practitioner's office by her mother. Julie has started to develop breast tissue and some pubic hair. Both the mother and daughter are concerned because Julie has been having increased vaginal discharge. Julie tells the nurse, "I wash my private area every day, but I still have fluid that comes out." What is the nurse's best response? a. "It sounds like you have an infection. We'll have the nurse practitioner check you to see what is causing this discharge." b. "Have you been using soap when you wash." c. "This sounds like a normal discharge that happens to all girls as they start to mature. It is a sign that your body is preparing for your periods to begin." d. "This is probably not related to hygiene. Are you concerned that this discharge might be causing an odor?"

c. "This sounds like a normal discharge that happens to all girls as they start to mature. It is a sign that your body is preparing for your periods to begin."

The nurse should obtain the vital signs of an infant in what order? a. Measure temperature, then count the pulse, and then count respirations. b. Count the pulse, then count respirations, and then measure temperature. c. Count respirations, then count the pulse, and then measure the temperature. d. Measure the temperature, then count the respirations, and then count the pulse.

c. Count respirations, then count the pulse, and then measure the temperature.

Parenting practices differ in small and large families. Which of the following characteristics is not found in small families? a. Emphasis is placed on the individual development of the child, with constant pressure to measure up to family expectations b. Adolescents identify more strongly with their parents and rely more on their parents for advice c. Emphasis is placed on the group and less on the individual d. Children's development and achievement are measured against those of children in the same neighborhood and social class

c. Emphasis is placed on the group and less on the individual

Mrs. Brown, 11-year-old Kenny, and you agree to the need to conduct a more intensive nutritional assessment. Which one of the following ways to record Kenny's dietary intake would you suggest as most reliable in providing needed information to assess his dietary habits? a. 12-hour recall. b. 24-hour recall. c. Food diary for 3-day period. d. Food frequency questionnaire.

c. Food diary for 3-day period

Which one of the following methods of analgesic drug administration is a liquid gel that provides anesthesia to non intact skin in about 15 minutes? a. Midazolam. b. EMLA. c. LAT. d. Numby Stuff.

c. LAT.

Read the following entry from a pediatric health history: "Nausea and vomiting for 3 days. Started with abdominal cramping after eating hamburger at home. No pain or cramping present. Unable to keep any food down but able to drink clear liquids without vomiting. No temperature elevation, no diarrhea." This entry represents which component of the health history? a. Chief complaint. b. Past history. c. Present illness. d. Review of systems.

c. Present illness.

Which of the following describes joint legal custody? a. Each parent is awarded custody of one or more of the children. b. The parents alternate the physical care and control of the children on an agreed-on basis while maintaining shared parenting responsibilities legally. c. The children reside with one parent but both parents are the legal guardians and both participate in childrearing. d. The children reside with the grandparents while both parents assume legal guardianship.

c. The children reside with one parent but both parents are the legal guardians and both participate in childrearing.

Which one of the following is not considered important by parents when telling their children about the decision to divorce? a. Initial disclosure should include both parents and siblings. b. Time should be allowed for discussion with each child individually. c. The initial disclosure should be kept simple, and reasons for divorce should not be included. d. Parents should physically hold or touch their child to provide feelings of warmth and reassurance.

c. The initial disclosure should be kept simple, and reasons for divorce should not be included.

Which of the following would negatively affect the communication process between the nurse and the patient? a. The nurse allows the child to express his or her concerns and fears. b. The nurse includes the child, as well as the parents, in the communication process. c. The nurse uses verbal and nonverbal communication to reflect approval of the patient's statement. d. The nurse uses a slow, even, steady voice to convey instruction.

c. The nurse uses verbal and nonverbal communication to reflect approval of the patient's statement.

Which of the following statements about adoption is true? a. Adoptive children from racial backgrounds different form that of the family should be treated no differently from biologic children. b. The task of telling children that they are adopted should follow clear-cut timing guidelines. c. The sooner infants enter their adoptive home, the better the changes of parent-infant attachment. d. Older children display fewer behavioral changes after adoption disclosure than do younger children.

c. The sooner infants enter their adoptive home, the better the changes of parent-infant attachment.

Which one of the following can the nurse expect to be included in the care plan for controlling acute pain in sickle cell crisis? a. Administration of long-term oxygen. b. Application of cold compresses. c. Use of opioids started early in childhood and continued throughout adult life. d. Relieving the pain completely as the goal of treatment of the acute episode.

c. Use of opioids started early in childhood and continued throughout adult life.

Which one of the following characteristics is most likely to be exhibited by an adolescent who is in pain? a. Decreased verbal expression and withdrawal. b. Requests to terminate the procedure. c. Verbal expression such as "You're hurting me!" d. Facial expression of pain and anger.

c. Verbal expression such as "You're hurting me!"

You are assessing 7-year-old Mary's lymph nodes. Using the distal portions of your fingers, you press gently but firmly in a circular motion along the occipital and post auricular node areas. You record the findings as "tender, enlarged, warm lymph nodes." Which of the following is true? a. Your findings are within normal limits for Mary's age. b. Your assessment technique was incorrect and should be repeated. c. Your findings suggest infection or inflammation in the scalp area or external ear canal. d. Your recording of the information is complete because it chinless temperature and tenderness.

c. Your findings suggest infection or inflammation in the scalp area or external ear canal.

Elements of principles moral reasoning emerge during adolescence. Which of the following is the best description of this moral development? a. moral guidelines are seen to emanate from authority figures b. moral standards are seen as objective and not be questioned c. absolutes and rules are questioned and subject to disagreement d. a personal value system is developed

c. absolutes and rules are questioned and subject to disagreement

One strategy to provide atraumatic care for pediatric patients undergoing surgery is: a. restrict fluids in infants for at least 10 hours. b. always use a face mask during induction. c. allow child to wear underpants or pajama bottoms into surgery. d. remove parents from the child's sight.

c. allow child to wear underpants or pajama bottoms into surgery. should not restrict fluids for too long

Transfer from the intensive care unit to the regular pediatric unit can be best facilitated by: a. discussing the details of the transfer at the bedside, where the child can listen. b. establishing a schedule that mimics the child's home schedule. c. assigning a primary nurse from the regular unit who visits the child before the transfer. d. explaining to the family that there are fewer nurses on the regular unit.

c. assigning a primary nurse from the regular unit who visits the child before the transfer.

sex typing involves the process by which the preschooler develops: a. a strong attachment to the same sex parent b. an identification with the opposite sex parent c. behavior and beliefs for his or her culture and sex d. all of the above

c. behavior and beliefs for his or her culture and sex

The two-step method approach for pain management: a. is used with children older than 3 years of age. b. always starts with administration of a nonopioid. c. consists of a choice of category of analgesic medications to the level of pain. d. always starts with the administration of morphine as the drug of choice.

c. consists of a choice of category of analgesic medications to the level of pain

The question "How does your child usually handle problems or disappointments?" would be asked on admission to assess the child's: a. role-relationship pattern. b. sexuality-reproductive pattern. c. coping-stress tolerance pattern. d. value-belief pattern

c. coping-stress tolerance pattern.

The dietary history of a pediatric patient includes: a. a 12-hour dietary intake recall. b. a more specific, detailed history for the older child. c. financial and cultural factors that influence food selection. d. criticism of parents' allowance of nonessential foods.

c. financial and cultural factors that influence food selection.

When bathing an uncircumcised boy over the age of 3 years, the nurse should: a. gently remind the child to clean his genital area. b. not retract the foreskin. c. gently retract the foreskin. d. avoid cleansing between the skinfolds of the genital area.

c. gently retract the foreskin. * older children who can bathe themselves may require gentle reminders clorhexidine not for <2mo never leave infants/small children alone, if they can't sit alone hold one hand during bath don't forget the ears, between skin folds, neck, back, and genitalia

During continuous enteral feedings, the nurse should: a. use the same pole as used for the intravenous line. b. use a burette to calibrate the feeding times. c. give the infant a pacifier for sucking. d. all of the above

c. give the infant a pacifier for sucking. use separate pole for continuous feeding solution (may accidentally administer enteral formula through IV)

Adolescent girls of low socioeconomic status are particularly at risk for dietary deficiencies of: i. calories ii. sodium iii. calcium iv. folic acid v. iron a. i, ii, and iii b. ii, iii, iv, and v c. iii, iv, and v d. i, iii, and v

c. iii, iv, and v

During the adolescent health screening interview, the nurse focuses on which of the following to best address injury prevention? a. drownings b. burns c. motor vehicle crashes d. drug use

c. motor vehicle crashes

An 18-month-old child hospitalized with RSV is in a crib with side rails up, but he is very mobile and the mother says he has climbed out of his crib at home. The best way to provide a safe environment for this toddler is to: a. place him in a Posey vest. b. use a papoose board to keep him from climbing out of the bed. c. place a crib top on the crib. d. use bilateral elbow restraints.

c. place a crib top on the crib.

General guidelines for care of a child's skin includes: a. covering the fingers of the extremity used for an intravenous line. b. lifting the child under the arms to transfer the child from the bed to a stretcher. c. placing a pectin-based skin barrier directly over excoriated skin. d. keeping the skin moist at all times.

c. placing a pectin-based skin barrier directly over excoriated skin. easiest to assess during bath, watch for reactive hyperemia indicating first stages of pressure ulcer

School-linked clinics: a. are located on school property and serve adolescent populations from that campus b. do not require parental consent before service can be provided to the adolescent c. provide greater access to adolescents for preventive and primary care services d. have not been widely accepted by the adolescents, since they are not receptive to services offered

c. provide greater access to adolescents for preventive and primary care services

Of the following heelsticks techniques, the one that would be most important to use to avoid the complication of necrotizing osteochondritis would be to: a. warm the site. b. cleanse the site with alcohol. c. puncture no deeper than 2 mm. d. use the inner aspect of the heel

c. puncture no deeper than 2 mm. * should be made at outer aspect of the heel heelsticks common in <6mo

To help the parents deal with issues related to separation while their child is hospitalized, the nurse should not suggest: a. using associations to help the child understand time frames. b. ways to explain departure and return. c. quietly leaving while the child is distracted or asleep. d. short, frequent visits over an extended stay if rooming in is impossible.

c. quietly leaving while the child is distracted or asleep.

If a child needs support during an invasive procedure, the nurse should: a. insist that the parents participate in distraction techniques. b. instruct parents to stand quietly in back of the room and maintain eye contact with the child. c. respect parents' wishes and coach the parents about what to do. d. instruct parents to stay close by to console the child immediately after the procedure.

c. respect parents' wishes and coach the parents about what to do. assess pt and parent wishes before deciding if they stay in room or not support if parent doesn't want to be there, inform about how procedure went afterwards if parents need further prep than the basic explanation given to kid, do it away from the child

Sleep patterns among adolescents a. show that teens should get at least 10 hours of sleep nightly b. show that 1 in 8 is regularly sleep deprived c. show that sleep deprivation contributes to school problems d. show that 1 in 4 report use of the internet as the major reason for lack of sufficient sleep

c. show that sleep deprivation contributes to school problems

The best positioning technique for a lumbar puncture in a neonate is a: a. side-lying position with neck flexion. b. sitting position. c. side-lying position with modified neck extension. d. side-lying position with knees to chest.

c. side-lying position with modified neck extension. children in same position with knees to chest, held gently to prevent involuntary movement

Early symptoms of malignant hyperthermia include: a. anemia. b. enlarged lymph nodes. c. tachycardia. d. hypertension

c. tachycardia. immediately discontinue triggering agent, hyperventilate w/ 100% O2, IV dantolene sodium cooling measures (iced NG lavage, ice packs)

In planning strategies to improve the child's compliance with the prescribed treatment, the nurse knows that: a. an every-8-hour schedule should be implemented. b. an every-6-hour schedule should be implemented. c. the child may not be able to swallow pills. d. the family usually does not remember or understand the instructions given.

c. the child may not be able to swallow pills. 6, 8 hour schedulea difficult to implement outside of the hospital may understand/remember instructions but are unable to give medicine as prescribed

Which one of the following best describes the formal operational thinking that occurs between the ages of 11 and 14 years a. thought process includes thinking in concrete terms b. thought process includes information obtained from the environment and peers c. thought process includes thinking in abstract therms, possibilities, and hypotheses d. thought process is limited to what is observed

c. thought process includes thinking in abstract therms, possibilities, and hypotheses

The statutes for the mature minor doctrine vary from state to state. Based on the doctrine, a minor may be permitted to consent for: a. treatment for any kind of health problem. b. routine physical examinations only. c. treatment for sexually transmitted infections. d. minor surgery.

c. treatment for sexually transmitted infections. recognized in a few states for >14y.o.

What statement is true in regard to nutritional changes from the infant to the toddler years?

caloric requirements decrease

Call a doctor immediately.

child is younger than 3 months old and has temperature of 100.4 child looks of acts sick, sleepy, stiff neck, severe headache, ear pains, confusion, touble breathing has a recent seizure has history of immune system problems has been in a very hot place like car has take steroid medication the fever continues for more than 24 hours in a child younger than 2 yo

which of the following accuraltely describes the expected cognitive development during the concrete operational period of middle childhood

children are able to use their through processes to experience events and actions and make judgements based on what they reason

which of the following is most characteristics of the relationship between school age children and their families

children need and want restrictions placed on their behavior by the family

authoritative parents

combine practices from both parenting styles. they direct their children's behavior and attitudes by emphasizing the reson for rules and negatively reinforcing deviations. they respect individuality of each child and allow the child to voice objections parental control is firm and consistent

according to piaget, what is the stage of development for middle childhood

conrete operational

implementing discipline

consistency timing commitment unity flexibility planning behavior orientation privacy termination

traditional nuclear family

consists of a married couple and their biologic children children live with biological parents anf full brothers, sisters

Obesity in children and adolescents is defined as: a) BMI >/= 90th percentile for age & height b) BMI </= 90th percentile for age & gender c) BMI >/= 95th percentile for age and height d) BMI >/= 95th percentile for age & gender

d) BMI >/= 95th percentile for age & gender

Based on the data collected, which one of the following nursing diagnoses would be most appropriate? a) altered family process b) altered family coping c) altered individual coping d) altered parenting

d) altered parenting

While Jenny, age 16, is in her routine checkup, her mother tells the nurse that Jenny wants to get a job at a local fast-food restaurant, where she would work 30 hours a week to earn extra money for clothes. The mother wonders whether this is a good idea. Which of the following is the nurse's best response? a. "Jenny is healthy and there is no reason she could not take the job." b. "all adolescents are preoccupied with clothes, so let her go ahead." c. that sounds like a dead-end job. why would Jenny want to work there?" d. "working 30 hours a week may take time away from her studies and extracurricular activities and increase fatigue. looking together at Jenny's future career goals may help identify alternatives."

d. "working 30 hours a week may take time away from her studies and extracurricular activities and increase fatigue. looking together at Jenny's future career goals may help identify alternatives."

Which of the following children meet(s) referral criteria? a. Jason, age 14 years, who identified fewer than four out of six correct letters with his right eye and five out of six correct with his left eye during visual acuity testing. b. Sandra, age 3 years, who demonstrated eye movement with the unilateral cover test. c. Tommy, age 4 years, who demonstrated a two-line difference between eyes on his visual acuity testing. d. All of the above.

d. All of the above.

While conducting an assessment of the child, the nurse communicates with the child's family. Which one of the following does the nurse recognize as not productive in obtaining information? a. Obtaining verbal and nonverbal input from the child. b. Observing the relationship between the parents and child. c. Using broad, open-ended questions. d. Avoiding the use of guiding statements to direct the focus of the interview.

d. Avoiding the use of guiding statements to direct the focus of the interview

Which of the following is not included in cultural humility? a. Lifelong commitment to self-refleciton and critique. b. Addressing the power imbalances in the nurse-patient relationship. c. Developing mutually beneficial praetorships with the community. d. Conforming to cultural norms to provide security and encourage change.

d. Conforming to cultural norms to provide security and encourage change.

To effectively establish a setting for communication, you enter the room, introduce yourself to Mrs. Brown and 11-year-old Kenny, and explain your role and the purpose of the interview. You include Kenny in the interaction as you ask his name and age and what he is expecting at his visit today. You next inform Mrs. Brown and Kenny that he is 25 lb overweight and that his diet and exercise plan must be "terrible" for Kenny to be in "such bad shape." Which aspect of effective communication have you, as a nurse, forgotten that will most significantly affect the exchange of information during this interview? a. Assurance of privacy and confidentiality. b. Preliminary acquaintance. c. Directing the focus away from the complaint of fatigue to one of obesity. d. Injecting your own attitudes and feelings into the interview.

d. Injecting your own attitudes and feelings into the interview.

Mike and Beverly Parker are adopting a 3-year-old girl from Russia. They have approached you for pre adoptive counseling. What would you include in the counseling? a. Provide information on appropriate referral agencies that can help with the adoptive process and support groups. b. Reassure them that because they are adopting the child at an early age, the child is less likely to remember previous parenting persons. c. Reassure them that because they are adopting, they will have greater sources of support and preparation than biologic parents. d. Instruct them on how to form an early parent-infant attachment that will eliminate difficulties.

d. Instruct them on how to form an early parent-infant attachment that will eliminate difficulties.

Which one of the following opioids is considered the gold standard for severe pain management? a. Hydromorphone. b. Gentanyl. c. Oxycodone. d. Morphine.

d. Morphine.

The receptionist at the clinic where you are employed as a nurse has forwarded a call to you from Mrs. Garcia, mother of 4-year-old Maria. Mrs. Garcia tells you that Maria has had a fever all morning of around 37.8 C (100 F) and that she now has diarrhea and vomiting. Maria is alert and still urinating. As you provide triage by phone, which one of the following actions is appropriate? a. Reassure Mrs. Garcia that Marie is not very sick and will be fine in a day or two. b. Confer with the practitioner at once. c. Wait to document in Maria's medical record until she comes in for a visit. d. Offer advice for home care and instruct Mrs. Garcia to call or come to the clinic if Maria's symptoms do not improve.

d. Offer advice for home care and instruct Mrs. Garcia to call or come to the clinic if Maria's symptoms do not improve.

In the female adolescent who has reached puberty, the lutenizing hormone initiates which of the following actions? a. Production of estrogen b. Growth of ovarian follicles c. Production of gonadotropin-releasing hormone d. Ovulation

d. Ovulation

Which one of the following best describes the appropriate use of play as a communication technique with children? a. Small infants have little response to activities that focus on repetitive actions like patting and stroking. b. Few clues about intellectual or social developmental progress are obtained from the observation of children's play behaviors. c. Therapeutic play has little value in reduction from illness or hospitalization. d. Play sessions serve as assessment tools for determining children's awareness and perception of illness.

d. Play sessions serve as assessment tools for determining children's awareness and perception of illness.

The nurse knows that that sexual history for an adolescent is an opportunity to a. Discuss the patinet's plans for future children b. Screen all adolescents for sexually transmitted infections c. Warn of the a risk of sexual activity d. Provide anticipatory guidance related to sexual health

d. Provide anticipatory guidance related to sexual health

You are assessing skin turgor in 10-month-old Ryan. You grasp the skin on the abdomen between the thumb and index finger, pull it taut, and quickly release it. The tissue remains suspended, or tented, for a few seconds and then slowly falls back on the abdomen. Which of the following conclusions can you correctly assume? a. The tissue shows normal elasticity. b. The child is poorly hydrated. c. The assessment was done incorrectly. d. The child has poor skin turgor.

d. The child has poor skin turgor.

The nurse is performing an otoscopic examination on a 14-month-old Justin. Which one of the following is recognized as an abnormal finding? a. The umbo, tip of the malleus, appears as a round, opaque, concave spot near the center of the drum. b. Light reflex is pointing away from the face. c. Tympanic membrane is translucent, light pearly pink or gray. d. Tympanic membrane is dull, nontransparent.

d. Tympanic membrane is dull, nontransparent.

When examining a child's genitalia the nurse should a. Conduct this examination first so that the child will not be as apprehensive b. Ask the parents to leave the room so that the young child will not be as shy c. Wait until the end of the examination before discussing findings with the parent and child d. Understand that this examination may provoke anxiety in the child

d. Understand that this examination may provoke anxiety in the child

Which of the following strategies is a powerful coping method that can be used with a small child during painful procedures? a. Ask the child whether he or she wants to take the pain medicine. b. Administer medication in the playroom. c. Give a comprehensive explanation of what will occur. d. Use distraction techniques for a painful procedure.

d. Use distraction techniques for a painful procedure. * sing favorite songs, counting aloud, blow bubbles only provide options if there are any actually available; "it's time for your medicine. do you want it plain or with water?" NEVER perform traumatic procedures in "safe" rooms simple explanations

According to recent research, the following intramuscular injection site is associated with fewer local and systemic reactions: a. Deltoid muscle b. Vastus lateralis c. Dorsogluteal d. Ventrogluteal

d. Ventrogluteal 1ml is max volume that should be administered in a single site on a child; the larger the amount, the larger the muscle must be best if supine on parent lap repeated IM use of a single site associated with fibrosis and contracture; permanent disability if major nerve is hit

The nurse should eliminate which of the following observations when recording the general appearance of the child? a. Impression of the child's nutritional status. b. Behavior, interactions with parents. c. Hygiene, cleanliness. d. Vital signs.

d. Vital signs.

you Complete the physical examination and determines that which one of the following is an abnormal finding a. Bowel sounds are stimulated by stroking the abdominal surface with fingernail b.Mary has no abdominal discomfort when she is supine with the legs flexed at the hips and knee c. Mary's eyes are open during palpation of the e abdomen d. When the nurse presses firmly over the area distal to the right side of the abdomen and quickly releases this pressure pain is intensified in the lower right side

d. When the nurse presses firmly over the area distal to the right side of the abdomen and quickly releases this pressure pain is intensified in the lower right side

Which one of the following statements is true in regard to nonpharmacologic pain management? a. When used properly, nonpharmacologic measures are a good substitute for analgesics. b. Nurses and physicians are generally well educated about nonpharmacologic approaches to pain management. c. Nonpharmacologic approaches to pain management are not effective with children. d. Whenever possible, nonpharmacologic and pharmacologic measures should be combined to manage pain.

d. Whenever possible, nonpharmacologic and pharmacologic measures should be combined to manage pain.

he moral and spiritual development of the preschooler is characterized by: a. concern for why something is wrong b. actions that are directed toward satisfying the needs of others c. thoughts of loyalty and gratitude d. a very concrete sense of justice

d. a very concrete sense of justice

stage II, families with infants according to Duvall's developmental stages of the family. Which one of the following is a developmental task of this stage? a. reestablishing couple identity b. socializing children c. making decisions regarding parenthood d. accomodating to parenting role

d. accomodating to parenting role

The most effective intervention for the treatment of fever in a 4-year-old child is to administer: a. a tepid sponge bath. b. ibuprofen. c. an alcohol sponge bath. d. acetaminophen.

d. acetaminophen. fevers require antipyretics (acetaminophin, aspirin, NSAIDs) to lower the set point - NO ASPIRIN in kids d/t Reyes syndrome - ibuprofin approved for >6mo - use cooling measures (less clothes, raise AC, moist compress) 1hr after administration so set point is lowered; STOP IF SHIVER don't frequently monitor temp, assess pt comfort

To manage opioid-induce respiratory depression in patients receiving opioids by continuous infusion, the nurse should: a. increase the solution by 25%. b. allow the patient long periods of uninterrupted sleep. c. administer naloxone and discontinue the infusion. d. administer naloxone by slow IV push every 2 minutes until the effect is obtained.

d. administer naloxone by slow IV push every 2 minutes until the effect is obtained.

Uninhibited scribbling and drawing can help the child to develop: a. symbolic language b. fine muscle skills c. eye hand coordination d. all of the above

d. all of the above

which of the following factors influences aggressive behavior? a. frustration b. modeling c. gender d. all of the above

d. all of the above

Areas of concern for parents of adoptive children include: a. the initial attachment process. b. telling the children that they are adopted. c. identity formation of children during adolescence. d. all of the above.

d. all of the above.

Standard Precautions involve the use of personal protective equipment such as gloves, gown, and mask to prevent contamination from: a. blood. b. body fluids. c. mucous membranes. d. all of the above.

d. all of the above.

To integrate spiritual care into practice, the nurse should: a. demonstrate respect. b. support visitation of spiritual leaders. c. listen to ensure understanding. d. all of the above.

d. all of the above.

An informed consent is required for: a. an emergency appendectomy. b. a cutdown for intravenous medications. c. release of medical information. d. all of the above.

d. all of the above. required for med/surg tx of a minor unless emergent verbal consent req.s 2 witnesses assent not legal requirement, but an ethical one

The benefit(s) of the ambulatory/outpatient setting is reduction of: a. stressors. b. infection risk. c. cost. d. all of the above.

d. all of the above. usually for surgical/dx procedures explicit discharge instructions are important after outpatient surgery follow up call in 2-3d after discharge

A change in vital signs of the young child in the postanesthesia recovery room that demands immediate attention is: a. increased temperature. b. tachypnea. c. muscle rigidity. d. all of the above.

d. all of the above. * also tachycardia, acidosis, and rhabdomyolysis may be malignant hypothermia

JImmy, a 13-year old, is sent to the school nurse because he and some of his peers were caught chewing tobacco while playing baseball. The nurse knows that the best way to influence Jimmy's behavior for health promotion would be which of the following? a. tell jimmy that he will be suspended from school if he continues to chew the tobacco b. show jimmy pictures of oral cancer from chewing tobacco c. tell Jimmy about the dangers of chewing tobacco and stress the fact that girls do not like boys who chew tobacco d. arrange for a local baseball hero talk with Jimmy and his friends, stressing that he does not use chewing tobacco, his friends do not chew tobacco, and chewing tobacco causes ugly teeth

d. arrange for a local baseball hero talk with Jimmy and his friends, stressing that he does not use chewing tobacco, his friends do not chew tobacco, and chewing tobacco causes ugly teeth

To effectively provide anticipatory guidance to the family, the nurse should: a. provide information to deal with each problem as it develops. b. provide teaching and interventions based on needs identified by the professional. c. be suspicious of the parent's ability to deal effectively with the child's needs. d. assist the parents in building competence in their parenting abilities.

d. assist the parents in building competence in their parenting abilities.

Although statutes vary from state to state, minors are usually recognized as having the legal capacity of an adult in all matters after they: a. have acquired a sexually transmitted infection. b. use contraceptives. c. use drugs or alcohol. d. become pregnant

d. become pregnant

Which one of the following statements about mass media is true? a. evidence demonstrates a benefit to selective media usage beginning in infancy b. Educational television programming teaches the habits of mind to be a good leader. c. Reading ability and intelligence are linked to the numbers and types of comic books read. d. cognitive and social outcomes in prescool-aged children may benefit from high-quality programming

d. cognitive and social outcomes in prescool-aged children may benefit from high-quality programming

The Wong-Baker FACES Pain Rating Scale: a. is easy to use but less reliable than other methods. b. is a rating of how children are feeling. c. has a coding system from 0.4 to 0.97. d. consists of six cartoon faces.

d. consists of six cartoon faces.

Questions related to activities of daily living at the time of admission are: a. inappropriate and should be saved for later. b. directed toward evaluation of the child's preparation for hospitalization. c. asked directly and in the order provided on the assessment form. d. designed to help the nurse develop appropriate routines for the hospitalized child.

d. designed to help the nurse develop appropriate routines for the hospitalized child.

During auscultation of S2, a split is heard that does not change during inspiration. Based on this, the nurse should suspect: a. a normal finding referred to as physiologic splitting. b. mitral valve prolapse. c. that no anatomic cardiac defect exists, but that a physiologic abnormality such as anemia is likely to be present. d. fixed splitting, which can be a diagnostic sign of atrial septal defect.

d. fixed splitting, which can be a diagnostic sign of atrial septal defect.

Adolescents who feel close to their parents show: i. more positive psychosocial development ii. greater behavioral competence iii. less susceptibility to negative peer pressure iv. less tendency to be involved in risk-taking behaviors a. i, iii, and iv b. i and ii c. iii and iv d. i, ii, iii, and iv

d. i, ii, iii, and iv

The formation of sexual identity development during adolescence usually involves which of the following? i. forming close friendships with same-sex peers during early adolescence ii. developing intimate relationships with members of the opposite sex during middle adolescence iii. developing emotional and social identities separate from those of families iv. incorporating sexuality successfully into intimate relationships a. i, ii, and iii b. ii, iii, and iv c. ii and iii d. i, ii, iii, and iv

d. i, ii, iii, and iv

The most frequently used site for bone marrow aspiration in children is the: a. femur. b. sternum. c. tibia. d. iliac crest.

d. iliac crest. in infants, tibial may be used

Expected characteristics of emotional autonomy during early adolescence include: a. increased independence from friends b. increased need for parental approval c. belief that parents are all-knowing and all-powerful d. less emotional dependence on parents

d. less emotional dependence on parents

School-based health promotion interventions for adolescents do not include which of the following? a. classroom health education b. adopting school-level policies c. environmental changes at the school d. mass media production

d. mass media production

With the concept of atraumatic care in mind, preoperative sedation in children is best accomplished by: a. intramuscular opioids. b. intravenous midazolam. c. intravenous opioids. d. oral midazolam.

d. oral midazolam. parental presence during sedation requires their edu on what to expect so they don't get more anxious

To obtain a sputum specimen to test for tuberculosis in an infant, the nurse may need to: a. stimulate the infant's cough reflex. b. obtain mucus from the throat. c. insert a suction catheter into the back of the throat. d. perform gastric lavage

d. perform gastric lavage. nasal washings; supine and instill NaCl with a syringe and aspirate with bulb

which of the following statements about social development of the preschooler is false? a. imaginary playmates are a normal part of the preschoolers play b. preschoolers have overcome much of their anxiety regarding strangers c. preschoolers use telographic speech between the ages of 3 and 4 y/o d. preschoolers particularly enjoy parallel play

d. preschoolers particularly enjoy parallel play

When assessing the ear of a 2-year-old child, the nurse should: a. expect cerumen in the external ear canal. b. use the smallest speculum to prevent trauma to the ear. c. pull the pinna up and back to visualize the canal better. d. pull the pinna down and back to visualize the canal better.

d. pull the pinna down and back to visualize the canal better.

Discharge instructions from the ambulatory setting should include all of the following except: a. guidelines for when to call. b. dietary restrictions. c. activity restrictions. d. referral to a home health agency.

d. referral to a home health agency.

Which of the following statements as it relates to adolescent physical fitness is true? a. female students are more likely to engage in vigorous physical activity b. high levels of physical activity may increase cardiovascular disease risk factors during adolescence c. routine exercise has little positive effect on adolescents' risk for depression and emotional stress d. routine screening of all adolescents should include information about frequency, intensity, and type of physical activity

d. routine screening of all adolescents should include information about frequency, intensity, and type of physical activity

The question "How does your child act when annoyed or upset?" would be asked on admission to assess the child's: a. health perception-health management pattern. b. cognitive-perceptual pattern. c. activity-exercise pattern. d. self-perception/self-concept pattern.

d. self-perception/self-concept pattern.

Behavior that signals the child's readiness to cooperate during the physical examination does not include: a. talking to the nurse. b. making eye contact with the nurse. c. allowing physical touching. d. sitting on the parent's lap or playing with a doll.

d. sitting on the parent's lap or playing with a doll.

Nonopioids: a. are used for moderate to severe pain. b. have the same effect on pain as morphine. c. have little antipyretic actions. d. take about 1 hour for effect.

d. take about 1 hour for effect

The nurse is conducting an interview with 8-year-old Jesus and his mother, Mrs. Lopez. Mrs. Lopez is worried because Jesus has been acting up at home and at school and disrupting everyone. An interpreter has been requested since the mother speaks little English. When using an interpreter for communication with Mrs. Lopez, the nurse realizes that: a. the interpreter will have little to do because Jesus can interpret for his mother. b. when the interpreter and Mrs. Lopez speak for a long period, it will be necessary to interrupt to refocus the interview. c. the nurse needs to communicate directly with Mrs. Lopez and ignore the interpreter. d. the nurse needs to pose questions to elicit only one answer at a time from Mrs. Lopez.

d. the nurse needs to pose questions to elicit only one answer at a time from Mrs. Lopez.

when children enter the school: a. parents no longer exert the major influence on them b. teachers have the most significant psychologic impact on children's develpment and socializations within the community c. the school becomes the center for establishing all rules and regulations d. the school serves as a major source of socialization for the child

d. the school serves as a major source of socialization for the child

Adolescents are more likely to participate in health care services when: a. they understand the potentially negative consequences of their health behavior b. they rank confidential care and respect higher than site cleanliness c. they view their health problems as not organic in nature d. they see the health provider as caring and respectful

d. they see the health provider as caring and respectful

stereopsis

depth perception begins to develop by 7-9 months

male sexual characteristics

development of viable sperm (1 year after first ejaculation) muscle mass, skeletal growth, bone age, bone density pubic, axilary, facial and body hair acne, body odor, deepening of the voice, spurt in hright, increase red blood cells levels

psychosocial development toddlers

diffirentiation of self from other toleration separation from parents ability to withstnd dealyed gratification control over bodily functions acquizision of socially acceptable behavior verbal means of communication ability to interact with others in less egocentric manner developing sense of autonomy negativism ritualism domestic mimicry object permanence

The nurse gives Tina a doll and a stethoscope and allows her to listen to that doll's heart

directeed play

early appearance of secondary sex characteristics of girls during preadolecens may be associated with which o =f the following feelings

dissatisfaction with physical appearance and lower self esteem

eye examination guidelines

distance visual acuity ( snelling, tumbling E, picture test); ocular alignment; ocular media clarity ( red reflex)

decrease perception of pain during IM

distract give something to concentrate on - squeezing, holding rail) spray vapocoolant before injection, cold compress 1 min before manual pressure 10 sec before reduce postinjection pain child hold bangade alow expressing of feelings hold and cuddle child

Today nurse otherwise Tina withCrayons and paper and asks herTo draw a picture of her family

drawing

the nurse knows that sleepwalking in childhood can be best described by which of the following statements

during sleepwalking the movements are clumsy and repetitive

which of the following description of school age children is most closely linked to eriksons theory

during this time, interested expand and children with a growing sense of independence engage in tasks that can be carried through to completion

Match each role of pediatric nurse to it's description a) family advocacy and caring b) disease prevention and health promotion c) health teaching d) support e) counseling f) therapeutic relationship g) coordination & collaboration h) ethical decision making i) research & EBP __ a mutual exchange of ideas and opinions __ health maintenance strategies __ working together as a member of the health team __ establishing relationships w/children and families, yet remaining separate __ systematically recording and analyzing observation __ attention to emotional needs (listening, physical presence) __ transmitting info __ using pt, family, and societal values in care __ acting in the childs best interest

e) counseling: mutual exchange of ideas and opinions b) disease prevention and health promotion: health maintenance and strategies g) coordination & collaboration: working together as a member of the health team f) therapeutic relationship: establishing relationships w/children and families, yet remaining separate i) research and EBP: systematically recording and analyzing observation d) support: attention to emotional needs (listening, physical presence) c) health teaching: trasmitting info h) ethical decision making: using pt, family & societal values in care a) family advocacy and caring: acting in the child's best interes

communicating early childhood

egocentric focus of communication on them tell them what you will do and how they will feel allow touch and experience article they will come into contact with they use hands to commjnicate - pull, push to show interpret words literally ( Ex. Two-faced), so simple direct language

basic consepts in family-centered care

enabling - creating opportunities and means for all family memebers to display their current abilities and competencies to acquire the new ones to meet the needs of the chid and family empowerment- interaction of professionalswith families in such a way that families maintainor acquire a sense of control over the family lives and acknowledge positive changes that result from helping behaviors that foster their own strength, abilities and actions

communicating with parents

encouraging the parents to talk directing the focus listening and cultural awareness using silence being empathetic providing anticipatory guideness avoiding blocks to communication communicating with families through an interpreter

limit setting

establishing the rules or guidelines for behavior ( amount of time on TV)

Estimated Average Requirement (EAR)

estimated to meet the nutrient requirement of half of healthy individuals for a specific age and gender group

permissive parents

exert little or no control over their children's actions, allow their children to regulate their own activity as much as possib;e

What is an INAPPROPRIATE method to help a toddler adjust to the initial dental check up?

explain to the child that a check up will not hurt.

List three strategies nurses can use to minimize stressors for the parents of the hospitalized child.

facilitate info sharing with pt/fam, explore emotional reaction, ensure that parental emotions are normal suggest way that support system can help parents, involve clergy

Nonverbal components of the communication processDo not convey significant messages

false

True or false: Role continuity is defined as role behavior that is expected of children conflicting with desirable adult behavior

false

True or false: Role definition are changing as a result of the changing economy and increased opportunities for women. Marital roles, however are still most stereotyped among the middle classes

false

child characteristics such as age and sex are more crucial to the child's well-being during divorce than are family characteristics

false

research has shown that children of divorce suffer no lasting psychologic and social difficulties

false

General Systems Theory

family is viewed as a system that cintinually interacts with its members and the environment direct cause and effect example - child abuse; problem doesnt rest solely with the parent or child but with the type of interactions between the parent and the child and the factors that affect their relationships

family of origin

family unit a person is born into

plan of atraumatic care for a hospitalized child.

fostering parent-child relationship during hospitalization preparing the child befoe unfamiliar treatment or procedure controlling pain allowing th chid privacy providing play activities for expression of fear and aggression provising choices to children respecting cultural differences

Adequate Intakes (AI), a category of DRI, are based on nutrient intake of?

full term breast fed infants

FDI

functional disability inventory child's ability to perform everyday physical activities

Describe at least one play activity for: Ambulation

give child something to push (toy, wagon, decorated IV stand) have a parade

According to Kohlberg, what is the best way to discipline children?

give explanations and help the child to change.

primary sexual characteristics females

growth and development of vagina, uterus, fallopian tubes skin of labia majora, breast areola, nipples grow and darkens under influence of estrogen breast enlargement, pubic, axillary hair, widening of hips

patient assessment vs family assessment

health history of immediate family members when you are assessing familly, child doesn't come into it

Tolerable Upper Intake Level (UL)

highest nutrient intake level likely to pose no risk of adverse health effects

Family Stress Theory

how families react to stressful events and suggests factors that promote adaptation to stress

Puberty begins when

hypothalamus produces increased levels of gonadotropin-releasing hormone, travels to anterior pituitary gland, where it stimulates the production and secretion of follicle stimulating hormone for felames - FSH stimulates groth of ovarian follicles and production of estrogen for males -maturation of testicles and testosterone production

Strategies to minimize the effects of separation in school-age children and adolescents include: i. allowing visits from peers ii. allowing children to wear their own clothes iii. bringing favorite items from home, such as a laptop or stuffed animal iv. enforcing strict rules and routines regarding diagnostic procedures v. asking the family to leave the room when the physician enters b. i, ii, and iii

i. allowing visits from peers ii. allowing children to wear their own clothes iii. bringing favorite items from home, such as a laptop or stuffed animal plan/anticipate family member return, distract create a familiar surrounding (photos, singing a song, prayers, pets) place ID bands on toys so they don't get misplaced and provides a symbol that toy is experiencing same needs

dillion is a 6 year old starting in a new neighborhood school. on the first day of school he complains o a headache and tearfully tells his mother he does not want to go the school. millions mother takes him to school and the nurse is consulted. the nurse recognizes tat doll ion is slow to warm up to the others and suggests which one of the following

include dillion in activities without assigning him tasks until he willingly patticiates in activities

What skill is NOT necessary for the toddler to acquire before separation and individualization can be achieved?

lack of anxiety during separations from parents

according to freud middle childhood is described as which one of the following periods

latency

spiritual development toddler

learn from family and envuronment from words and actions close to the toddler

each group reaction to separation/ hospital

like clothing on ( sure!) let mom hold the child anything to fell in control let them have choices but the ones that will happen one way or another

deltoid IM

location - acromion process; inject only into upper third of muscle that begins about 2 finger bredths below acromion needle insertion and site - perpendicular to site but angled slightly toward shoulder 22-25 gauge ( 1/2-1") advantages - faster absorption than gluteal; easy accesible; less pain and fewer local side effects from vaccines compared with vastus lateralis disadvantages - small muscle mass-> limited drug amount (0.5-1 ml); small margin of safety with possible damage to radial nerve and axillary nerve

ventrogluteal IM

location - locate great trochanter, anterior superior iliac tubercle and posterior iliac crest; place palm of hand over greater trochanter, index finger over anterior superior iliac tubercle, and middle finger along crest of ilium posteriorly as far as possible; inject into center of V formed by fingers nedle insertion and size - perperdicular to site but angled slightly toward iliac crest 22-25 gauge ( 1/2-1") advantages - free of important nurves and vascular structures; easily identified by prominent bony landmarks; thinnner layer of SQ tissue ( than gorsogluteal), so less change of SQ rather than IM; tolerate larger quantities ( 0.5 in infant to 2.0 ml in child); easily accesible; less painful than vastus laretalis fewer systemic reactions,well defined landmarks, easy to immobilize during administration disadvantage - health professionals unfmiliarity with site

gross and fine motor development of toddlera

locomotion development 12-13 months - walks alone 18 months tries to run but fall easily 2yo can walk up and down stairs 2 1/2 jump up and down on both feet 18 months tower of 3-4 blocks 24 mnths - 6-7 blocks exploration, investigation

List at least two ways that drawing or painting can be used by the nurse in caring for the hospitalized child.

media for expression used as springboard for discussion observing changes in paintings over time can be helpful assessment

adolescents can consent to treatment without parent's knowledge

medically emancipated conditions: - STI - mental health service - substance abuse and addiction - pregnancy - contraceptives

Bright Futures Program

national health promotion initiative with a goal to improve the health of our nations's children - family support - child development - mental health - healthy nutrition - physical activity - oral health - healthy sexual development - sefaty and injury prevention

informed consent

nature of the illness proposed care or treatment potential risks, benefits and alternatives what might happen if the patient chooses not to consent

dorsogluteal

no longer recommended for children under 10 yo

polygamous family

not legal the conjugal unit extended by the addition of spouses in polygamous matings polygyny - multiple wives polyandry - multiple husbands sororal - wives are sisters nonsororal - wives are unrelated

Which are common reasons that adolescents pierce or tattoo their bodies? Select all that apply. To avoid being bullied Because parents have body art To express individualism To represent a deep belief To identify with a specific peer group

o express individualism Expressing individualism is a common reason for body art. To identify with a specific peer group Trying to identify with a specific peer group is a common reason for adolescents to obtain body art. Adolescents often try to fit in with different groups of people by looking and acting like them.

developmental theory

outgrowth of several theories of development 8 developmental tasks of the family throughout its life span - family doesn't change in one part without a series of changes in other parts

dual-erner family parenting

overload is a common source of stress, and social activities are significantly curtailed, with time demands and scheduling seen as major problem

N-PASS

pain assessemnt 23-40 weeks procedural and prolonged ( 0-2 each) vital signs crying, facial expressions behavioral state extremities

PIPP-revised

pain assessment 25-40 weeks procedural and postoperative score range 0-21

chronic primary pain

pain in one or more anatomic regions that persists or recurrs for longer than 3 months

first degree relatives

parents, siblings, grandparents, and immediate aunts an uncles

school age children

participate in hero worship

the nurse is planning an educational session for a group of 9 year olds and their parents arimed at decreasing injuries and accidents among this group. the nurse would best accomplish this goal by reviewing

pedestrian safety rules and skills training programs to prevent motor vehicle accidents

Healthy ways of serving foods to toddlers include?

permitting nutritious nibbling in lieu of meals

list factors children possess that influence theri behavior

personal history biologic factors

biologic development of the preschooler

physical growth rate slows and stabilizes during preschool years; physical proportions change: slender but sturdy, graceful, agile, posture erect; males and females similar in size and proportion

The toddler's decreased nutritional requirements are manifested in a phenomenon known as?

physiologic anemia

liquid med to 2 yo

plastic calibrated syringe ( convenient and reliable dose measure as well as administration) mix with small amount of sweet substance, but avoid essential items ( child may refuse to eat later) give water "chaser" to wach it down avoid dairy ( may interfere with absorption) in nausea - give carbonated drink over ice before or after medication) if medication has unpleasant taste - tell child to pinch nose and drink through straw (taste associated with smell) commercially available flavourings use a nipple or special pacifier with a reservoir for the drug paper cups unsuitable, household spoons avoid RXMedibottle or molded plastic cups/medicine spoons in ml with lines, dropper all liquid oral meds should be dosed in ml and not ts prevent aspiration - use semireclining position, along the side of tongue, toddlers can drink from a cup give toddlers choice, let be involved, or help with taking meds never give meds lying flat no EBR regarding specific time frame for preparing a dose after a patient has vomited because it is difficult to estimate swallowed amoutn

health and health care priorities for american children

poverty hunger lack of health insurance child abuse and neglect overweight and obesity firearms death and injuries mental health racial and ethnic desparities immigration

the nurse plans to conduct a sex education class for 10 year olds. which one of the following does the nurse recognize as most appropriate for this age group

present sex information as a normal part of growth and development

terapeutic care

prevention diagnosis treatment palliation of acute of chronic conditions

atraumatic care

provisions of therapeutic care throught the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and their families

adolescent health promotion match

pubertal delay occurs when girls fail to develop breasts by the age 13 puberty biologic changes of adolescence menarche onset of menstrual periods thelarche development of breast tissue precocious puberty when boys develop secondary sexual characteristics before the age of 9 years gynecomastia male breast enlargement and tenderness pubertal growth spurt general increase in growth of the skeleton, muscles, and internal organs; reaches a peak of about 12 years of age in girls and 14 years of age in boys genetic endowment most important determinant of the onset, rate, and duration of pubertal growth pubarche development of pubic hair physiologic leukorrhea normal vaginal discharge ovulation release of an ovum by a follicle

disparities in pediatric care

race ethnicity socioeconomic status geographic factors

biological development infant

rapid growth ( especially 6 month) - 1.5 lb a month; 1" a month; head circumference 2 cm a month closure cranial sutures with the posterior fontanel - 6-8 weeks, anterior fontanel 12-18 months heart large comparing to chest still binocularity - fixation of 2 ocular images into one cerebral picture - begins at 6 weeks and ends by 4 months depth perception - begins develop 7-9 months 7 months parachute reflex 6 months responds to facial expressions and distinguish between familiar faces; separation anxiety begins 4 weeks tear glands begin to function convergence begins 6 weeks, ends 4 month HR slows maternally derived iron deples by 5-6 month lipase adult level -5-6 months end of 1 year - 3 meals bile secretes after 2 weeks immaturity of renal - predisposes to dehydration

What is one recommended method to foster language development in the toddler?

read books together

Types of discipline

reasoning scolding when reprimanding focus on misbehavior not on the child

blended family

reconstituted family includes at least one stepparent, stepsiblings, half-siblings

time out

refinement of the common practice of sending the child to his or her room as a type of unrelated consequence

authoritative

respects each child's individuality; directs the child's behavior by emphasizing the reason for rules

major causes of illness during childhood

respiratory illness infection injuries

Children on strict vegetarian and macrobiotic diets should be evaluated for what?

rickets and iron deficiency anemia

egocentric

seeing things only in relation to oneself and one's own point of view

List four essential teaching points the nurse should cover when providing anticipatory guidance for a family who asks about the danger of fever in a child.

seizures may occur, especially 6mo-6y.o. - no antipyretics/anticonvulsants - if <10min, no brain damage dehydration from hyperthermia may be prevented by offering liquids - sponging only for hyperthermia ice water and alcohol are potentially dangerous solution teach how to take temp properly reduce activity and encourage small frequent sips of liquids

crucial events of sensorimotor phase

separation - child earns to separate seld from the enironment object prmanance - objects leaving visual field still exist mental representaton - use symbols

single parenting

shortages of money, time and energy are major concerns

list sociocultural factors that influence children's behavior

social policy cultural norms media

interviewing

specific form of goal-directed communication

Duvall's developmental stages of the family

stage 1 - marriage and independent home: the joining of families stage 2 - families with infants ( integrate infat into the family unit) stage 3 - families with preschoolers stage 4 - families with school children ( children develop peer relations) stage 5 - families with teenagers ( increasing autonomy of adolescents) stage 6 - families as launching centers (parents nd young adults establish independent identities) stage 7 - middle-aged families - reinvest in couple identity with concurrent development of independent interets stage 8 - aging family - shift from work role to leisure

One of the best ways to prevent drowning in the toddler groups is for parents to?

supervise children within arm's reach whenever they are near any source of water.

jim a 7 year old has been diagnosed with childhood obesity. which one of the following does the nurse recognize as being most likely to contribute to sims obesity

the availability of inexpensive high caloric goods and the tendency towards sedentary activities

toward the end of middle childhood the discrepancies in growth and maturation between boys and girls because apparent. which of the following statements is true

the average age of puberty is 12 years in girls and 14 years in boys

a factor that most influences the amount and manner of discipline and limit settings imposed on school age children is

the childs response to rewards and punishments

ethnocentrism

the emotional attitude that the one's values, beleifs, and perceptiosn are the correct once and that the group's ways of livign and behaving are the best

Describe the role of ritualism in relation to feeding behaviors in toddlers.

they like to have the same plate, spoon, fork, cup and food to eat at almost every meal. -they may refuse to eat if some of these change. -some believe its part of gaining autonomy or control.

The nurse should assume a position That is at eye level with the child

true

even when a divorce is amicable and open, children recall parental separation with the same emtions felt by victims of a natural disaster: loss, greif, and vulnerability to forces beyond their control

true

positive outcomes of divorce include a successful postdivorce family that can improve the quality of life for both adults and chidren

true

preschoolers assume themselves to be the cause of the divorce and interpret the separation as punishment

true

Body righting

turning the hips and shoulders to one side causes all the other body parts to follow

social development infant

when child is not provided a safe haven and consisten loving care, insecure attachment develops, they feel they can not trust the world forming attachment: 1. responds to anyone 2. 8-12 weeks - cry, smile and vocalize more to mother 3. 6 months - direct preference to mother 4. one month after attachment to mother - will start showing attachment to other members of family separation anxiety 4-8 months. stages: 1. early second half of the year - protest when placed in crib 2. protests when mother leaves the room 3. alert of her activities 4. 11-12 months able to anticipate her leaving and begin protest before leaving stranger fear 6-8 months 2 month single vowel sounds 4 months consonants 6 months imitate sounds, combile syllables 9-10 month comprehend meaning of no 1 year 3-5 words with meaning and understand 100 words nby 6 months ther are very personable from 11 months increasing independence 3-6 can play alone

presence of parents during procedure

yes depending on the precodure and depends how parent feel, but they calm the child

Why is flossing necessary?

-remove plaque from below the gum margin -remove debris between the teeth -reach areas where brushing is ineffective

What is the most important considerations when evaluating their child's growth charts

Comparing growth measurement over time

children can fixate on one visual field with both eyes

by 3-4 months

Preparation for hospitalization reduces stress in which of the following age-groups? a. Adolescence b. Toddlerhood c. Preschool d. All of the above

d. All of the above