EXAM 1 PEDS PERRY

A terminally ill male adolescent is being admitted to the hospital due to lack of pain relief. When communicating with this patient about his feelings on death, the nurse should incorporate which actions into the plan of care? (Select all that apply.) A. Reassure the adolescent that the illness is not a result of him not cleaning his room. B. Establish an alliance with the patient to build a rapport with him. C. Speak to the patient keeping in mind that he views death as temporary. D. Discuss what future implications his death may have on his friends and family. E. Emphasize the need to frequently talk about his prognosis and treatment plan. F. Allow the adolescent to participate in the treatment decisions as much as possible.

A & F Adolescents are likely to see deviations from accepted behavior as reasons for their illness. The nurse should avoid alliances with either parent or child when discussing death. Adolescents usually have a mature understanding of death rather than view death as temporary. Adolescents are usually concerned only about the present, not past or future. Adolescents' orientation to the present compels them to worry about physical changes even more than the prognosis. The nurse should structure hospital admission to allow for maximum self-control and independence.

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

A. Part of learning permanence is learning that although an object is no longer visible, it still exists. At 1 year of age, a child may not be able to understand that an object that changes shape is still the same object. Understanding conservation occurs between ages 7 to 11 years.

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for mommy. The nurse's BEST reply is: A. "Mommy will be here after lunch." B. "Mommy always comes back to see you." C. "Your mommy told me yesterday that she would be here today about noon." D. "Mommy had to go home for a while, but she will be here today."

A. Since toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time. Such statements do not give the child any information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Such statements do not give the child any information about when his mother will visit.

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of: A. pneumothorax. B. bronchodilation. C. carbon dioxide retention. D. increased viscosity of sputum.

A. The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. He or she needs to be seen as soon as possible. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially caused by a pneumothorax.

The mother of a 3-month-old breastfed infant asks about giving her baby water since it is summer and very warm. The nurse should recommend that: 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. water once or twice a day will make up for losses caused by environmental temperature. D. clear juices would be better than water to promote adequate fluid intake.

A. The child will nurse according to needs. Additional fluids are not necessary for the breastfed baby. Supplemental water should not be given. It may cause water intoxication. Supplemental water should not be given. It may cause water intoxication. Clear juices do not provide sufficient caloric or nutrient intake and may interfere with breastfeeding.

The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: A. trust. B. industry. C. initiative. D. separation.

A. The task of infancy is the development of trust. Industry vs. inferiority is the developmental task of school-age children. Initiative vs. guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage as described by Piaget.

A 6-year-old child has difficulty hearing faint or distant speech. His speech is normal, but he is having problems with his school performance. This hearing loss would MOST likely be classified as: A. slight. B. severe. C. moderate. D. moderately severe.

A. This is the definition of a slight hearing loss. With severe loss the child may hear a loud voice if nearby and may be able to identify loud environmental noises. Moderate hearing loss results in symptoms of being able to understand conversation at a distance of only 3 to 5 feet. With a moderately severe hearing loss, he would be unable to understand a conversation unless it was very loud.

When caring for a child after a tonsillectomy, the nurse should: A. watch for continuous swallowing. B. encourage gargling to reduce discomfort. C. position the child on the back for sleeping. D. apply warm compresses to the throat.

A. This is the most obvious early sign of bleeding from the operative site. Gargling should be avoided because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage. Cold is preferred. Ice collars and cold liquids are encouraged.

The nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. They talk with these parents more than with the nurses. The nurse should recognize that the: A. parent-to-parent support is valuable. B. parent-to-parent dependence is unhealthy. C. situation has developed because the nurses are unresponsive to the parents. D. situation is unusual and has the potential to increase friction between the parents and nursing staff.

A. This type of support is unique and not available from other sources. Being with other parents who have shared similar experiences (e.g., hospitalization) allows a mutually supportive environment. Rather than being a dependent relationship, parents provide support for each other. The nurses cannot provide the same type of support as another parent who has had the "lived experience." It is becoming increasingly common for parent-to-parent interaction to be facilitated by hospitals.

The parent of a hospitalized child tells the nurse, "We do not eat meat. We are practicing Buddhists and strict vegetarians." The most appropriate intervention by the nurse is to: A. order the child a meatless tray. B. tell the parent to take any meat off the child's meal tray. C. ask the parent if they would like to have a Buddhist priest visit. D. explain to the parent that meat provides protein needed to heal their child.

A. It is essential for the nurse to respect the religious practices of the child and parent. The nurse is not culturally sensitive to the religious practices of the child and parent and should ensure that nutritionally complete vegetarian meals are prepared by the dietary department. Asking the parent if they would like a Buddhist priest is not addressing the vegetarian diet and not being respectful of the child and parent's religious beliefs. The nurse should not encourage the child and parent to go against their religious beliefs.

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a: A. spacer. B. nebulizer. C. peak expiratory flow meter. D. trial of chest physiotherapy.

A. The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. A peak expiratory flow meter is a measure of pulmonary function not related to medication administration. Chest physiotherapy is unrelated to medication administration.

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs/practices. The nurse should recognize that this is: A. normal in spiritual development. B. abnormal in spiritual development. C. related to illness and occurs only at times of crisis. D. related to the inability of parents to explain adequately their beliefs/practices.

A. This describes stage 4 in spiritual development. Adolescents attempt to determine which of their parental standards and beliefs to incorporate into their own.

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

A. Whenever they are compatible, folk remedies should be used to reinforce the treatment plan. This will assist in establishing a caring environment. Depending on the remedy, they may not be incompatible. These circumstances vary with the remedy. These circumstances vary with the remedy.

The exhausted parents of a 2-month-old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse's initial action is to: A. advise the mother to follow a milk-free diet for 3 to 5 days. B. take a thorough, detailed history of usual daily events. C. administer simethicone drops to provide relief from gas pains. D. explain that the parents need to stay calm so the infant will remain calm.

B. The initial step in managing colic is to take a thorough, detailed history of the usual daily events including: diet, time of day when child cries, presence of family members, type of cry, etc. Before suggesting formula changes or medications to relieve symptoms, a detailed history is needed. It is important that the nurse convey an empathetic and compassionate attitude and reassure the parents that they are not doing anything wrong.

A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention? A. "Never shake baby powder directly on your infant because it can be aspirated into his lungs." B. "Do not permit your child to chew paint from window ledges because he might absorb too much lead." C. "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall." D. "Keep doors of appliances closed at all times."

C. This is appropriate guidance for a first-month appointment. This information should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand. Rolling over from abdomen to back occurs between 4 and 7 months. This is the appropriate anticipatory guidance for this age. This information should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand.

The most overwhelming adverse influence on health is: A. race. B. customs. C. socioeconomic status. D. genetic constitution.

C. Although children of different racial groups have differing health issues, socioeconomic status is a key predictor. Customs do not usually have an adverse effect on health. A higher percentage of lower-class individuals have some health problem at any one time than other individuals in different classes. There is a high correlation between poverty and poor nutrition. On a population basis, genetic constitution is not an overwhelming adverse influence.

What is appropriate advice for parents who are preparing to tell their children about their decision to divorce? A. Avoid crying in front of children. B. Avoid discussing the reason for the divorce. C. Give reassurance that the divorce is not the children's fault. D. Give reassurance that the divorce will not affect most aspects of the children's lives.

C. Parents can cry in front of children; it may give the children permission to do the same. Parents should provide the reasons for the divorce in a manner the children will understand. If parents are able, they should hold and touch children and reassure them that they are not the cause of the divorce. This would most likely be false reassurance because many aspects will change.

Parents of a 10-year-old child are concerned that their child has recently been showing signs of loneliness and abandonment. What should the nurse consider when discussing this issue with the parents? A. Changing self-esteem is difficult after about age 5. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of loneliness and abandonment are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

C. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem changes with development. Transient changes are expected and with positive encouragement and support are only temporary. Self-esteem is based on several components: competence, sense of control, moral worth, and worthiness of love and acceptance.

Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is: A. appropriate because families expect this expression of concern. B. appropriate because it can assist in the resolution of personal grief. C. inappropriate because it is unprofessional. D. inappropriate because it increases burnout.

B. Families may or may not expect this expression of concern. Nurses should attend the funeral of a child if they felt closeness with the family. This will help the nurses grieve and gain closure. The behavior is appropriate if a relationship existed between the nurses and family. This may prevent burnout.

The primary goal in caring for the child with cognitive impairment is to: A. encourage play. B. promote optimum development. C. help families adjust to future care. D. develop vocational skills.

B. Provide parents guidance for the selection of developmentally appropriate activities. A comprehensive approach is desirable to establish acceptable social behavior and feelings of self-worth in the child. This is an ongoing process that changes as the child meets developmental milestones. These skills will be addressed as the child's capabilities are developing.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? A. Vitamin B B. Vitamin D C. Vitamin C D. Vitamin K

B. The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 200 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency. Vitamin B is not needed. Vitamin C is not needed. Vitamin K is not needed.

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C. The nurse suspects croup and should recommend: A. controlling fever with acetaminophen and calling if the cough gets worse during the night. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. trying over-the-counter cough medicine and coming to the clinic in the morning if there is no improvement. D. admitting to the hospital and observing for impending epiglottitis.

B. The child does not have a temperature to manage. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency room if they develop. Cool mist is recommended to provide relief. Cough suppressants are not indicated. This is characteristic of laryngotracheobronchitis, not epiglottitis.

Early detection of a hearing impairment is critical because of its effect on areas of a child's life. The nurse should evaluate further for effects of the hearing impairment on: A. reading development. B. speech development. C. relationships with peers. D. performance at school.

B. The child will have greater difficulty learning to read, but the primary issue of concern is the effect on speech. The ability to hear sounds is essential for the development of speech. Babies imitate the sounds that they hear. Relationships with peers and performance at school will be affected by the child's lack of hearing. The effect will be augmented by difficulties with oral communication. Relationships with peers and performance at school will be affected by the child's lack of hearing. The effect will be augmented by difficulties with oral communication.

An immediate intervention when an infant chokes on a piece of food would be to: A. have infant lie quietly while a call is placed for emergency help. B. position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades. C. administer mouth-to-mouth resuscitation. D. give water by cup to relieve the obstruction.

B. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. This is the correct initial sequence of actions for an infant with an obstructed airway. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child's airway is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem? A. Putting her in parents' bed to cuddle B. Beginning to put her to bed while still awake C. Letting her cry herself back to sleep D. Giving her a bottle of formula instead of breastfeeding her so often at night

B. The nurse needs to discuss the issue of co-sleeping with parents. Having the infant in bed with them may still interfere with their sleep. Parents need to develop bedtime rituals that involve putting the child in bed when awake. If the child is put in bed awake, she will be able to return to sleep more easily if she awakens at night. Providing formula at night contributes to bottle-mouth caries.

The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. The nurse should recognize that: A. this assessment is normal. B. the child is probably cognitively impaired. C. developmental/neurologic evaluation is needed. D. the parent needs to work with the infant to stop head lag.

C. A 6-month-old infant should have social interaction beyond smiling and cooing. The child requires evaluation. The head lag should be almost gone by 4 months of age. This child requires evaluation. The child requires evaluation before interventions can be determined.

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, O.K.?" The nurse should: A. start the IV line because allowing the child to manipulate the nurse is bad. B. start the IV line because unlimited procrastination results in heightened anxiety. C. postpone starting the IV line until the child is ready so that the child experiences a sense of control. D. postpone starting the IV line until the child is ready so the child's anxiety is reduced.

B. The nurse should start the IV line, recognizing that the child is attempting to gain control. Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. If the timing of the IV line start was not essential for the start of IV antibiotics, this might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.

The nurse is caring for a child dying from cancer. Physical signs that the child is approaching death include: A. rapid pulse. B. change in respiratory pattern. C. sensation of cold, although body feels hot. D. loss of hearing followed by loss of other senses.

B. The pulse becomes weak and slowed. In the final hours of life the respiratory pattern may become labored, with periods of apnea. The opposite is true; there is a sensation of heat, although the body feels cold. Hearing is the last sense to fail.

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

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

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? A. Inactivity B. Clings to parent C. Depressed, sad D. Regression to earlier behavior

B. These are characteristics of despair. In the protest phase, the child aggressively responds to separation from parents. These are characteristics of despair. These are characteristics of despair.

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that: A. the infant is most likely spoiled. B. this is a normal reaction for this age. C. this is an abnormal reaction for this age. D. grandparents are not responsive to that infant.

B. These are developmentally appropriate. The infant is experiencing stranger anxiety, which is expected for this age child. These are developmentally appropriate. No data have been shown to support this.

A camp nurse is assessing a group of children attending summer camp. Based on the nurse's knowledge of special parenting situations, which group of children is at risk for a sense of belonging? A. Children adopted as infants B. Children recently placed in foster care C. Children whose parents recently divorced D. Children who recently gained a stepparent

B. Children placed in foster care are at greater risk to have problems perceiving a sense of belonging. Children adopted at birth have fewer problems with acceptance when parents follow preadoption counseling about disclosure. Children of divorced parents often fear abandonment. Children who gain a stepparent are at risk for having trust problems with the new parent.

The nurse is caring for an 8-year-old child who has a chronic illness. The child has a tracheostomy, and a parent is rooming-in during this hospitalization. The parent insists on providing almost all of the child's care and tells the nurses how to care for the child. When planning the child's care, the primary nurse should recognize that the parent is: A. controlling and demanding. B. assuming the nurse's role. C. the expert in care of the child. D. not allowing nurses to function independently.

C. Because these parents care for this child with complex health needs at home, they are most familiar with the care requirements and routine. The nurse's role includes assessment and evaluation, not just the implementation phase. The nurse recognizes that the philosophy of family-centered care states that the parents are the experts in the care of their child. The nurse functions collaboratively with the family.

The parents of a cognitively impaired child ask the nurse for guidance with discipline. The nurse's BEST response is: A. "Discipline is ineffective with cognitively impaired children." B. "Discipline is not necessary for cognitively impaired children." C. "Behavior modification is an excellent form of discipline." D. "Physical punishment is the most appropriate form of discipline."

C. Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential in assisting the child in developing boundaries. Positive behaviors and desirable actions should be reinforced (p. 1181). Most children with cognitive impairment will not be able to understand the reason for the physical punishment; consequently behavior will not change as a result of the punishment.

Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary? A. C, D B. A, E, K C. A, D, E, K D. C, folic acid

C. C is not one of the fat-soluble vitamins. D also needs to be supplemented. A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. C and folic acid are not fat soluble.

At what age would the nurse advise parents to expect their infant to be able to say "mama" and "dada" with meaning? A. 4 months B. 6 months C. 10 months D. 14 months

C. Consonants are added to infant vocalizations. Babbling resembles one-syllable sounds. At this age infants say sounds with meaning. This is late for the development of sounds with meaning.

Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake? A. Using developmental stimulation by a specialist during feedings B. Avoiding solids until after the bottle is well accepted C. Being persistent through 10 to 15 minutes of food refusal D. Varying schedule of routine activities on a daily basis

C. Feeding times should have a nonstimulating environment so the focus is on the meal. Solids should be introduced slowly to decrease dependence on the bottle. Calm perseverance is important. Parents often fail to persist through the child's refusals. Daily schedule should be structured to provide consistency for the child.

The MOST appropriate recommendation for relief of teething pain is to instruct the parents to: A. rub gums with aspirin to relieve inflammation. B. apply hydrogen peroxide to gums to relieve irritation. C. give child a frozen teething ring to relieve inflammation. D. have child chew on a warm teething ring to encourage tooth eruption.

C. Gums should not be rubbed with aspirin. It can be dangerous if the child aspirates aspirin. Hydrogen peroxide would not be effective. Cold reduces inflammation and should be used for relief of teething irritation. Cold, not warmth, reduces inflammation.

The nurse in the pediatric clinic identifies which infants at risk for developing vitamin D-deficient rickets? A. Lacto-ovo vegetarians B. Those who are breastfed exclusively C. Those using yogurt as primary source of milk D. Those exposed to daily sunlight

C. Individuals who follow this diet include milk and its products in their diet. Breast milk has sufficient vitamin D if the mother is not deficient in this vitamin. Yogurt may not be supplemented with vitamin D. Lack of sunlight contributes to vitamin D-deficient rickets.

A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for: A. rickets. B. marasmus. C. kwashiorkor. D. pellagra.

C. Kwashiorkor is defined as primarily a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.

A 4-year-old child will be having cardiac surgery next week. The child's parents call the hospital, asking about how to prepare her for this. The nurse's BEST response is to inform the parents that: A. preparation at this age will only increase the child's stress. B. preparation needs to be at least 2 to 3 weeks before hospitalization. C. children who are prepared experience less fear and stress during hospitalization. D. children who are prepared experience overwhelming fear by the time hospitalization occurs.

C. Preparation will reduce stress by having the child incorporate the threat more slowly. For this age group 1 week of preparation is recommended. Preparing the child for the hospitalization will reduce the number of unknown elements. Tours, handling some of the equipment, or being told stories about what to expect will increase the familiarity with items. A reduction in fear is usually observed.

The psychosexual conflicts of preschool children make them extremely vulnerable to: A. separation anxiety. B. loss of control. C. bodily injury and pain. D. loss of identity.

C. Separation anxiety is a characteristic of infancy. Loss of control is a characteristic fear of school-age children. Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschool child because of the poorly developed concept of body integrity. Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.

A 9-year-old child has several physical disabilities. His father explains to the nurse that his son concentrates on what he can, rather than cannot do and is as independent as possible. The nurse's best interpretation of this is that: A. the father is experiencing denial. B. the father is expressing his own views. C. the child is using an adaptive coping style. D. the child is using a maladaptive coping style.

C. The father is describing an adaptive coping style. The father views his son's coping as adaptive. This description is characteristic of a child using an adaptive coping style. The child learns to accept physical limitations but finds achievements in a variety of compensatory motor and intellectual pursuits. This is an adaptive coping style.

A Mexican American adolescent states to the nurse, "I have cancer because it is God's will. It will make me stronger." The MOST appropriate response by the nurse is: A. "You're too young to think that way. You still have many years to live." B. "Tell me how you feel about the treatment plan." C. "I'll move your family into the waiting area to give you some quiet time." D. "I'll contact the hospital chaplain for you."

B. It is very common in the Mexican American culture for patients to feel that health is controlled by environment, fate, and will of God. Asking the patient an open-ended question to assess how the patient feels about the treatment plan will provide the nurse with more information about what the patient understands about the illness and exactly what treatment measures the patient desires. The nurse should not provide false reassurance. Family and strong kinship is important in this culture. Separating a family member is not the most appropriate action. The nurse should ask about religious preferences first before assuming the patient would like to speak with a chaplain.

The nurse is caring for a dying boy whose religion is Islam (Muslim/Moslem). An important nursing consideration related to his impending death and religion is that: A. there are no special rites. B. there are specific practices to be followed. C. the family is expected to "wait" away from the dying person. D. baptism should be performed if it has not been done previously.

B. The nurse should contact someone from the person's mosque to assist. Islam has specific rituals for bathing and wrapping the body in cloth before it is to be moved. Family may be present. No baptism is performed at this time.

The parent of a 12-month-old infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much of a mess." The nurse's BEST response is: A. "It's important not to give in to this kind of temper tantrum at this age. Simply ignore the behavior and the mess." B. "You need to try different types of utensils, bowls, and plates. Some are specifically designed for young children." C. "It's important to let him make a mess. Just try not to worry about it so much." D. "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."

D. The child is developmentally ready for self-feeding. Ignoring the behavior and not allowing the child to self-feed is not fostering the child's development. The child is developmentally ready for self-feeding. The parent should not force the use of the spoon but should substitute finger foods. This response minimizes the parent's concerns about the mess created by self-feeding. At 12 months the child should be self-feeding. Since children this age eat primarily finger foods, it is useful to offer the parent suggestions for keeping the mess to a minimum.

One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection: A. lessens effectiveness of medications. B. encourages exercise-induced asthma. C. increases sensitivity to allergens. D. can trigger an episode or aggravate an asthmatic state.

D. The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean.

A 3-month-old bottle-fed infant is allergic to cow's milk. The nurse's BEST option for a substitute is: A. goat's milk. B. soy-based formula. C. skim milk diluted with water. D. casein hydrolysate milk formula.

D. The milk protein in goat's milk cross-reacts with cow's milk protein. This is avoided because of the cross-reaction with soy. The cow's milk protein is also found in skim milk. The milk protein is broken down in these formulas.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates: A. liquefying secretions. B. improving oxygenation. C. promoting ventilation. D. soothing inflamed mucous membrane.

D. The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. By humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.

The most consistent indicator of pain in infants is: A. increased respirations. B. increased heart rate. C. squirming and jerking. D. facial expression of discomfort.

D. These responses vary, depending on infant and pain. These responses vary, depending on infant and pain. These responses vary, depending on infant and pain. This is the most consistent behavioral manifestation of pain in infants.

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: A. atrophic changes in the mucosal wall of intestines. B. hypoactivity of the autonomic nervous system. C. hyperactivity of the sweat glands. D. mechanical obstruction caused by increased viscosity of mucous gland secretions.

D. Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.

A 5-year-old male child has bilateral eye patches that were put in place after surgery yesterday morning. Today he can be allowed to get out of bed. The MOST important nursing intervention is to: A. reassure Adam and allow his parents to stay with him. B. allow him to assist in feeding himself. C. speak to him when entering the room. D. orient him to his immediate surroundings.

D. This should be occurring throughout the hospitalization. Orientation to the room now that he is out of bed is essential. He should be allowed to feed himself with assistance as needed. This should always be done so the child can verify who is entering his room. Since Adam is being allowed to move about while both eyes are patched, the immediate safety concern for him is ensuring his familiarity with his immediate surroundings.

A 5-year-old girl's sibling dies from sudden infant death syndrome. The parents are concerned because she showed more outward grief when her cat died than she is showing now. The nurse should explain that: A. this is suggestive of maladaptive coping and referral for counseling is needed. B. the child is not old enough to have a concept of death. C. the child is not old enough to have formed a significant attachment to her sibling. D. the death may be so painful and threatening that the child must deny it for now.

D. This suggests limited defense mechanisms, not maladaptive coping. The child is beginning to understand the permanence of death. At 5 years old, this child will have formed a relationship with the infant sibling. A child at this age has limited defense mechanisms. Often the child will react with more overt grief to a less significant loss than to the loss of a very significant person.

The nurse is talking to a group of parents about different types of play in which children engage. Which statement made by a parent would indicate a correct understanding of the teaching? A. "Parallel-play children borrow and lend play materials and sometimes attempt to control who plays in the group." B. "In associative play, children play independently but among other children." C. "During onlooker play, children play alone with toys different from those used by other children in the same area." D. "Cooperative play is organized, and children play in a group with other children."

D. Play in which children borrow and lend play materials and attempt to control who plays in the group is known as associative play. Parallel play occurs when children play independently but among other children. Onlooker play is described as play in which children watch but make no attempt to enter into play with other children. Cooperative play is play that is organized; children play in a group with other children and plan activities for purposes of accomplishing an end.

The nurse is planning care for a patient with cultural background different from that of the nurse. An appropriate goal is to: A. strive to keep cultural background from influencing health needs. B. encourage continuation of cultural practices in the hospital setting. C. attempt in a nonjudgmental way to change cultural beliefs. D. adapt as necessary cultural practices to health needs.

D. The cultural background is part of the individual; it would be very difficult to eliminate its influence. The cultural practices need to be evaluated within the context of the health care setting to determine whether they are conflicting. The cultural background is part of the individual; it would be very difficult to eliminate its influence. Whenever possible, nursing care should facilitate the integration of cultural practices into health needs.

Before transporting a 16-year-old American Indian female for a magnetic resonance imaging (MRI) scan, the nurse notices the girl is wearing a decorated amulet necklace. The nurse's next BEST action is to: A. remove the necklace and place it at the nurse's station. B. explain the risks of wearing the necklace during the MRI. C. ask the patient if there is a special reason for wearing the necklace. D. place tape around the neck covering the necklace.

C. The nurse should first ask the patient the purpose of wearing the necklace. The amulet may be worn as a religious ritual or simply as an accessory. After assessing why the necklace is worn, the nurse could then explain the reason for having to remove the necklace for the procedure. The first step though is to assess. Placing tape around the neck is not an appropriate action and could be unsafe. The necklace should be left with family members if possible or in a locked cabinet, rather than at the nurse's station.

The nurse should expect to possibly incorporate which religious and cultural practices into the plan of care when caring for a 35-year-old Jewish mother who just gave birth to a healthy baby boy? (Select all that apply.) A. Circumcision in hospital B. Ordering house diet lunch tray of roasted pork with mashed potatoes C. Allowing family, friends, and rabbi to visit patient often D. Ask males to remove shawl and yarmulke while visiting E. Ordering house diet with the exception of shellfish

C. & E. Ritual circumcision of male infants is custom on the eighth day and performed by a mohel. Jews generally are prohibited from eating pork or shellfish. Family, friends, and rabbi should be allowed to visit. Asking males to remove shawls or yarmulkes is not necessary while visiting.

A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse's knowledge of breastfed infants, what type of stool is expected? A. Dark brown and small hard pebbles B. Loose with green mucus streaks C. Formed and with white mucus D. Semiformed, seedy, yellow

D. Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow. Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant. Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant. Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant.

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on knowledge that: A. children tend to be overmedicated for pain. B. giving large doses of opioids causes euthanasia. C. narcotic addiction is common in terminally ill children. D. large doses of opioids are justified when there are no other treatment options.

D. Continuing studies report that children are consistently undermedicated for pain. The dose is titrated to relieve pain. Addiction refers to a psychologic dependence on the medication, which does not happen in terminal care. Large doses may be needed because the child has become physiologically tolerant to the drug, requiring higher doses to achieve the same degree of pain control.

A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to: A. confirm the diagnosis of asthma. B. determine the cause of asthma. C. identify "triggers" of asthma. D. assess the severity of asthma.

D. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child's baseline.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. What is the nurse's BEST reply? A. A pacifier should be substituted for the thumb. B. Thumb-sucking should be discouraged by age 12 months. C. Thumb-sucking should be discouraged when the teeth begin to erupt. D. There is no need to restrain nonnutritive sucking during infancy.

D. Evidence is inconclusive regarding whether a pacifier or thumb is better for satisfying sucking needs. Thumb-sucking and the use of pacifier should be stopped after 4 years of age. Thumb-sucking and the use of pacifier should be stopped after 4 years of age. Nonnutritive sucking reaches its peak at about 18 to 20 months of age.

A 4-year-old girl is brought to the emergency room. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should: A. examine her oral pharynx and report to the physician. B. make her lie down and rest quietly. C. auscultate her lungs and make preparations for placement in a mist tent. D. notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

D. Examination of the oral pharynx may cause total obstruction. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Preparation should be made to care for her if an obstruction occurs. Sitting upright, drooling, agitation, and a froglike cough indicate epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.

The diagnosis of cognitive impairment is based on the presence of: A. intelligence quotient (IQ) of 75 or less. B. IQ of 70 or less. C. subaverage intellectual functioning, deficits in adaptive skills, and onset at any age. D. subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.

D. IQ is only one component of the diagnosis of cognitive impairment. IQ is only one component of the diagnosis of cognitive impairment. The onset of the deficit must be before age 18 to meet the diagnosis of cognitive impairment. The diagnosis of cognitive impairment has these components, including an onset before age 18.

A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold; that "He's like a rag doll. He doesn't cuddle up to me like my other babies did." The nurse's best interpretation of this lack of clinging or molding is that it is: A. a sign of maternal deprivation. B. a sign of detachment and rejection. C. suggestive of autism associated with Down syndrome. D. the result of the physical characteristics of Down syndrome.

D. Mothers may have difficulty forming attachment to their children because of these characteristics of Down syndrome. The nurse should recommend swaddling and wrapping the baby before picking him or her up. Mothers may have difficulty forming attachment to their children because of these characteristics of Down syndrome. The nurse should recommend swaddling and wrapping the baby before picking him or her up. Autism is not associated with Down syndrome. This lack of clinging is a result of the muscle hypotonicity and hyperextensibility of the joints associated with Down syndrome.

A 9-month-old infant is seen in the emergency department after developing a urticaric rash with cough and wheezing. When collecting the history of events before the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant? A. Potatoes B. Green beans C. Spinach D. Peanut butter

D. Nuts of any type, including peanuts, have a high allergy index in children and infants. The infant has demonstrated the cutaneous and respiratory type of reaction after possible ingestion of peanut butter. Potatoes are not a highly allergenic food. Green beans are not a highly allergenic food. Spinach is not a highly allergenic food.

It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent: A. otitis media. B. diabetes insipidus. C. nephrotic syndrome. D. acute rheumatic fever.

D. Otitis media and diabetes insipidus are not sequelae to GABHS. Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for glomerulonephritis, not nephritic syndrome. Children with Group A ß-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis.

The genetic testing of a child with Down syndrome (DS) showed that it was caused by translocation. The parents ask about further genetic testing. The nurse's BEST response for the parents is: A. "No further genetic testing is indicated." B. "The child should be retested to confirm diagnosis of DS." C. "The mother should be tested if she is over age 35." D. "The parents can be tested themselves because the child's condition might be hereditary."

D. The child does not require further genetic testing, but parents and siblings do. Retesting is not necessary because the diagnosis has been validated with chromosome testing. This type of chromosome abnormality occurs in children of parents of all ages. The parents and any siblings should be tested. Down syndrome resulting from a translocation may be inherited. This type of chromosome abnormality presents issues for future pregnancies.

The practice of cultural humility is continual and an important concept in the nursing process. Nurses can facilitate this process by: (Select all that apply.) A. integrating cultural knowledge. B. recognizing cultural differences. C. acting in a culturally appropriate manner. D. being aware of their own beliefs and practices. E. helping the family adapt to the health care practices.

A, B, C, D Integrating cultural knowledge is essential to providing care to families and the community. Recognizing cultural difference is a component of cultural awareness, humility, and competence. Acting culturally appropriate is essential in understanding and being able to deal effectively with families in a multicultural community. Nurses must be aware of their own beliefs and practices before they can begin to understand the varied and numerous cultural influences on the life of children and family. It is essential that nurses make an effort to adapt health care practices to the family's health needs rather the attempting to change longstanding beliefs.

Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. When teaching the parents about the infant's care, what is the most important information the nurse should include in the discharge teaching plan? A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous (IV) fluids C. Reassurance that the infant cannot be electrocuted during monitoring D. Advice that the infant not be left with other caretakers such as baby-sitters

A. CPR is essential for parent and caregivers to know. Most likely the child will not have venous access; thus home IV therapy is not necessary. The monitor is insulated and grounded. The parents should arrange for other caregivers to help out. All need to be taught how to use the monitoring equipment and how to perform CPR.

Which best describes Piaget's cognitive stage of formal operations? A. Deductive and abstract reasoning B. Inductive reasoning and beginning logic C. Transductive reasoning and egocentrism D. Cause-and-effect reasoning and object permanence

A. Piaget's cognitive stage of formal operations occurs between the ages of 11 and 15; deductive and abstract reasoning are developed. Inductive reasoning and beginning logic begin in the concrete operations stage between the ages of 7 and 11. Transductive reasoning and egocentrism occur in the preoperational stage at age 2 to 7. Cause-and-effect and object permanence occur during the sensorimotor stage from birth to 2 years.

An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to: A. prevent respiratory syncytial virus (RSV) infection. B. make isolation of infant with RSV unnecessary. C. prevent secondary bacterial infection. D. decrease toxicity of antiviral agents.

A. Synagis is a monoclonal antibody specific for RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. The antibody is specific to RSV, not bacterial infection. This will have no effect on antiviral agents.

The potential effects of chronic illness or disability on a child's development vary at different ages. Which is a threat to a toddler's normal development? A. Hindered mobility B. Poorly defined body image C. Limited opportunities for socialization D. Sense of guilt that the child caused the illness or disability

A. The inability to move about and master the environment will inhibit the toddler's developing autonomy. These indicate effects on a preschooler's development.

The nurse is providing education to a parent of a 10-month-old infant receiving iron supplements. What will be included in the teaching? (Select all that apply.) A. Administer iron with meals. B. Place iron toward the back side of the mouth with a dropper. C. Mix iron with milk for greater absorption. D. Report black, tarry stools to health care provider. E. Apply barrier ointment if needed to buttocks.

B & E

Infants most at risk for sudden infant death syndrome (SIDS) are those: (Select all that apply.) A. who sleep supine B. who sleep prone C. who were premature D. with prenatal drug exposure E. with a cousin that died of SIDS

B, C, D Infants at increased risk for SIDS are low birth weight, have low Apgar scores, sleep prone, cosleep, were premature, and have a mother who smokes. It is recommended that infants sleep supine to reduce the risk of SIDS. A cousin dying of SIDS does not present an increased risk for the infant.

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

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

A child in the clinic exhibits reduced visual acuity in one eye despite appropriate optical correction. The nurse expects the child's health care provider to diagnosis the child with: A. myopia. B. hyperopia. C. amblyopia. D. astigmatism.

C. Myopia is nearsightedness, which is the ability to see objects up close but not clearly at a distance. Hyperopia is farsightedness, which is the ability to see distant objects clearly but not those up close. This is the definition of amblyopia. Astigmatism is an alteration in vision caused by unequal curvature in the refractive apparatus of the eye.

The nurse working in an outpatient surgery center for children should understand that: A. children's anxiety is minimal in such a center. B. waiting is not stressful for parents in such a center. C. accurate and complete discharge teaching is the responsibility of the surgeon. D. families need to be prepared for what to expect after discharge.

D. Although anxiety may be reduced because of the lack of an overnight stay, the child will still experience the stress associated with a medical procedure. The waiting period while the child is having the procedure is a very stressful time for families. Discharge teaching is a responsibility of both the surgeon and the nursing staff. Discharge instructions should be provided in both written and oral form. They need to include normal responses to the procedure and when to notify the practitioner if untoward reactions are occurring.

The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib already asleep. The nurse should suspect his death was caused by: A. suffocation. B. child abuse. C. infantile apnea. D. sudden infant death syndrome (SIDS).

D. Although the child was found under the blanket, the bloody fluid is consistent with SIDS, not suffocation. No other injuries are reported. No previous acute life-threatening events had been reported. The death is consistent with the characteristics of SIDS.

The parents of a child with fragile X syndrome want to have another baby. They tell the nurse they worry that another child might be similarly affected. The MOST appropriate nursing action is to: A. reassure them that the syndrome is not inherited. B. assess for family history of the syndrome. C. recommend that they not have another child. D. explain that prenatal diagnosis of the syndrome is now available.

D. The syndrome is inherited on the X chromosome. Assessing for family history should be done, but it does not address the parents' concern and need for genetic counseling. The nurse should not offer a recommendation, although a referral for genetic counseling is indicated. Fragile X syndrome can now be detected prenatally. The family should be referred for genetic counseling.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy in the toddler? A. Helping the toddler complete tasks B. Providing opportunities for the toddler to play with other children C. Helping the toddler learn the difference between right and wrong D. Encourage the toddler to do things for self when capable of doing them

D. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks for the toddler. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy. Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable.

Parents ask the nurse for advice when telling their 4-year-old about a grandmother's death. The nurse's best response involves teaching the parents that the child's concept of death is: A. temporary. B. permanent. C. personified in various forms. D. inevitable at some age.

A. Death is seen as a temporary departure. Death is thought of as not permanent; life and death can change places with each other. Personification is typical of school-age children. Children 9 to 10 years old have this understanding of death.

The nurse is caring for a Vietnamese child and observes various marks on the child's body. When completing a thorough assessment, the nurse should keep which applicable cultural practices in mind? (Select all that apply.) A. Coining B. Cupping C. Forced kneeling D. Topical garlic application E. Burning

A, B, E Cultural practices possibly considered abusive by the dominant culture are: Coining—A Vietnamese practice that may produce welt like lesions on the child's back when the edge of a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of disease Cupping—An Old World practice (also practiced by the Vietnamese) of placing a container (e.g., tumbler, bottle, jar) containing steam against the skin surface to "draw out the poison" or other evil element. When the heated air within the container cools, a vacuum is created that produces a bruise like blemish on the skin directly beneath the mouth of the container. Burning—A practice of some Southeast Asian groups whereby small areas of skin are burned to treat enuresis and temper tantrums Forced kneeling—A child discipline measure of some Caribbean groups in which a child is forced to kneel for a long time Topical garlic application—A practice of Yemenite Jews in which crushed garlic cloves or garlic-petroleum jelly plaster is applied to the wrists to treat infectious disease. The practice can result in blisters or garlic burns.

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include: (Select all that apply.) A. lung function. B. associated allergies. C. frequency of symptoms. D. frequency and severity of exacerbations.

A, C, D The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.

The nurse working in an outpatient eye clinic should report which clinical manifestations to the health care provider out of concern for retinoblastoma? (Select all that apply.) A. White eye reflex B. Red reflex C. Strabismus D. Red, painful eye, often with glaucoma E. Sever permanent visual impairment F. Inability to read two syllable words displayed on a wall poster

A, C, D, E The clinical manifestations of retinoblastoma include: white eye reflex (most common); strabismus (second most common sign); red, painful eye, often with glaucoma; severe permanent visual impairment (late sign). Red reflex is normal, and inability to read is not a concerning sign for retinoblastoma.

A 5-year-old child is brought to the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) A. Vital signs B. Throat culture C. Medical history D. Assessment of breath sounds E. Emergency airway equipment readily available

A, C, D, E Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.

The nurse is discharging a young child from the hospital. The nurse should instruct the parents to look for which posthospital child behaviors? (Select all that apply.) A. Tendency to cling to parents B. Jealousy toward others C. Demands for parents' attention D. Anger toward parents E. New fears such as nightmares

A, C, E

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

A, C, E Both gross and fine motor skills are becoming more developed and children at this age enjoy toys that can help refine these skills. Children at this age enjoy more colorful toys. Children at this age are less interested in placing toys in the mouth and more interested in toys that can be manipulated.

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

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

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

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

When completing a health history on a hospitalized child, the nurse should assess for which factors that can commonly affect the parents' reaction to the child's illness? (Select all that apply.) A. Previous experience with illness or hospitalization B. Available support systems C. Medical procedures involved with treatment D. Previous coping abilities E. Cultural and religious beliefs

All are correct. The following are all factors affecting parents' responses to their child's illness or hospitalization: -Seriousness of the threat to the child -Previous experience with illness or hospitalization -Medical procedures involved in diagnosis and treatment -Available support systems -Personal ego strengths -Previous coping abilities -Additional stresses on the family system -Cultural and religious beliefs -Communication patterns among family members

The nurse is developing a teaching plan about preventing fetal exposure to teratogens. The nurse should include which teratogenic agents or conditions? (Select all that apply.) A. acetaminophen (Tylenol) B. isotretinoin (Accutane) C. Cocaine D. Hyperthermia E. Ethyl alcohol F. phenytoin (Dilantin)

All except A Teratogens, agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors. Many of these teratogenic exposures and the resulting effects are completely preventable, such as ingestion of alcohol resulting in fetal alcohol syndrome or fetal alcohol effects, which causes severe birth defects, including cognitive impairment.

When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child's stress level associated with hospitalization? (Select all that apply.) A. Mild temperament B. Lack of fit between parent and child C. Below-average intelligence D. Age E. Gender

All except A. Risk factors for increased stress level of a child to illness or hospitalization: -"Difficult" temperament -Lack of fit between child and parent -Age (especially between 6 months and 5 years old) -Male gender -Below-average intelligence -Multiple and continuing stresses (e.g., frequent hospitalizations)

The nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8-week-old make which statement? (Select all that apply.) A. "I only smoke in the kitchen." B. "I put my baby to sleep on her back." C. "I have my baby sleep with me instead of alone in the crib." D. "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." E. "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night."

All except B. Maternal smoking increases the risk of SIDS. Smoking anywhere in the home with an infant present is not recommended. The "Back to Sleep" Campaign is given credit for reducing the rate of SIDS in the United States. Co-sleeping increases the risk of SIDS. Overheating increases the risk of SIDS. Leaving a stuffed animal in the crib is a suffocation risk but still needs to be addressed as a safety hazard.

When preparing to administer Hepatitis B vaccine to a newborn, the nurse should: (Select all that apply.) A. initiate an immunization record. B. confirm the hepatitis B status of the newborn's mother. C. obtain a syringe with a 25-gauge, 5/8-inch needle. D. assess the dorsogluteal muscle as the preferred site for injection. E. confirm that the newborn's mother has signed the informed consent.

All except D. An immunization record is important for the nurse to initiate and give to the mother so that a continuous record of immunizations is maintained. Hepatitis B vaccine is the primary prevention for the disease. If the mother is positive for the hepatitis B virus, the newborn will need to receive the hepatitis B immunoglobulin (HBIG) in addition to the hepatitis B vaccine. The dose of hepatitis B vaccine is 0.5 mL, to be given with a 25-gauge, 5/8 inch needle, intramuscularly (IM) in the newborn. Signed informed consent must be obtained from the mother before administration of the vaccine. The only safe intramuscular injection site for the newborn is the vastus lateralis muscle.

The primary goals in the nutritional management of children with failure to thrive (FTT) are: (Select all that apply.) A. allow for catch-up growth. B. correct nutritional deficiencies. C. achieve ideal weight for height. D. restore optimum body composition. E. educate the parents or primary caregivers on child's nutritional requirements. F. educate the parents or primary caregivers that the child will need tube feedings first.

All except F.

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (Select all that apply.) A. Parallel play B. Social interaction C. Gross motor development D. Inability to maintain eye contact E. Language as used in social communication

B, D, E Children diagnosed with autism show delayed or abnormal functioning in social interactions. A hallmark characteristic of autism is the child's inability to make and maintain eye contact. A characteristic of autism is the child's delay of language at an early age or the sudden deterioration in extant expressive speech. Parallel play is not an area in which autistic children may show delay. When interacting with other children in other forms of play they display functional limitations. Gross motor development is not an area in which autistic children show delayed or abnormal functioning.

When planning a child safety health fair presentation addressing causes of death in children, the nurse should include which topics? (Select all that apply.) A. Suicide prevention support groups for 5 to 9 year olds. B. Sexually transmitted infection prevention for 15 to 19 years old. C. Blood pressure screenings for 5 to 9 year olds. D. Gun safety for 10 to 14 year olds. E. Information on bullying and violence prevention for 15 to 19 year olds.

B, D, E The leading causes of death in children 5 to 9 years old include injuries (accidents), malignant neoplasms, congenital anomalies, assault (homicide), and heart disease. In children 10 to 14 years old, suicide is the third leading cause of death after injuries (accidents) and malignant neoplasms. In youths 15 to 19 years old, assault (homicide), suicide, malignant neoplasms, and heart disease follow accidents as the most prevalent causes of death (Anderson and Smith, 2005). Suicide is not a prevalent concern in the 5- to 9-year old age group. Hypertension is not a leading cause of death or safety concern for the 5- to 9-year old age group.

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

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

Denial is a common reaction to the diagnosis of a disability or chronic illness. The nurse knows that the use of denial as a defense mechanism: A. is maladaptive. B. is a necessary cushion to prevent disintegration. C. prevents a sense of hope. D. prevents the mobilization of energies toward goal-directed, problem-solving behavior.

B. Denial is not maladaptive until it interferes with treatment goals. Adaptive denial is effective as the family begins to learn the effect that the diagnosis will have on their family. Denial may allow a sense of hope at a time when the family is feeling overwhelmed by the diagnosis. Using denial at first to cope with the diagnosis enables families to mobilize energies toward goal-directed problem solving.

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

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

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

B. Development is the mental and cognitive attainment of skills. Growth is the increase in physical size—both height and weight.

The nurse expects which characteristic of fine motor skills in a 5-month-old infant? A. Strong grasp reflex B. Neat pincer grasp C. Able to build a tower of two cubes D. Able to grasp object voluntarily

D. A-This is characteristic of a 1-month-old infant. B-This is characteristic of an 11-month-old infant. C-This is characteristic of a 15-month-old infant. D-This is appropriate for a 5-month-old infant.