Exam 2 (2nd year fall)

25. 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.

b. Your height will increase on average 2 inches a year. Between the ages of 6 and 12 years, children grow an average of 5 cm (2 inches) per year.

4. 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

a. A common belief at this age 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 childs belief in what is right and wrong.

19. 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.

a. Achieving social acceptance is a primary objective. 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.

5. 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

a. Anxiety c. Low self-esteem d. Psychosomatic complaints 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.

10. 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

a. Asks many questions c. Repeats sentence of six syllables d. Uses primarily telegraphic speech 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.

2. 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.

a. Attend after-school activities with a friend. 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. 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.

4. What are common causes of speech problems? (Select all that apply.) a. Autism b. Prematurity c. Hearing loss d. Developmental delay e. Overstimulated environment

a. Autism c. Hearing loss d. Developmental delay 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.

1. 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

a. Can help with routine household tasks b. Likes the reward system for accomplished tasks e. Goes about home and community freely, alone or with friends 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.

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

a. Decreased hematocrit 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.

2. 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

a. Disrespect b. Noncompliance e. Unprovoked physical attacks on other children 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.

3. 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. Dont give them much information about the activity.

a. Female b. Depressed c. Good peer relationships d. Poor academic performance 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.

Nurses should be alert for increased fluid requirements in which circumstance? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure

a. Fever 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.

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.

a. Gently tap over the site. 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.

10. 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

a. Physical fitness b. Basic motor skills c. A positive self-image 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.

25. 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.

a. Place a Band-Aid over the site. 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.

11. 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.

a. Refer the child for a professional psychosocial assessment. 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 childs 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.

9. 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.

a. Restrict riding to familiar terrain. c. Nighttime riding should not be allowed. e. Vehicles should include seat belts, roll bars, and automatic headlights. 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.

8. 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

a. Rides a tricycle c. Jumps off the bottom step d. Stands on one foot for a few seconds 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.

6. 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

a. Riding tricycles b. Running after balls c. Playing in the street 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.

13. 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

a. Signs of stress 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 childs 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.

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

a. Tachycardia 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.

7. 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.

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. Parents should be reassured that the childs fantasy is a sign of health that helps differentiate between makebelieve 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.

18. 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

a. The parents 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.

14. 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.

a. The quality of the food consumed is more important than the quantity. 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 perio

2. 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.

a. Thoughts are all powerful. 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 preschoolers 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.

11. 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

a. Very independent b. Has mood swings e. Tends to be selfish and impatient 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.

24. 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.

a. We will make sure our child is praised about his or her looks. 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 childs size as being little.

19. 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

b. 2 to 3 kg The average weight gain remains approximately 2 to 3 kg (4.56.5 lb) per year during the preschool period.

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

b. 50 to 90 ml/kg 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.

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.

b. Check the insertion site frequently for signs of infiltration. 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.

6. 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.

b. Children frequently have best friends. Identification with peers is a strong influence in childrens gaining independence from parents. Interaction among peers leads to the formation of close friendships with same-sex peersbest 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.

5. 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 nurses 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

b. Common at this age 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.

1. 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.

b. Copy (draw) a circle. 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.

5. 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

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 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.

6. 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

b. Delinquency c. Daydreaming d. Delaying tactics 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.

4. 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

b. Depressed d. Poor academic performance e. Exposed to domestic violence 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.

11. 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.

b. Encourage growth of a sense of responsibility in children. 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.

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.

b. End the infusion and notify the practitioner. 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.

21. 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.

b. Head injuries are the major causes of bicycle-related fatalities. 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).

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

b. Hypotonic dehydration 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.

13. 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 nurses best suggestion for coping with this problem? a. Let the child sleep with his parents. b. Keep a night light on in the childs bedroom. c. Help the child understand that these fears are illogical. d. Tell the child that monsters and bogeymen do not exist.

b. Keep a night light on in the childs bedroom. 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.

15. 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.

b. Leave the child alone unless he or she is in danger of harming him- or herself or others. 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 childs 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.

10. 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.

b. Neither condone nor condemn the curiosity. 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.

15. 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

b. Sleep terror 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 parents presence. This is not the case with sleep apnea. This behavior is not indicative of seizure activity.

22. 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

b. Snowmobiling 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 instructors safety record with students.

20. 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.

b. Teach basic rules of water safety. 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.

4. 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 nurses 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.

b. They will come after dinner. 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 childs 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.

1. 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

b. Throws a ball overhead c. Has a vocabulary of 1500 words e. Tends to be selfish and impatient f. Commonly has an imaginary playmate 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 gr

3. 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 persons perspective.

b. Use magical thinking. 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 persons perspective.

8. 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 ring 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.

b. Watch for and yield to pedestrians. d. Ride bicycles with traffic away from parked cars. e. Keep both hands on the handlebars except when signaling. 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.

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.

b. Weigh diapers after each void. 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.

27. 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

c. 12 years The average age of puberty is 12 years in girls.

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

c. 1200 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 x 100 ml/kg/day = 1000 ml 4 kg x 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.

28. 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

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

8. A parent asks about whether a 7-year-old child is able to care for a dog. Based on the childs 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 childs weaknesses. c. A dog can help the child develop confidence and emotional health. d. Cats are better pets for school-age children.

c. A dog can help the child develop confidence and emotional health. Pets have been observed to influence a childs 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 childs being responsible for a pet.

1. What statement accurately describes physical development during the school-age years? a. The childs weight almost triples. b. Muscles become functionally mature. c. Boys and girls double strength and physical capabilities. d. Fat gradually increases, which contributes to childrens heavier appearance.

c. Boys and girls double strength and physical capabilities. 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.

9. 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

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 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.

2. 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

c. Characteristic of cognitive development at this age 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 Eriksons stage of industry versus inferiority.

17. 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.

c. Establish limited rituals that signal readiness for bedtime. 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.

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

c. Fluid shift from interstitial space to intravascular space 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.

24. 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.

c. I will serve foods that are low in saturated fat and cholesterol. School-age children should be eating foods that are low in saturated fat and cholesterol to prevent long-term consequences. The childs 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.

6. A 4-year-old child tells the nurse that she doesnt want another blood sample drawn because I need all of my insides and I dont want anyone taking them out. What is the nurses 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.

c. Preschoolers have poorly defined body boundaries. 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.

22. 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

c. Identifies with the same-sex parent 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 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

c. Immature kidney functioning 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.

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

c. Irritability and seizures 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.

27. 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.

c. It is OK to stay part of the first day, but be inconspicuous. 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.

10. 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.

c. Knowing the rules of a game gives an important sense of belonging. 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.

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

c. Water depletion 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.

12. 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.

c. Lying is used to meet expectations set by others that they have been unable to attain. 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.

14. 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.

c. Most of the new fears that trouble them are related to school and family. 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 childrens 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.

7. 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

c. Need and want restrictions placed on their behavior by the family 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.

3. 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

c. Perfectionism as a focus d. Inquisitive; always asking questions e. Displays intense feelings and emotion 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.

9. 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 boys birthday is close to the cut-off date, and he has not attended preschool. What is the nurses best recommendation? a. Start kindergarten. b. Talk to other parents about readiness. c. Perform a developmental screening. d. Postpone kindergarten and go to preschool.

c. Perform a developmental screening. 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 fathers concerns about readiness for school. Talking to other parents about readiness does not ascertain if the child is ready and does not address the fathers concerns.

9. 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.

c. Sexuality is presented as a normal part of growth and development. 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.

12. 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

c. Stammering 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.

7. 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.

c. Teach the child weather-related safety. e. Emphasize fire safety rules and conduct practice fire drills. 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.

26. 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.

c. The caloric needs for school-age children are lower than they were in the preschool years. 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.

31. 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.

c. Treat sex as a normal part of growth and development. 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 childrens level of understanding. School-age children may be more comfortable when boys and girls are segregated for discussions.

30. The nurse is explaining about the developmental sequence in childrens 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

c. Volume There is a developmental sequence in childrens 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).

29. 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.

c. You will gain about 4.4 to 6.6 lb per year. 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.

32. 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.

d. A 5-year-old child requires 11.5 hours of sleep. Sleep requirements decrease during school-age years; 5-year-old children generally require 11.5 hours of sleep.

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)

d. Antidiuretic hormone (ADH) 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.

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

d. Associative Associative play is group play in similar or identical activities but without rigid organization or rules. Schoolage children play in teams. Parallel play is that of toddlers. Solitary play is that of infants.

23. 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 parentchild activities. d. At age 12 years, parents should be certain that the childs sex education is adequate with accurate information.

d. At age 12 years, parents should be certain that the childs sex education is adequate with accurate information. 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 parentchild activities should be encouraged.

21. 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

d. Can copy a circle and imitate a cross 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.

23. 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.

d. Children in this stage have little, if any, concern for why something is wrong. Young childrens 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

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

d. Dry mucous membranes and generally ill appearance 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.

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

d. Dry, sticky mucous membranes 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.

17. 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.

d. Educate parents about the need for good dental hygiene because these are the years in which permanent teeth erupt. 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.

20. 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

d. Farm animals and equipment 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.

28. 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.

d. Find out what your child knows or thinks. 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 childs inquiries.

26. 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.

d. Help your child to resolve the fears through play activities. 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.

18. 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.

d. I should expect my 3-year-old child to have a more stable appetite and an increase in food selections. 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-yearold child.

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

d. Metabolic and respiratory alkalosis 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.

What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)? a. Nausea, vomiting b. Weakness, fatigue c. Muscle hypotonicity d. Neuromuscular irritability

d. Neuromuscular irritability 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.

5. 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

d. Provides them with security as they gain independence from their parents 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 childs concept of appropriate sex roles is influenced by relationships with peers.

16. The school nurse is discussing after-school sports participation with parents of children age 10 years. The nurses 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 childs abilities.

d. Sports participation is encouraged if the type of sport is appropriate to the childs abilities. 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.

8. 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

d. Talks incessantly regardless of whether anyone is listening 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.

16. 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

d. Teaching about safety and potential hazards 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.

3. 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.

d. The child is able to judge an act by the intentions that prompted it rather than just by the consequences. 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.