Exam 4 (promotions)
Which intervention lowers the risk of sudden infant death syndrome (SIDS)?
Putting the infant to sleep in the supine position The "Back to Sleep" campaign is given credit for reducing the rate of SIDS in the United States. Maternal smoking increases the risk of SIDS. Overheating increases the risk of SIDS. Co-sleeping increases the risk of SIDS because of accidental rollover deaths.
Which statement explains why it can be difficult to assess a child's dietary intake?
Recall of food consumption is frequently unreliable. It is difficult for parents to recall exactly what their child has eaten. Concurrent food diaries are somewhat more reliable. Nutrients for different foods are known; it is the quantity and type of food consumed that is difficult to ascertain. The family does not need nutritional knowledge to describe what the child has eaten. Systematic tools are available.
A very depressed adolescent tells the school nurse: "I just don't know how I'm going to cope with everything I'm going through—maybe it would be better if I wasn't around anymore." What approach is most important for the nurse to use when working with this student?
Recognize he is exhibiting warning signs of suicide. It is imperative that the nurse recognize warning signs of a potential suicide. All threats must be taken seriously. For the depressed young person, suicide may appear to be the only way out. To tell the adolescent that his or her attempt is immature is a certain block to further therapeutic communication. Even if the crisis is temporary, the adolescent's perception may still be that suicide is the only way out. Remember that adolescents are focused on the here and now.
What nursing intervention to promote health during middle childhood (school age) would be appropriate?
Reinforce the need for good dental hygiene because these are the years in which permanent teeth erupt. Dental care is increasingly important as the primary teeth are replaced by permanent teeth. Malocclusion is not unusual in children of this age. A balanced diet is important to prepare for the adolescent growth spurt. Because of the earlier onset of puberty, sex education programs should be introduced in elementary school. Parents should approach sex education with a life span approach and respond to a child's questions with an answer appropriate to the child's age. School-age children often need to be reminded to go to sleep.
According to Piaget, at what stage of development do children typically solve problems through trial and error?
Sensorimotor During the sensorimotor stage, infants and young toddlers develop a sense of cause and effect. Relational problem solving is characteristic of the preoperational stage. In the formal operational stage, adolescents can test hypotheses. Children in concrete operations solve problems in a tangible, systematic fashion.
Which is most descriptive of the spiritual development of the older adolescent?
The beliefs become more abstract. Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols. Strict observance of religious customs, rituals, and practices become less important as the adolescent questions values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors.
When the nurse lifts the skin on the abdomen and releases it quickly to check skin turgor, the tissue remains suspended for a few seconds, then slowly falls back on the abdomen. Which evaluation can the nurse correctly determine from the findings?
The child is dehydrated. Skin remaining suspended, or "tented," when released is seen when poor skin turgor is related to dehydration. In normal elasticity, the skin would return immediately to its original position. If the child was overly hydrated, the skin would not remain suspended or tented. If the child was properly hydrated, the skin would spring back quickly when released.
The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. What evaluation of these findings by the nurse is correct?
The infant's neurologic status is appropriate. The Moro, tonic neck, and withdrawing reflexes are usually present in infants less than 3 to 4 months old. Therefore, the presence of these reflexes indicates neurologic health. Moro, tonic neck, and withdrawal reflexes are expected in a 2-month-old. These findings are appropriate and normal for a 2-month-old. Decerebrate posturing is indicative of dysfunction at the level of the midbrain.
Why are infants particularly vulnerable to acceleration-deceleration head injuries?
The musculoskeletal support of the head is insufficient. The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants. Anterior fontanel closure, nerve tissue development, and vascularity of the scalp do not have an effect on this type of injury.
The parents of a 16 year old child tell the nurse that they are concerned because the child sleeps until noon every weekend. Which is the most appropriate nursing response?
"Adolescents love to sleep late in the morning."
The parents of an 8 year old child tell the nurse that they are concerned about the child because the child seems to be more attentive to friends than anyone else. Which is the appropriate nursing response?
"At this age, the child is developing his or her own personality."
The parent of a 12-month-old male 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 because he makes too much of a mess." What is the most appropriate response by the nurse?
"He's at the stage where he is old enough to begin learning how to feed himself." At 12 months the child should be self-feeding. Because children this age eat primarily finger foods, it is useful to offer the parent suggestions for providing meals which the child can feed himself without much frustration while keeping mess to a minimum.
Which statement by a nursing student about Kohlberg's theory of moral development indicates the need for further teaching about the theory?
"Individuals move through all six stages in a sequential fashion."
The nurse determines a child is in the "preoperational" phase of Piaget's cognitive developmental theory when the child makes which statement?
"The moon follows me, and goes to bed when I go to bed."
The parent of a 4 year old child expresses concern because her hospitalized child has started sucking his thumb. The mother states that this behavior began 2 days after hospital admission. Which is the appropriate nursing response?
"This is common during hospitalization."
An infant is expected to be able to say "mama" and "dada" with meaning by what age?
10 months At 10 months, infants say sounds with meaning. At 4 months, consonants are added to infant vocalizations. At 6 months, babbling resembles one-syllable sounds. 14 months is late for the development of sounds with meaning.
Chronological age
Age in years
A 16 year old child is admitted to the hospital for acute appendicitis, and an appendectomy is performed. Which intervention is most appropriate to facilitate normal growth and development?
Allow the child to participate in activities with other individuals in the same age group when the condition permits.
By what age would the nurse expect that most children would be using sentences of six to eight words?
5 years Children can make sentences of 6 to 8 words at 5 years of age. Most will use all parts of speech and construct sentences of the length an adult would use. At 18 months of age, a child has a vocabulary of only 10 words. A child at 24 months uses 2- to 3-word phrases. A child at 3 years of age uses 3- to 4-word sentences.
The nurse is caring for a 5 year old child who has been placed in traction after a fracture of the femur. Which is the most appropriate activity for this child?
A 10-piece puzzle.
The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. What assessment should the nurse make about this infant's development?
A developmental/neurologic follow-up evaluation is needed. The head lag should be almost gone by 4 months of age. This child requires evaluation by a specialist. A 6-month-old infant should have social interaction beyond smiling and cooing and should no longer have head lag. The assumption that the child is cognitively impaired is unwarranted. The child requires evaluation before appropriate interventions can be determined.
The nurse is caring for an older client who is reminiscing about past life experiences in a positive manner. The nurse plans care with the understanding that this behavior indicates which?
A normal psychosocial response.
Which statement is most characteristic of the motor skills of a 24-month-old child?
A toddler's activities begin to produce purposeful results. Gross and fine motor mastery occur with other activities. A toddler is able to walk up and down stairs at this age. Grasping small objects but being unable to release them at will is a characteristic of infancy. Interaction with the environment is essential at this age.
When caring for a 3 year old child, the nurse should provide which toy for the child?
A wagon.
Developmental age
Age based on functional behavior and ability to adapt to the environment
A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever the infant is left with the grandparents. The nurse's response is based on which observation?
An infant screaming when left with grandparents is a normal reaction for this age. The infant is feeling stranger anxiety, which is expected for this age.
A cooperative 6-year-old child is being evaluated for a sore throat. Which method should the nurse use to view the tonsils and oropharynx of this child?
Ask the child to open her mouth wide and say, "Ahh." If the child is cooperative, the child can open her mouth and move the tongue around for the examiner. During crying there is insufficient opportunity to accurately visualize the mouth. Placing the tongue blade in the back of the throat can cause gagging. The child is being evaluated for a sore throat, not a neurologic issue. It would be traumatic and a safety risk to pinch the nostrils closed, forcing the child to open her mouth, and then insert the tongue blade. No reason would warrant such measures, especially with cooperative children.
The nurse is preparing to assess the lung sounds of a 3-month-old sleeping infant who is being held on her belly by her mother against the mother's upper chest. Which techniques should the nurse use to obtain an accurate assessment?
Assess the lungs from the apex to the base bilaterally. Identify the hyper resonance heard as normal because of the thin chest wall. Auscultate the lung sounds through her back.
A 4-month-old is sleeping during her well infant checkup. Which assessment should the nurse do first?
Auscultation Auscultation requires quiet to hear the sounds clearly and should be done first. Inspection of the entire infant and palpation would require moving the infant and could interfere with a quiet environment, which would facilitate accurate auscultation. Percussion is rarely done on infants. It would interfere with a quiet environment, which would facilitate accurate auscultation.
The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. Which is the most essential part in this assessment?
Checking the reactivity of pupils. Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for presence of reactivity, whether the reactivity is equal, and the rate of reactivity. A doll's head maneuver should not be performed if there is a cervical spine injury. Oculovestibular response is a painful test that should not be done on a child who is having variable levels of consciousness. Papilledema does not develop until 24 to 48 hours into the course of unconsciousness. This is also not within a pediatric nurse's scope of practice unless there is advanced training and education.
Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, what can gradually be achieved by the toddler?
Control of anal and urethral sphincters The voluntary control of elimination occurs between 18 and 24 months. Visual acuity at this age is 20/40. Throwing a ball occurs at approximately 15 months. Increased capacity is responsible for decreased number of bowel movements each day.
A child remarks, "I share my toys and snacks with my friends so they will like me more." The nurse determines the child is in which stage of moral development?
Good boy-nice girl orientation.
Which best describes colic?
It is paroxysmal abdominal pain or cramping manifested by episodes of loud crying. Colic is defined as paroxysmal abdominal pain or cramping manifested by episodes of loud crying. There is no identified relationship between colic and inadequate mothering. Most commonly colic occurs in infants under 3 months of age.
The school nurse overhears a group of adolescent girls talking about gaining weight and getting fat deposits during puberty. What anticipatory advice would be appropriate for the nurse to give to the girls?
Provide reassurance that these changes are normal. Muscle mass increases in boys, and fat deposits increase in girls. Ultimately, diet, exercise, and hereditary factors influence adolescents' height, weight, and body build. A healthy balance must be achieved between expected healthy weight gain and obesity. Dietary measures to control weight gain or a recommendation for increased exercise would not be given unless weight gain was excessive.
Which interventions are appropriate for the care of an infant?
Provide swaddling. Hang mobiles with black and white contrast designs. Caress the infant while bathing or during diaper changes.
Recommended dietary allowance
Recommendations for the average amount of nutrients that should be consumed by healthy people in the United States.
Heredity
Transmission of a genetic characteristics.
A 16-year-old girl tells the school nurse that she has not started to menstruate yet. The onset of secondary sexual characteristics occurred in this girl about 3 years ago. The appropriate action by the nurse is to
refer the adolescent for an evaluation. The establishment of menstruation (menarche) usually occurs between ages 9 and 15 years and should be evaluated. Menstruation usually begins approximately 2 years after the beginning of secondary sexual characteristics. Although pregnancy and excessive exercising are possibilities, further assessment is warranted.
The parents of a 4-year-old girl are worried because she has an imaginary playmate. What response by the nurse is most appropriate?
"Imaginary playmates are normal and useful at this age." Imaginary playmates are a part of normal development at this age. The peak incidence of imaginary playmates occurs at 2 to 3 years of age. These playmates usually are not present once school starts.
A mother tells the nurse that she will visit her 2-year-old child tomorrow around noon. During the child's bath in the morning, the child asks for her Mommy. What is the best response by the nurse?
"Mommy will be here after lunch." Because 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 as lunch. "Mommy always comes back to see you" doesn't give the child any information about when her mother will visit. "Mommy had to go home for a while, but she will be here today." Doesn't give the child any information about when her mother will visit. Noon is a meaningless concept for a toddler.
The nurse is providing instructions to a new parent regarding the psychosocial development of the infant. Using Erikson's psychosocial development theory, which instruction should the nurse reinforce in the parents?
Allow the infant to signal a need.
The anterior fontanel appears slightly bulging when a 4-month-old cries. What action by the nurse is indicated?
Document the findings The finding is normal. Crying causes the fontanel to bulge slightly. There's no need to notify the pediatrician since this is normal. There is no need to check the Moro reflex. The length of time the infant cries has nothing to do with the fontanel bulging.
Upon palpation of the fontanel of a 3 month old newborn, the nurse notes that the anterior fontanel has not closed and is soft and flat. Which action should the nurse take?
Document the findings.
The nurse notes that a 6 year old child does not recognize that objects exist even when the objects are outside the visual field. Based on this observation, which action should the nurse take?
Report the observation to the primary health care provider
The parents of a 2 year old arrive at the hospital to visit their child. The child is in the play room and ignores the parents during the visit. The nurse tells the parents that this behavior in a 2 year old child indicates which characteristic about the child?
The child is exhibiting a normal pattern.
A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). What is the most appropriate recommendation by the nurse?
Use condoms. Condoms provide the best available barrier to the organisms that cause STDs. Complete protection from pregnancy and STDs is achievable only through sexual abstinence. However, the adolescent is sexually active and the nurse needs to be open, forthright, and respectful of the decisions she made about sexual activity.
Nutrients
Foods that supply the body with elements necessary for metabolism.
The nurse is performing a well-child examination. Which is the most accurate method of determining the length of a child less than 24 months of age?
Measure the child recumbent in the supine position. The crown-heel length measurement is the most accurate measurement for infants. Children less than 24 months are unable to stand still enough to allow an accurate height measurement. An infant or toddler should be measured in the supine position, not prone. The measurement should not be estimated if an accurate number is needed.
Cephalocaudal
Progression from head to toe
Proximodistal
Progression from midline to periphery.
What does body mass index measure in children older than 2 years?
Growth and nutritional status
Initiative vs.
Guilt
Morality of self-accepted moral principles
"I won't blast my radio. It's not fair to the other patients."
Pre-morality
"I won't hit them because the nurse will yell at me."
Morality of conventional role conformity
"I'll take my medicine to make my nurse happy."
A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention?
"We stopped using the car seat now that my child is older." Locking medicines in a cabinet, turning down the thermostat on the hot water heater, and placing gates at the top and bottom of steps are appropriate actions. A car seat should be used until the child weighs 40 pounds, at approximately 4 years of age. After that point, a booster seat that complies with federal safety guidelines should be used. Seat belts must be used with the booster seat.
The nurse is reinforcing discharge instructions to the parents of a 2 year old child who sustained accidental burns from a hot cup of coffee. The nurse determines that the parents have correctly understood the teaching when they make which statement?
"We will be sure not to leave hot liquids unattended."
An infant's birth weight typically triples by?
1 year
Freud's Latency Stage
Child typically prefers same-sex friends
Dramatic play
Children act out roles and experiences that happened to them or someone else.
Primary dentition consists of?
20 teeth
Symbolic play
Children use games and interactions that represent an issue or a concern to be addressed.
Familiarization play
Children use materials associated with health care in creative, playful activities.
Nurses must be familiar with normal patterns of growth and development so that what can be detected and treated early?
Delays
An increase in the capabilities resulting from growth, maturation, and learning:
Development
Permanent teeth number?
32 teeth
Sensorimotor
Develops a sense of object permanence
The nurse is performing a well-child exam. During an otoscopic examination on an infant, in which direction should the nurse gently pull the pinna?
Down and back Down and back is correct for examining an infant's ear because it slightly straightens the ear canal. Down and forward would not allow sufficient visualization. Up and forward would not allow sufficient visualization. Up and back is the correct position for a child age 3 years or older.
An infant's birth weight typically doubles by?
6 months
Simple to complex growth and development
A toddler can use two word sentences; a preschooler can tell stories.
Stage of growth and development for 17 year old's?
Adolescents
Name two prescreening tools that have been found to be sensitive and specific for detecting developmental problems.
Ages and stages questionnaire Parent's Evaluation of Developmental Status
General to specific growth and development
An infant responds to an earache by flailing the extremities; the toddler responds by tugging at the ear.
Regression
Appearance of behavior more appropriate at an earlier stage of development.
What is anticipatory guidance?
Basic information about normal growth and development as a child approaches different ages.
The nursing student is preparing a conference on Freud's psychosexual stages of development, specifically the anal stage. Which appropriately relates to this stage?
Beginning of toilet training.
Learning
Behavior changes that occur as a result of maturation and experience with the environment.
Define critical period
Blocks of time during which children are ready to master specific developmental tasks.
Growth spurts
Brief periods of a rapid increase in growth rate.
Freud's Genital Stage of Development
Child develops an adult view of sexuality
Freud's oral stage of development
Child explores the world with the mouth
Freud's Anal Stage
Child learns to control the elimination processes
Preoperational
Exhibits magical thinking
The Denver Developmental Screening Test II assesses development in which four functional areas?>
Gross motor Fine motor Language Personal-social
An increase in physical size is referred to as:
Growth
What is an indicator of brain growth?
Head circumference
How does the onset of the pubertal growth spurt compare in girls and boys?
In girls, it occurs about 1 year before it appears in boys. Average age of onset is 9.5 years for girls and 10.5 years for boys.
Proximodistal growth and development
In the embryo, the development of the bronchus precedes the development of the bronchioles and alveoli.
Stage of growth and development for 10 month old's?
Infancy
Stage of growth and development for 3 week old's?
Infancy
Why is dietary fat intake not restricted in children younger than 2 years?
Infancy is a period of rapid growth, and infants need sufficient calories to support this growth.
Industry vs.
Inferiority
Formal operations
Is able to appreciate symbolism
Concrete operations
Is able to see another's point of view
Changes in behavior that occur as the result of both maturation and experience with the environment are termed:
Learning
In general, children who are immunocompromised should not receive what vaccines?
Live
Physical changes in complexity of body structures that enable a higher level functioning are known as:
Maturation
Nurses need to have an understanding of growth and development to design care plans that:
Meet the needs of their young patients.
Trust vs.
Mistrst
List four methods of assessing development
Observing a child's behaviors and interactions. Interviewing a child and his or her parents. Physcial examinations Standardized assessment tools
Why are a child's height, weight, and head circumference plotted on standardized growth charts at every well-child checkup?
Physcial growth in infants and young children is an indicator of physcial health.
Stage of growth and development for 4 year old's?
Preschool
Identity vs.
Role confusion
Stage of growth and development for 8 year old's
School aged
The parent of a 3 year old tells the nurse that the child is constantly rebelling and having temper tantrums. Which instruction should the nurse reinforce to the parent?
Set limits on the child's behavior.
Autonomy vs.
Shame and doubt
Why is it important to recognize abnormal growth patterns?
The earlier growth disorders are detected and treated, the better are the long term prognosis.
Cephalocaudal growth and development
The infant can lift the head before being able to lift the trunk.
Stage of growth and development for 2 year old's?
Toddlerhood
Children may regress to earlier developmental levels when they are?
Under stress
List three parameters used to measure growth in infants and children.
Weight Height Head Circumference
Play is considered to be children's
Work
After age 4, what should fat intake be?
between 25 and 35%
Freud's Phallic Stage of Development
child may initially demonstrate aggression toward the same-sex parent.
Solitary play
child plays alone
Onlooker play
child watches others play
Parallel play
children paly side by side but do not interact with each other
Cooperative play
children play in groups and establish rules for participating
Associative play
children play together but without establishing rules and goals
Language development closely parallels
cognitive development
Because of the possibility of anaphylactic reactions, it is essential to have what available while administering immunizations?
epinephrine
Practice play is also known as
functional play
Expressive language is the ability to:
produce meaningful vocalizations
Symbolic play uses games and interactions to
represent an issue to be addressed
Games include
rules
Why is it important to gather data about a hospitalized child's food preferences?
to ensure that the child will not be further stressed by unfamiliar foods in the hospital
Receptive language is the ability to:
understand the spoken word
According to Erikson, with which development task is infancy concerned with acquiring?
Trust The task of infancy is the development of trust. Industry versus inferiority is the developmental task of school-age children. Initiative versus guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage as described by Piaget.
The nurse is performing a basic neurologic assessment of a 6-month-old. How can the nurse accurately assess cranial nerve V?
Watch how the baby sucks on his pacifier. Cranial nerve V deals with the ability to suck and swallow. The ability to smile is tested with cranial nerve VII Hearing occurs with cranial nerve VIII. Smell is tested using cranial nerve I.
According to Erikson, what is the primary psychosocial task of the preschool period?
Initiative Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity is the stage associated with adolescence. Intimacy is an adult stage. Industry is the stage seen in the school-age child.
Which is an important consideration related to childhood stress?
Some children are more vulnerable to stress than others. Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children.
A mother is concerned about giving her infant the scheduled immunizations. What information should the nurse provide to inform the mother about the risks and benefits of immunizations?
"If your child is feverish or sick, we will not give any immunizations at that time." "Since live measles vaccine is produced by using chicken eggs, there is a slight chance of hypersensitivity in children with egg allergies." "Before a second dose of any vaccine is given, we check if there were any side effects after the previous dose of that vaccine." "Immunizations are the primary and safest means of managing preventable infectious diseases."
Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which developmental information should the nurse consider when discussing this issue with the parents?
Transitory periods of lowered self-esteem are expected developmentally. Self-esteem changes with development. Transient changes are expected, and with positive encouragement and support the changes are only temporary. Self-esteem is based on several components: competence, sense of control, moral worth, and worthiness of love and acceptance.
For a toddler with sleep problems, what should the nurse suggest?
Using a transitional object A transitional object, such as a stuffed animal or blanket, may help the child ease anxiety and facilitate sleep. A toddler requires stimulating physical activity during the daytime, although such activity just before bed prolongs the transition from wakefulness to sleepiness. A consistent ritual will facilitate sleep and is very important at this age. Verbal explanations that rationalize fears away are not internalized by a child at this age.
Which is the most appropriate recommendation for relief of teething pain?
Give the child a frozen teething ring to relieve inflammation. Cold reduces inflammation and should be used for relief of teething irritation. Home remedies, such as rubbing the gums with whiskey or aspirin, should be discouraged. Hydrogen peroxide should not be used because it is ineffective and can cause tissue damage.
Which is descriptive of the social development of school-age children?
Children frequently have "best friends." Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with a peer group is an important factor toward gaining independence from families. During these years, the child's world expands from the tight circle of the family to include children and adults at school, at a worship community, and in the community at large. Children learn a body of rules, sayings, and superstitions as they enter the culture of childhood. Rules are important to children because they provide predictability and offer security.
The school nurse is discussing dental health with children in first grade. Which information should the nurse include in the presentation?
Emphasize the importance of brushing before bedtime. Children should be taught to brush their teeth after meals and before bedtime. Parents should help with flossing until children develop the dexterity required, which occurs at about the time of third grade. Proper brushing and flossing and a well-balanced diet promote healthy gums and prevent cavities. Sugary or sticky between-meal snacks should be limited. The American Dental Association recommends fluoridated toothpaste for this age group.
The nurse is preparing to care for a dying client and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family?
Encourage expression of feelings, concerns, and fears. Touch and hold the client's or family member's hand if appropriate. Be honest and let the client and family know that they will not be abandoned by the nurse.
The nurse is discussing toddler development with a parent. Which intervention will best foster the achievement of autonomy in the toddler?
Encouraging the toddler to do things for self when capable of doing them Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks for the toddler. Learning the difference between right and wrong is a concept that is too advanced for toddlers and will not contribute to autonomy. Children at this age engage in parallel play, which will not foster autonomy.
Primary prevention of communicable disease results from which method of infection control?
Immunizations Communicable diseases are prevented through immunization, which is primary prevention. Early diagnosis can prevent spread by initiating treatment and isolation if necessary. Strict isolation and good hand hygiene prevent the spread of disease.
What change in boys indicates the onset of puberty?
Testicular enlargement Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 and 14 years during Tanner stage 2 development. Voice change occurs between Tanner stages 3 and 4. Fine pubic hair may occur at the base of the penis; darker hair and increasing penis size occurs during Tanner stage 3.
Which is characteristic of the psychosocial development of school-age children?
Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. The school-age child is eager to develop skills and participate in activities. Not all children are able to do all tasks well, and the child must be prepared to accept some feeling of inferiority. Peer group formation is one of the major characteristics of this age group. A developing sense of initiative is characteristic of preschoolers. School-age children gain satisfaction from successful independent behaviors.
The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What is the most appropriate recommendation by the nurse?
Fluids in addition to breast milk are not needed. Sufficient water is provided in breast milk and in prepared formula during early infancy. Fruit juice should be avoided in infants younger than 6 months of age.
Which statement best explains the growth and development of children?
The sequence of developmental milestones is predictable. There is a fixed, precise order to child 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.
Several adolescents approach the school nurse with questions about skin enhancement including tanning, body piercing, and tattoos. Which responses by the nurse contain correct information?
Generally, body piercing is harmless, but these procedures must be done under sterile conditions or there can be complications, such as bleeding, infection, keloid formation, and allergies to metal. There are risks of bloodborne infections, skin infections, and allergic reactions to dyes used in the tattoo process. Since many of the tattoo inks contain metal, such as iron, an adolescent needing magnetic resonance imaging (MRI) must inform the MRI center about the tattoo prior to the procedure.
The nurse is ready to begin a physical examination of an 8-month-old infant who is sitting contentedly on her mother's lap, chewing on a toy. Which assessment should the nurse do first?
Heart and lungs While the child is quiet, auscultation should be performed. Because this is the least intrusive of the options given, it affords the best opportunity to hear the required sounds. Eliciting reflexes might disturb the child, making auscultation afterward difficult. Examining the eyes, ears, and mouth might disturb the child, making auscultation of the heart and lungs afterward difficult. Although examining the head is often the starting point, the nurse should perform the assessments that require quiet and cooperation of the infant first.
A 12-year-old child being seen in the clinic has not received the vaccine for the hepatitis B virus (HBV). What recommendation should the nurse make?
The three-dose series of HBV vaccine should be started. Adolescents should be vaccinated against hepatitis B at this age if it has not been done previously. Three doses are necessary to achieve immunity. The recommendation is that the hepatitis B vaccine series be started at birth. The American Academy of Pediatrics recommends vaccination by age 13 years.
A 4-year-old girl lies down and goes to sleep without any parental intervention, but she sometimes wakes her parents at night by screaming, thrashing, sweating, and appears frightened. The child is not aware of her parents' presence when they check on her. What information can the nurse provide to the parents about this occurrence?
These behaviors are characteristic of a night terror. During night terrors the child is only partially aroused; therefore she does not remember her parents' presence. A nightmare is a frightening dream followed by full awakening. Sleep apnea is a cessation of breathing during sleep. Screaming, thrashing, sweating, and appearing frightened does not resemble seizure activity.
A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." How can the nurse explain the difference to the parent?
This is normal because the onset of pubescence is usually earlier in girls than it is in boys. Girls begin puberty an average of approximately 2 years before boys. The average age of onset for puberty in boys is 12 years. In boys, puberty is considered delayed if testicular enlargement or pubic hair development has not occurred by age 14 years.
The nurse needs to check the blood pressure of a small child with no suspected cardiac problem. Of the cuffs available, one is too large and one is too small. What nursing action is best?
Wait to check the blood pressure until a proper cuff can be located. An inaccurate blood pressure is no better than omitting its measurement. Get the appropriate sized blood pressure cuff. Too small of a cuff would give a falsely high blood pressure. Too large of a cuff would give a falsely low blood pressure Auscultation is preferred to palpation.
The development of a 2-year-old child is characterized by
engaging in parallel play. Two-year-old's typically play alongside each other. A toddler still needs help with clothing at 2 years of age. A vocabulary of 300 words is expected at this age. Usually, the birth weight doubles by 6 months of age and triples by 1 year of age. Between 2 and 3 years of age, the birth weight quadruples.
Factors that can lead to malocclusion, a condition in which the teeth are crowded, crooked, or out of alignment include all of the following except
pacifier use or thumb sucking. Pacifier use or thumb sucking is not believed to cause malocclusion unless it persists past age 2 to 4 years; because of the risk, children should stop using the pacifier before their permanent teeth erupt
The nurse observes that a 13-year-old male has gynecomastia (breast enlargement). How should the nurse explain this to this adolescent?
It is a normal occurrence during puberty. Gynecomastia is common during mid-puberty in about one third of boys. For most, the breast enlargement disappears within several years. Although gynecomastia may occur in overweight children, in children of normal body weight it is a normal occurrence. It is not related to diet or hormones.
Which should the nurse recommend to help a toddler cope with the birth of a new sibling?
Give the toddler a doll with which he or she can imitate parenting. The toddler can participate in the activity of caring for a new family member but can have a doll of his or her own to care for. The toddler should be encouraged to participate in accordance with his or her abilities. Telling the toddler a new playmate will soon come home will establish unrealistic expectations. Preparation should begin as soon as changes in the mother's physical appearance and the home setting occur.
Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation?
Have the child "help" with palpation by placing his or her hand over the palpating hand. It allows the nurse to perform the assessment while including the child to have the child "help" with palpation by placing his or her hand over the palpating hand. It would not promote relaxation and would make it more difficult to perform the assessment to palpate another area simultaneously. It might only contribute to the child's laughter to ask the child not to laugh or move if it tickles. It would not promote relaxation and would make it more difficult to perform the assessment to begin with deeper palpation and gradually progress to superficial palpation.
During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure whether his son is ready for kindergarten. The child's birthday is close to the cutoff date and child has not attended preschool. Which is the nurse's best recommendation?
Have the child get a developmental screening. A developmental screening will provide the necessary information to help the family determine readiness.
Which behavior is most characteristic of the concrete operations stage of cognitive development?
Increasingly logical and coherent thought processes Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Inability to put oneself in another's place is characteristic of the preoperational stage (ages 2 to 7 years). Progression from reflex activity to imitative behavior is characteristic of the preoperational stage (ages 2 to 7 years). Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.
Which characteristic best describes the fine motor skills of a 5-month-old infant?
Is able to grasp object voluntarily Grasping an object is a characteristic appropriate for a 5-month-old infant. Pincer grasp is a characteristic of an 11-month-old infant. Strong grasp reflex is a characteristic of a 1-month-old infant. Building a tower of two cubes is a characteristic of a 15-month-old infant.
A mother tells the nurse that her daughter's favorite toy is a large, empty box in which a stove was packaged. She plays "house" in it with her toddler brother. What information should the nurse tell the mother about this type of play?
It is an example of creative play that should be encouraged. Creative play should be encouraged. After children create something new, they can then transfer their new knowledge to other situations. As long as the play is supervised, it should be encouraged.
While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs/practices. How should the nurse interpret this behavior?
It is normal in spiritual development. Skepticism describes stage 4 in spiritual development. Adolescents attempt to determine which of their parental standards and beliefs to incorporate into their own. Such skepticism is a normal response for adolescents, unrelated to illness, crisis, or parental communication ability.
Which is an important consideration in preventing injuries during middle childhood?
Most injuries are unintentional in this age group. Unintentional injury is the leading cause of death in children of every age-group beyond 1 year of age. Aside from injury from falls, the leading causes of nonfatal unintentional injury in children of this age-group include being struck by or striking an object that resulted in injury, overexertion, lacerations, bites and stings, bicycle injury, and motor vehicle passenger injuries. Peer pressure is significant in this age group. School-age children have more refined muscle development.
The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. What guidance would be appropriate for the nurse to share with the parents?
Sports participation is encouraged if the sport is appropriate to the child's abilities. The parents should help the child select a sport that is suitable to her capabilities and interests. Organized sports can provide safe, appropriate activities with supportive parents and coaches. School-age children enjoy competition. Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely. Increased muscle mass in boys occurs at puberty. Before that, boys and girls can compete on the same teams.
The nurse is assessing a preschooler's chest as part of a well-child exam. What normal findings would the nurse expect to document?
Movement of the chest wall to be symmetric bilaterally and coordinated with breathing. The preschooler has a coordinated breathing pattern. For a preschooler, breathing is a coordinated function that uses abdominal breathing as well as a little chest movement. It is incorrect for the anteroposterior diameter to be equal to the transverse diameter. Retraction of the muscles between the ribs on respiratory movement is indicative of respiratory distress.
A mother asks the pediatric office nurse why her toddler son needs to be seen by an eye specialist. Which explanation by the nurse to the mother states the importance of detecting and following up strabismus in young children?
Muscle imbalance can cause loss of vision. Loss of vision may develop if the eyes do not work together. The brain may ignore the visual cues from one eye, resulting in blindness. Color vision is dependent on rods and cones in the retina, not on muscle coordination. Epicanthic folds are present at birth. Symmetric corneal light reflexes are normal and tests alignment of the eyes. It doesn't explain why strabismus testing is important.
Since the preschoolers' thought process is egocentric and they enjoy learning about their environment, what is the most effective approach for communication with children this age?
Play Play is the child's way to learn to understand and adjust to situations. Language is too abstract to be the most effective communication tool for preschool children. Drawing is not developed at this age. Actions are not effective for communication. Interpreting actions requires a level of abstraction not yet achieved by a preschooler.
The nurse is observing a parent and child interacting in the clinic waiting room. The child begins to bounce on the couch. The parent removes the child from the couch stating firmly, "Couches are for sitting, not for jumping." The parent then gives the child a toy to play with on the carpet. The child plays with the toy until called by the nurse. The nurse determines the child is acting within which Kohlberg stage of moral development?
Punishment-obedience stage.
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?
Start putting her to bed while still awake. Placing the infant in the crib or bassinet after cuddling but before the infant is completely asleep facilitates self-consoling behavior. Infants who do not learn to self-console when going to sleep expect the parents to console them should they awaken during the night. Never put the infant in the adults' bed. The parents may roll over on the infant and suffocate her. Besides, having the infant in bed with them would be no guarantee of her staying asleep. The infant needs to be checked on if she awakens crying to make sure she is all right. When the infant is allowed to fall asleep with a bottle containing milk or juice, the carbohydrate-rich solution bathes the teeth for a long period and may cause dental caries.
The nurse is conducting a water-safety program for parents of young children at the pediatrician's office. What water safety information should be included?
Supervise the toddler in the tub regardless of how much water is in the bathtub. Secure the pool drain with a protective cover. A tub of water used to bathe the dog can be a water hazard. Constant supervision of the child is the best safety mechanism for water safety.
The nurse is reviewing with a group of parents about what to expect regarding their school-age children. What information should the nurse include?
The average increase in height is 2 in. per year. Children this age like to collect groups of things like coins. Children this age are able to understand sports and social rules. The average increase in height is 2 in. per year. Children this age like to collect groups of things like coins. Children this age engage in recreational sports and are able to understand rules. The average weight gain is 5½ lb. per year. Parents and teachers profoundly influence moral development. The developmental task for this age is industry.
