GROWTH AND DEVELOPMENT

52. Which method is the most effective way to present an educational program on abstinence to adolescents? 1. Use peer-led programs that emphasize the consequences of unprotected sexual contact. 2. Teach students methods to resist peer pressure. 3. Offer students the opportunity to care for a simulator infant for 1 week. 4. Offer statistics, pamphlets, and fi lms discussing the consequences of unprotected sexual contact.

1 (1. Adolescents are most concerned with what their peers think and feel. They are most receptive to information that comes from another adolescent. 2. It is very diffi cult for teens to resist peer pressure even with the appropriate tools of resistance. 3. Infant simulators are useful, but they are very expensive and often diffi cult to obtain. 4. Pamphlets are helpful aids in relaying information to teens, but hearing the information fi rsthand from a peer is the most effective method of education.)

33. A 5-year-old boy has always been one of the shortest children in class. His mother tells the school nurse that her husband is 6 ′ tall and she is 5 ′ 7 ″ . What should the nurse tell the child ' s mother? 1. He is expected to grow about 2 inches every year from ages 6 to 9 years. 2. He is expected to grow about 3 inches every year from ages 6 to 9 years. 3. He should be seen by an endocrinologist for growth-hormone injections. 4. His growth should be re-evaluated when he is 7 years old.

1 (1. During the school-age years, a child grows approximately 2 inches per year. 2. During the school-age years, a child grows approximately 2 inches per year. 3. This is not the appropriate time to have the child evaluated. His mother needs to reserve her concerns until he is older. He will likely begin to catch up with his peers within the next year. 4. The child should continue to see his pediatrician for annual visits, but there is no need for a special visit to re-evaluate his growth at this time.)

29. A 4-year-old is hospitalized for an ASD repair. The parents have decided to go home for a few hours to spend time with their other children. The child asks when her mommy and daddy will be back. The nurse ' s best response is: 1. "Your mommy and daddy will be back after your nap." 2. "Your mommy and daddy will be back at 6:00 p.m." 3. "Your mommy and daddy will be back later this evening." 4. "Your mommy and daddy will be back in 3 hours."

1 (1. Preschoolers understand time in relation to events. 2. Preschoolers cannot tell time. 3. Preschoolers want concrete information, and the words "this evening" are not meaningful to them. 4. Preschoolers have no concept of how long an hour is.)

49. Which should the nurse recommend to the parents of a 9-year-old hospitalized following a bicycle injury? To prevent future injury, their child should: 1. Wear safety equipment while riding bicycles. 2. Read educational material on bicycle safety. 3. Watch a video on bicycle safety. 4. Ride his bike in the presence of adults.

1 (1. Safety equipment is essential for bicycling, skateboarding, and participating in contact sports. Most injuries occur during the school-age years, when children are more active and participate in contact sports. 2. Educational material is a good way to reinforce the use of safety equipment, but the parents must insist that the child use his safety equipment. 3. Video material is a good way to reinforce the use of safety equipment, but the parents must insist that the child use his safety equipment. 4. The child ' s parents may not always be present when he rides his bike, so the use of safety equipment is the primary concern.)

54. A 13-year-old boy is hospitalized for a femur fracture. He was hit by a car while he and his friends were racing bikes near a major intersection. The child ' s parents are concerned about his judgment. The nurse should tell the parents that the behavior is: 1. Typical of young teens. 2. Related to hormonal surges during adolescence. 3. An isolated incident and will not likely happen again. 4. Related to teen rebellion.

1 (1. The brains of young teens are not completely developed, which often leads to poor judgment and impulse control. 2. Hormonal changes in teens play a primary role in the development of secondary sex characteristics. 3. The child may be prone to other lapses in judgment. The brains of young teens are not completely developed, which often leads to poor judgment and low impulse control. 4. The child ' s behavior had nothing to do with rebellion.)

32. What can a nurse do to reinforce a 5-year-old ' s intellectual initiative when he asks about his upcoming surgery? 1. Answer the child ' s questions about his upcoming surgery in simple terms. 2. Provide the child with a book that has vivid illustrations about his surgery. 3. Tell the child he should wait and ask the doctor his questions. 4. Tell the child that she will answer his questions at a later time.

1 (1. The child is taking the initiative to ask questions, as all preschoolers do, and the nurse should always answer those questions as appropriately and accurately as possible. 2. A book illustrating what will happen to the child may help him, but it will not encourage his intellectual initiative. 3. By not answering the child ' s questions, the nurse may actually be stifl ing his sense of initiative. 4. By not answering the child ' s questions, the nurse may actually be stifl ing his sense of initiative.)

19. Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. "My child is able to stand but is not yet taking steps independently." 2. "My child has a vocabulary of approximately 15 words." 3. "My child is still sucking his thumb." 4. "My child seems to be quite wary of strangers."

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

37. A 4-year-old hospitalized with FTT has orders for daily weights, strict intake and output, and calorie counts. Which action by the nurse would be a concern? 1. The nurse weighs the child every morning after breakfast. 2. The nurse weighs the child with no clothing except for undergarments. 3. The nurse sits with the child while the child eats her meals. 4. The nurse weighs the child using the same scale every morning.

1 (1. The child should be weighed every day on the same scale before eating. Her weight will not be an accurate refl ection if she is fed prior to being weighed. 2. The child should be weighed only in undergarments. The weight of clothing must not be included. 3. The nurse should remain in the room while the child eats in order to accurately record a calorie count. 4. The child should be weighed on the same scale every time. All scales are not equally accurate, so it is important to use the same scale in order to obtain an accurate trend.)

11. Which fi nding would the nurse consider abnormal when performing a physical assessment on a 6-month-old? 1. Posterior fontanel is open. 2. Anterior fontanel is open. 3. Beginning signs of tooth eruption. 4. Able to track and follow objects.

1 (1. The posterior fontanel should close between 6 and 8 weeks of age. 2. The anterior fontanel usually closes between 12 and 18 months. 3. The infant usually has a fi rst tooth erupt at about 6 months of age. 4. The infant should be able to track objects.)

7. A fi rst-time mother brings in her 5-day-old baby for a well-child visit. The nurse weighs the infant and reports a weight of 7 lb 5 oz to the mother. The mother looks concerned and tells the nurse that her baby weighed 7 lb 10 oz when she was discharged 4 days ago. The nurse ' s best response to the mother is: 1. "I will let the doctor know, and he will talk with you about possible causes of your infant ' s weight loss." 2. "A weight loss of a few ounces is common among newborns, especially for breastfeeding mothers." 3. "I can tell you are a fi rst-time mother. Don ' t worry; we will fi nd out why she is losing weight." 4. "Maybe she isn ' t getting enough milk. How often are you breastfeeding her?"

2 (1. A loss of a few ounces during the fi rst few days of life is normal. There will be a reason for concern if the infant does not get back to birth weight in the fi rst 2 weeks of life. 2. Newborns can lose up to 10% of their birth weight without concern but should regain their birth weight by 2 weeks of age. 3. The nurse should not make this comment. The mother will likely feel belittled, and she may be afraid to ask questions in the future. 4. A loss of a few ounces during the fi rst few days of life is normal. Many times, infants of breastfeeding mothers lose weight initially because the mother ' s milk has not come in yet.)

55. A 16-year-old is having a discussion with the nurse about the teen ' s recent diagnosis of lupus. In explaining the child ' s prognosis, the nurse uses the knowledge that adolescents are: 1. Preoccupied with thoughts of the here and now. 2. Able to understand and imagine possibilities for the future. 3. Capable of thinking only in concrete terms. 4. Overly concerned with past events and relationships.

2 (1. Adolescents are becoming abstract thinkers and are able to imagine possibilities for the future. 2. Adolescents are becoming abstract thinkers and are able to imagine possibilities for the future. 3. Preschool and school-age children think in concrete terms. Adolescents are beginning to think in abstract terms. 4. Adolescents are becoming abstract thinkers and are able to imagine possibilities for the future. They are not preoccupied with past events.)

53. An 18-year-old with a rash and itching in the groin area is concerned that he has contracted a sexually transmitted disease and does not want his parents to fi nd out. The nurse ' s best response is: 1. "We will need to contact your parents to let them know." 2. "We will not contact your parents regarding this visit." 3. "Who would you like us to contact about your visit here today?" 4. "We cannot promise that the hospital will not contact your parents."

2 (1. An adolescent has a right to privacy; if he does not want his parents contacted and as long as no harm has come to him, they do not need to be contacted. 2. An adolescent has every right to privacy as long as the situation is not life threatening. 3. The nurse can ask if the patient would like the nurse to contact someone; again, if the teen says no, that is his or her right. 4. An adolescent has every right to privacy as long as the situation is not life threatening. Therefore, the hospital can promise not to contact the parents.)

10. The mother of a newborn asks the nurse when the infant will receive the fi rst hepatitis B immunization. Which is the nurse ' s best response? 1. "Babies receive the hepatitis B vaccine only if their mother is hepatitis B-positive." 2. "The fi rst dose of the hepatitis B vaccine will be given prior to discharge today." 3. "The fi rst dose of hepatitis B vaccine is given at 1 year of age." 4. "Babies receive their fi rst hepatitis B vaccine at 6 months of age."

2 (1. Babies born to mothers positive for hepatitis B receive the fi rst dose of hepatitis B vaccine within 12 hours of delivery. 2. The fi rst dose of hepatitis B vaccine is recommended between birth and 2 months. In most hospitals, newborns are given the vaccine prior to discharge. 3. The fi rst dose of hepatitis B vaccine is recommended between birth and 2 months. In most hospitals, newborns are given the vaccine prior to discharge. 4. The fi rst dose of hepatitis B vaccine is recommended between birth and 2 months. In most hospitals, newborns are given the vaccine prior to discharge.)

44. Which activity can the nurse provide for a 9-year-old to encourage a sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

2 (1. Giving the child choices while in the hospital is important. However, medications should be kept on schedule. It is essential to give them at the prescribed time. 2. The school-age child is focused on academic performance; therefore, the child can achieve a sense of industry by completing his homework and staying on track with his classmates. 3. The child should have already mastered bathing. It is not likely to give him a sense of accomplishment. 4. The child may enjoy assisting with his dressing change, but it is not the best example of industry.)

15. The mother of an 11-month-old with iron-defi ciency anemia tells the nurse that her infant is currently taking iron and a multivitamin. Which statement made by the mother should be of concern to the nurse? 1. "I give the iron and multivitamin at the same time each morning." 2. "I give the iron and multivitamin in the morning 6-oz bottle." 3. "I give the iron and multivitamin 2 hours before I feed the morning bottle." 4. "I give the iron and multivitamin in oral syringes toward the back of the cheek."

2 (1. It is always a good idea for parents to administer medications at the same time each day. 2. Medications should never be mixed in a large amount of food or formula because the parent cannot be sure that the child will take the entire feeding. Formula decreases the absorption of iron. 3. Giving medications in a nipple is an acceptable method of administering liquid oral medications to infants. 4. An oral syringe is a good method of administering oral medications. The syringe should be placed in the back side of the cheek. Small amounts of the medication should be given at a time.)

12. A mother requests that her child receive the varicella vaccine at the 9-month wellchild checkup. The nurse tells the mother that: 1. Children who are vaccinated will likely develop a mild case of the disease. 2. The vaccine cannot be given at that visit. 3. The vaccine will be administered after the physician examines the child. 4. A booster vaccination will be needed at 18 months of age.

2 (1. It is possible for children to develop a mild rash after receiving the varicella vaccine. However, the varicella vaccine is not usually administered prior to 1 year of age. CHAPTER 3 GROWTH AND DEVELOPMENT 33 2. The nurse should not give the vaccine. The varicella vaccine is not usually administered prior to 1 year of age unless there are extenuating circumstances. 3. The varicella vaccine is not usually administered prior to 1 year of age. 4. The recommendation is that a second dose be administered at 4 to 6 years of age.)

21. Which foods would the nurse recommend to the mother of a 2-year-old with irondefi ciency anemia? 1. 32 oz of whole cow ' s milk per day. 2. Meats, eggs, and green vegetables. 3. Fruits, whole grains, and rice. 4. 8 oz of juice, three times per day.

2 (1. One of the primary reasons toddlers develop iron-defi ciency anemia is because they are consuming too much milk, which is limiting their intake of iron-rich foods. Milk is a poor source of iron and should be limited to 24 ounces per day. 2. Meat, eggs, and green vegetables are excellent sources of iron. 3. Iron-enriched cereals are a good choice for children, but this list of foods does not contain the most iron-rich foods. 4. Increasing the amount of juice the child consumes will not provide needed iron. Instead, the focus is on providing the child with the most iron-rich foods.)

31. Which reaction would a nurse expect when giving a preschooler immunizations? 1. The child remains silent and still. 2. The child cries and tells the nurse that it hurts. 3. The child tries to stall the nurse. 4. The child remains still while telling the nurse that she is hurting him.

2 (1. Teens are more likely to be stoic and remain still and silent during injections. 2. The common response of a 5-yearold is to cry and protest during an immunization. 3. School-age children are most likely to try to stall the nurse. 4. Teens usually remain still, and they may calmly tell the nurse that they are feeling pain during the injection.)

51. To obtain an adolescent ' s health information, the nurse should: 1. Interview the adolescent using direct questions. 2. Gather information during a casual conversation. 3. Interview the adolescent only in the presence of the parents. 4. Gather information only from the parents.

2 (1. Teens may not speak as freely when asked direct questions. 2. Frequently adolescents will share more information when it is gathered during a casual conversation. 3. Teens may share more information when they are not in the presence of their parents. It is important to interview the teen fi rst. Parent information can be obtained following the interview with the teen. 4. It is important to gather information from both the teen and the parent fi rst, then the teen alone.)

46. A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside her clubhouse that has "No boys allowed" printed on it. The child ' s parents are concerned that she is excluding their neighbor ' s son, and they are upset. What should the school nurse tell the child ' s parents? 1. Her behavior is cause for concern and should be addressed. 2. Her behavior is common among school-age children. 3. Her feelings about boys will subside within the next year. 4. They should have their daughter speak with the school counselor.

2 (1. The child ' s behavior is normal. Girls of 9 and 10 generally prefer to have friends who are of the same gender. 2. This is common behavior. Girls of 9 and 10 generally prefer to have friends who are of the same gender. 3. Girls of 9 and 10 generally prefer to have friends who are of the same gender. The child will likely have the same feelings next year. 4. There is no need for the child to see the counselor. Girls of 9 and 10 generally prefer to have friends who are of the same gender.)

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

2 (1. The child can play with a small baby doll, but she will likely just put the doll in her mouth. She is not old enough to play appropriately with this toy. 2. A musical rattle is the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation. 3. Reading to children is essential throughout childhood. However, the child will likely just chew on the book, so it is not the ideal choice. 4. Beads are not appropriate toys for infants because of the risk of choking.)

What must the nurse do when the 1.5-mL dose arrives from the pharmacy? 1. Administer the injection into the deltoid muscle. 2. Divide the dose into two injections. 3. Administer the injection into the dorsogluteal muscle. 4. Give dose as a single injection into the vastus lateralis muscle.

2 (1. The deltoid of a 6-month-old is not developed enough and should not be used for IM injections. 2. The nurse should not deliver more than 1 mL per IM injection to a 6-month-old. 3. The dorsogluteal muscle should not be used in children until they have been walking for at least 2 years. 4. The vastus lateralis is the site of choice for an IM injection for a child 6 months old. However, the volume injected should not be more than 1 mL for a single injection.)

50. A 16-year-old male is hospitalized for cystic fi brosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. Which action taken by the nurse will most enhance his psychosocial development? 1. Fax the teen ' s teacher and have her send in his homework. 2. Encourage the teen ' s friends to visit him in the hospital. 3. Encourage the teen ' s grandparents to visit frequently. 4. Tell the teen he is free to use his phone to call or text friends.

2 (1. The teen may want to continue his schoolwork while in the hospital, but it is not the best means of enhancing his psychosocial development. 2. Teens are most concerned about being like their peers. Having the teen ' s friends visit will help him feel he is still part of the school and social environment. 3. The teen may want to see his grandparents, but they are not the primary focus in his life. 4. Calling or texting friends is a good means of remaining in contact with peers. However, having direct contact with friends is a better means of maintaining social contact.)

39. A 4-year-old boy has been hospitalized because he fell down the stairs. His mother is crying and states, "This is all my fault." Which is the nurse ' s best response? 1. "Accidents happen. You shouldn ' t blame yourself." 2. "Falls are one of the most common injuries in this age-group." 3. "It may be a good idea to put a gate on the stairs." 4. "Your son should be profi cient at walking down the stairs by now."

2 (1. This comment will not make the mother feel any better. The mother is going to blame herself regardless of where the blame lies. The nurse would do better to just listen than to make this sort of comment. 2. Falls are one of the most common injuries, and it may make the parent feel better to know that this is common. 3. It may be a good idea to put up a gate, but in this situation the nurse ' s comment may be interpreted as judgmental. 4. Children walk, climb stairs, and run without paying attention to what might be in their way and can fall easily.)

38. A 3-year-old is attending her grandfather ' s funeral. Her parents told her that her grandfather is in heaven with God. Which statement describes a 3-year-old child ' s understanding of spirituality? 1. "The body is here with us on Earth, and the spirit is in heaven." 2. "He is in heaven. Is this heaven?" 3. "The spirit is no longer in his body." 4. "He won ' t need his body in heaven."

2 (1. Three-year-old children do not understand the difference between body and spirit. Their understanding of spirituality is literal in nature. 2. Three-year-old children are literal thinkers. The child ' s parents told her that Grandpa was in heaven. She sees his body, so she thinks they are all in heaven. 3. Three-year-old children do not understand the difference between body and spirit. Their understanding of spirituality is literal in nature. 4. Three-year-old children think of spirituality in literal terms and do not understand the concept of heaven.)

26. Which stressor is common in hospitalized toddlers? Select all that apply. 1. Social isolation. 2. Interrupted routine. 3. Sleep disturbances. 4. Self-concept disturbances. 5. Fear of being hurt.

2, 3, 5. (1. Social isolation is a stressor of the hospitalized teen. 2. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 3. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 4. Self-concept disturbance is a stressor of the hospitalized teen. 5. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt.)

4. Which statements by an infant ' s mother lead the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? Select all that apply. 1. "I will continue to breastfeed my son and will give him oatmeal cereal two times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 4 to 6 ounces of baby juice per day." 5. "I will make sure my son gets cereal three times a day."

2,4,5 (1. Breastfeeding is the ideal nutrition for the fi rst year of life. Cereal can be introduced between 4 and 6 months of age and offered twice a day. 2. Infants should be started on vegetables prior to fruits. The sweetness of fruits may inhibit infants from taking vegetables. 3. It is essential to introduce new foods one at a time to determine whether a child has any allergies. 4. Infants can be given fruit juice by 6 months of age, but it is recommended not to exceed 4 to 6 ounces per day. 5. Infants need another source of iron by 4 to 6 months of age, so cereal is introduced twice a day.)

60. During an adolescent ' s initial physical assessment, the nurse notes signs and symptoms of nutritional defi cit. Which assessment led the nurse to this initial conclusion? 1. Protein level within normal limits. 2. Blood pressure is 110/66. 3. Hair and nails are brittle and dry. 4. Teeth appear to be eroded.

3 (1. A low protein level could indicate a nutritional defi cit. However, this would not be an indication that the nurse sees on an initial assessment. Laboratory work would be required to have this information. 2. This is a normal blood pressure for a teen. 3. Dry and brittle hair and nails are common among people who have a nutritional defi cit. 4. Eroded teeth are common in those who have frequent vomiting. The acidic nature of the vomitus causes the enamel of the teeth to deteriorate, causing erosion. Eroded teeth may be seen in teens with bulimia; however, by itself, this is not a sign of nutritional defi cit.)

35. A 3-year-old admitted to the hospital with croup has the following vital signs: heart rate 90, respiratory rate 44, blood pressure 100/52, and temperature 98.8°F (37.1°C). The parents ask the nurse if these vital signs are normal. The nurse ' s best response is: 1. "Your son ' s blood pressure is elevated, but the other vital signs are within the normal range." 2. "Your son ' s temperature is elevated, but the other vital signs are within the normal range." 3. "Your son ' s respiratory rate is elevated, but the other vital signs are within the normal range." 4. "Your son ' s heart rate is elevated, but the other vital signs are within the normal range."

3 (1. A normal systolic blood pressure for a child from 3 to 6 years is 78 to 111. A normal diastolic blood pressure for a child from 3 to 6 years is 42 to 70. 2. A normal temperature is 96.6°F to 100°F (35.8°C to 37.7°C). 3. A normal respiratory rate for a child from 3 to 6 years is 20 to 30 breaths per minute. 4. A normal heart rate for a child from 3 to 6 years is 75 to 120.)

1. A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse ' s best response is: 1. "At 6 months, his weight should be approximately three times his birth weight." 2. "Each child gains weight at his or her own pace." 3. "At 6 months, his weight should be approximately twice his birth weight." 4. "At 6 months, a child should weigh about 10 lb more than his or her birth weight."

3 (1. At 6 months the weight should be approximately two times the birth weight. 2. Infants gain weight at their own pace but should double the birth weight by 4 to 6 months. 3. Infants should double their birth weight by 4 to 6 months of age. 4. By 6 months an infant should have doubled the birth weight; 10 lb is a lot of weight to gain in 4 to 6 months.)

6. The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with an adequate source of iron in her diet. Which statement refl ects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortifi ed formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby ' s diet when she is 2 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortifi ed cereals to her diet."

3 (1. Breast milk or an iron-fortifi ed formula is recommended as the primary source of nutrition for the fi rst year of life. 2. Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months of age. 3. Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months of age. Full-term infants have iron stores that last approximately 4 to 6 months. 4. Iron-fortifi ed cereals are a good source of iron once a child is old enough to consume solid foods.)

17. A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental milestones, what should the nurse caring for the child expect the current weight to be? 1. 16 lb 4 oz 2. 20 lb 5 oz 3. 24 lb 6 oz 4. 32 lb 8 oz

3 (1. Children should double their birth weight by 6 months of age. 2. Children should triple their birth weight by 12 months of age. 3. Children should triple their birth weight by 12 months of age. 4. Children should triple their birth weight by 12 months of age.)

48. Which technique should the nurse suggest to the mother of an 8-year-old who does not want to complete her chores? 1. Grounding. 2. Time-out. 3. Reward system. 4. Spanking.

3 (1. Grounding is a technique that generally works well with adolescents. 2. Time-out is a technique that is primarily used for toddler and preschool children. 3. School-age children usually respond very well to a reward system and often enjoy the rewards so much that they will continue chores without continual reminders. 4. Spanking is a suggestion that should never be given to families.)

57. A 13-year-old tells the nurse that he is worried because his breasts are growing. They hurt, and he is embarrassed to take his shirt off during gym class. What should the nurse tell him? 1. "The pediatrician will draw some blood to fi nd out why your breasts are growing." 2. "It is just a slight hormonal imbalance that can be easily corrected with medication." 3. "This is a normal condition of puberty that will resolve within a year or two." 4. "This is a rare fi nding that occurs in about 5% of boys during puberty."

3 (1. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years. 2. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years. 3. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years. 4. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years.)

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

3 (1. Having parents close to the child is important, but infants are most secure when they are being held, patted, and talked to. 2. It is important that the nurse keep the parents informed about their child ' s condition, but it does not have any impact on the child ' s trust-versus-mistrust relationship with the parents. 3. Having parents hold their child while in the hospital is an excellent means of building the trust relationship. Infants are most secure when they are being held, patted, and spoken to. 4. Parents should be encouraged to learn their child ' s care, but it is not the best means of enhancing the trust relationship.)

27. Which nursing action would help foster a hospitalized 3-year-old ' s sense of autonomy? 1. Let the child choose what time to take the oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of cephalexin (Kefl ex) via oral syringe. 4. Let the child watch age-appropriate videos.

3 (1. Medication administration times must be adhered to. A preschooler should not be allowed to choose administration times. 2. A doll for medical play is an excellent method for teaching children about medical procedures, but it will not enhance her sense of autonomy. 3. Allowing preschoolers to participate in actions of which they are capable is an excellent way to enhance their autonomy. 4. Age-appropriate videos are a good way to occupy the child during hospitalization, but they will not enhance her autonomy.)

9. The parents of a newborn are asking the nurse how to use the infant car seat and where it should be placed in their vehicle. Which is the most appropriate action by the nurse? 1. Give the parents a pamphlet explaining how to install the car seat. 2. Accompany the parents to the car and show them how to install the car seat. 3. Contact the hospital ' s car-seat safety offi cer and ask the offi cer to accompany the parents to the car for car-seat installation. 4. Show the parents a video on car-seat installation and safety and ask if they are comfortable with the information.

3 (1. Pamphlets may be a useful tool to reinforce teaching. However, a hands-on approach is best in this situation. 2. The nurse could accompany the parents if she is profi cient in car-seat safety and installation. 3. The car-seat safety offi cer is the best choice, as that individual would have the needed information and certifi cation to help the family. 4. A video may be a useful tool to reinforce teaching. However, a hands-on approach is best in this situation.)

13. Which should the nurse teach the parents is one of the most common causes of injury and death for a 9-month-old infant? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

3 (1. Poisoning is more common among toddlers and preschoolers who are ambulating. 2. Child abuse is not one of the leading causes of injury and death in children. Accidents are the most common cause of injury and death. 3. Aspiration is a common cause of injury and death among children of this age. These children often fi nd small objects lying on the fl oor and place them in their mouth. Older siblings are often responsible for leaving small objects around. 4. Dog bites are not a leading cause of injury or death in children.)

36. Which action is a developmentally appropriate method for eliciting a 4-year-old ' s cooperation in obtaining the blood pressure? 1. Have the child ' s parents help put on the blood pressure cuff. 2. Tell the child that if he sits still, the blood pressure machine will go quickly. 3. Ask the child if he feels a squeezing of his arm. 4. Tell the child that measuring the blood pressure will not hurt.

3 (1. Preschool children like to do things for themselves and will not likely behave any better for the parents than for the nurse. 2. The nurse should not promise the child that the procedure will go quickly. The nurse needs to develop a trusting relationship with the child; therefore, only promises that can be kept should be made. 3. Preschool children enjoy games, and it is a good way to elicit their assistance and cooperation during a procedure. 4. The nurse should not promise the child that the procedure will not hurt. Each child ' s perception of pain is individual. The nurse needs to develop a trusting relationship with the child; therefore, only promises that can be kept should be made.)

43. Which is the best method of distraction for an 8-year-old who is having surgery later today to insert a central line and is NPO? 1. Use the telephone to call friends. 2. Watch television. 3. Play a board game. 4. Read the central-line pamphlet he was given.

3 (1. Talking to friends may distract the child for some time. However, the conversation could revert to a discussion about the upcoming surgery. 2. Watching television may distract the child for some time, but he may still be thinking about his surgery. 3. A board game is the optimal choice because school-age children enjoy being engaged in an activity with others that will require some skill and challenge. 4. Reading material about the surgery will only increase his thoughts about the surgery.)

59. The mother of a 15-year-old is frustrated because he spends much of his weekend time sleeping. Which is the nurse ' s best response to the mother ' s frustration? 1. "Your son may be trying to catch up on the sleep missed during the week." 2. "Developmental theorists believe that teens require more sleep as they begin to integrate new roles into their lives." 3. "Teens require more sleep because of the rapid physical growth that is occurring." 4. "Teens require more sleep because of the increase in their social obligations."

3 (1. Teens require more sleep because of the rapid physical growth that occurs during adolescence. 2. Teens are trying to integrate new roles into their lives. However, that has no impact on their need for increased sleep. 3. Teens require more sleep because of the rapid physical growth that occurs during adolescence. 4. Teens are generally more social and may be staying out late. However, their increased requirement for sleep is related to their rapid growth during adolescence.)

58. An adolescent has a diagnosis of new-onset diabetes. What would most infl uence a teenager ' s food choices as he begins to make changes in his diet? 1. Parents and their dietary choices. 2. Cultural background. 3. Peers and their dietary choices. 4. Television and other forms of media infl uence.

3 (1. The child ' s family does have some infl uence on his dietary choices, but teens are more focused on being like their peers. 2. The child ' s culture does affect his food choices. However, teens are more likely to choose "junk foods" and foods that their peers are eating. 3. As a teen, the child is most infl uenced by his peers. Teens long to be like others around them. 4. Television does affect personal food choices, but the peer group still has the most prevalent impact in a teen ' s life.)

28. The best method to explain a procedure to a hospitalized preschool-age child is to: 1. Show the child a pamphlet with pictures showing the procedure. 2. Have the 5-year-old next door tell the 4-year-old about the experience. 3. Demonstrate the procedure on a doll. 4. Show the child a video of the procedure.

3 (1. The child is too young to understand the procedure using pamphlets. 2. Four-year-old children are egocentric and will not relate other children ' s experiences to their own. 3. A 4-year-old child understands in very concrete and simple terms. Therefore, medical play is an excellent method for helping to understand the procedure. 4. Showing a video of the procedure to a preschooler would be very inappropriate. The preschooler is a concrete thinker and would not understand the video.)

40. Which nursing action is most appropriate to gain information about how a child is feeling? 1. Actively attempt to make friends with the child before asking about her feelings. 2. Ask the child ' s parents what feelings she has expressed in regard to her diagnosis. 3. Provide the child with some paper to draw a picture of how she is feeling. 4. Ask the child direct questions about how she is feeling.

3 (1. The nurse should not attempt to make friends with the child too quickly. The child should be given the opportunity to observe the nurse working in order to increase her comfort level with the nurse. 2. The child ' s parents are a good source of information, but the child may not have expressed all of her feelings to her parents. 3. Often children will include much more detail about their feelings in drawings. They will often express things in pictures they are unable to verbalize. 4. School-age children do not often share all of their feelings verbally, especially to people with whom they are not familiar.)

23. Which should the nurse do to prevent separation anxiety in a hospitalized toddler? 1. Assume the parental role when parents are not able to be at the bedside. 2. Encourage the parents to always remain at the bedside. 3. Establish a routine similar to that of the child ' s home. 4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

3 (1. The nurse should try to comfort the child and be friendly, but should not try to replace the parent. 2. Parents should be encouraged to be with their child as much as possible. However, parents may feel guilty if they leave knowing the staff believes the parents should always be at the bedside. 3. It is very important to try to maintain a child ' s home routine both when parents are present and when they have to leave the hospital. This will increase the child ' s sense of security and decrease anxiety. 4. Providing consistent nursing care is important, not rotating staff. The child needs consistent care to decrease anxiety.)

45. The mother of 10-year-old fraternal twins tells the nurse at their well-child checkup that she is concerned because her daughter has gained more weight and height than her twin brother. The mother is concerned that there is something wrong with her son. The nurse ' s best response is: 1. "I understand your concern. I will talk with the physician, and we can draw some lab work." 2. "Let me ask you whether your son has been ill lately." 3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." 4. "It is normal for you to be concerned, but I am sure your son will catch up with your daughter eventually."

3 (1. This is not an appropriate response. The nurse should be aware that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood. 2. This is not an appropriate response. The nurse should be aware that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood. 3. This is the appropriate response. The nurse understands that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood. 4. This is not the best response. The boy will likely surpass his sister when he reaches adolescence.)

20. The mother of a child who is 2 years 6 months in age has arranged a play date with the neighbor and her child who is 2 years 9 months old. During the play date the two mothers should expect that the children will do which of the following? 1. Share and trade their toys while playing. 2. Play with one another with little or no confl ict. 3. Play alongside one another but not actively with one another. 4. Only play with one or two items, ignoring most of the other toys.

3 (1. Toddlers do not share their possessions well. One of their favorite words is "mine." 2. Because toddlers do not share well, they are often in confl ict with one another during play. 3. Toddlers engage in parallel play. They often play alongside another child, but they rarely engage in activities with the other child. 4. Toddlers have very short attention spans and commonly play with various items for short periods.)

16. The nurse is using the FLACC scale to rate the pain level in a 9-month-old. Which is the nurse ' s best response to the father ' s question of what the FLACC scale is? 1. "It estimates a child ' s level of pain utilizing vital sign information." 2. "It estimates a child ' s level of pain based on parents ' perception." 3. "It estimates a child ' s level of pain utilizing behavioral and physical responses." 4. "It estimates a child ' s level of pain utilizing a numeric scale from 0 to 5."

3 (1. Vital signs are not considered when measuring pain using the FLACC scale. 2. The parents ' perception of their child ' s pain level is not considered when using the FLACC scale. 3. The FLACC scale utilizes behavioral and physical responses of the child to measure the child ' s level of pain. The scale utilizes facial expression, leg position, activity, intensity of cry, and level of consolability. 4. The FLACC scale assigns a numeric value to a child ' s pain level, which is rated from 0 to 10.)

18. The nurse is assessing the pain level in an infant who just had surgery. The infant ' s parent asks which vital sign changes are expected in a child experiencing pain. The nurse ' s best response is: 1. "We expect to see a child ' s heart rate decrease and respiratory rate increase." 2. "We expect to see a child ' s heart rate and blood pressure decrease." 3. "We expect to see a child ' s heart rate and blood pressure increase." 4. "We expect to see a child ' s heart rate increase and blood pressure decrease."

3 (1. When a child is experiencing pain, the normal physiological response is for the heart rate and respiratory rate to increase. 2. When a child is experiencing pain, the normal physiological response is for the heart rate and blood pressure to increase. 3. When a child is experiencing pain, the normal physiological response is for the heart rate, respiratory rate, and blood pressure to increase. 4. When a child is experiencing pain, the normal physiological response is for the heart rate, respiratory rate, and blood pressure to increase.)

56. The mother of a 13-year-old girl tells the nurse that she is concerned because her daughter has gained 10 lb since she began puberty. The child ' s mother asks the nurse for advice about what to do about her daughter ' s weight gain. Which should the nurse do? 1. Provide the child ' s mother with some pamphlets on nutrition and healthy eating. 2. Provide the child ' s mother with information about a new exercise program for teens. 3. Inform the child ' s mother that it is common for teen girls to gain weight during puberty. 4. Inform the child ' s mother that her daughter will likely gain another 5 to 10 lb in the next year.

3 (The child ' s mother may be interested in information relating to proper nutrition and exercise. However, the most important thing is for the nurse to let the child ' s mother know that this is a normal fi nding in teenage girls as they enter puberty. 2. The child ' s mother may be interested in information relating to proper nutrition and exercise. However, the most important thing is for the nurse to let the mother know that this is a normal fi nding in teenage girls as they enter puberty. 3. The nurse should tell the child ' s mother that this is a normal fi nding in teenage girls as they enter puberty. 4. The nurse knows that it is normal for girls to gain weight during puberty but has no idea how much weight the child will gain or if she will gain any more.)

41. Which statements would indicate to the nurse that a school-age child is not developmentally on track for age? Select all that apply. 1. The child is able to follow a four- to fi ve-step command. 2. The child started wetting the bed on admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister. 5. The child is not able to follow rules.

3, 5. (1. School-age children should be able to follow a four- to fi ve-step command, so this does not indicate that the child has a developmental delay. 2. The child was potty-trained before entering the hospital, and bedwetting is a common form of regression seen in hospitalized children. The child will likely return to her normal toileting habits when she returns home. 3. Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age. 4. Most school-age children do enjoy playing board games. 5. Most school-age children like rules and understand the consequences of not obeying them.)

34. The nurse realizes that a 3½-year-old ' s mother needs further education about the Denver Developmental Screening Test when she states: Select all that apply. 1. "It screens for gross motor skills." 2. "It screens for fi ne motor skills." 3. "It screens for intelligence level." 4. "It screens for language development." 5. "It screens for school readiness."

3, 5. (1. The Denver Developmental Screening Test evaluates children from 1 month to 6 years of age and is used to screen gross motor skills, fi ne motor skills, language development, and personal/social development. 2. The Denver Developmental Screening Test evaluates children from 1 month to 6 years and is used to screen gross motor skills, fi ne motor skills, language development, and personal/social development. 3. The Denver Developmental Screening Test does not test a child ' s level of intelligence. 4. The Denver Developmental Screening Test evaluates children from 1 month to 6 years and is used to screen gross motor skills, fi ne motor skills, language development, and personal/social development. 5. The Denver Developmental Screening Test evaluates children from 1 month to 6 years and is used to screen gross motor skills, fi ne motor skills, language development, and personal/social development not school readiness .)

14. An 8-day-old was admitted to the hospital with vomiting and dehydration. The newborn ' s heart rate is 170, respiratory rate is 44, blood pressure is 85/52, and temperature is 99°F (37.2°C). What is the nurse ' s best response to the parents who ask if the vital signs are normal? 1. "The blood pressure is elevated, but the other vital signs are within normal limits." 2. "The temperature is elevated, but the other vital signs are within normal limits." 3. "The respiratory rate is elevated, but the other vital signs are within normal limits." 4. "The heart rate is elevated, but the other vital signs are within normal limits."

4 (1. A normal systolic blood pressure for a child from birth to 1 month is 50 to 101. A normal diastolic blood pressure for a child from birth to 1 month is 42 to 64. 2. A normal temperature is 96.6°F to 100°F (35.8°C to 37.7°C). 3. A normal respiratory rate for a child from birth to 1 month is 30 to 60. 4. A normal heart rate for a child from birth to 1 month is 90 to 160.)

5. Which statement accurately describes the best method for assessing a 12-month-old? 1. The nurse should assess the child on the examining table. 2. The nurse should assess the child in a head-to-toe sequence. 3. The nurse should have the child ' s parent assist in holding her down. 4. The nurse should assess the child while she is in her parent ' s lap.

4 (1. Children 12 months old are best assessed in proximity to their parents. 2. The appropriate sequence for assessment with an infant is to auscultate fi rst, palpate next, and assess ears, eyes, and mouth last. Least invasive procedures are recommended fi rst. 3. Infants do not like to be held down. This will likely cause the child distress. If the child needs to be held down, it is best to enlist the aid of another staff member. 4. Infants are most secure when in proximity to the parent. The parent ' s lap is an excellent place to assess the child.)

61. The mother of an adolescent complains that he has had some recent behavioral changes. He comes home from school every day, closes his door, and refrains from interaction with his family. The nurse ' s best response to the mother is: 1. "You should speak with your son and ask him directly what is wrong with him." 2. "You should set limits with your son and tell him that this is unacceptable behavior." 3. "Your son ' s behavior is abnormal, and he is going to need a psychiatric referral." 4. "Your son ' s behavior is normal. You should listen to him without being judgmental."

4 (1. If the child ' s parents confront him, he may feel as though they are being judgmental, and he will likely not want to communicate with them. When parents begin a dialogue with their child early on in life, they are more capable of approaching the child when they do notice behavioral changes. 2. Setting limits is always a good thing to do with children. However, the child ' s parents are not addressing the reason for his behavioral changes. 3. The child ' s behavior is typical of a teen ' s response to developmental and psychosocial changes of adolescence. He does not need a psychological referral at this time. 4. The child ' s behavior is typical of a teen ' s response to developmental and psychosocial changes of adolescence.)

42. Which statement accurately describes how the nurse should approach an 11-year-old to do a physical assessment? 1. Ask the child ' s parents to remain in the room during the physical exam. 2. Auscultate the heart, lungs, and abdomen fi rst. 3. Explain that the physical exam will not hurt. 4. Explain what the nurse will be doing in basic understandable terms.

4 (1. Privacy is very important to school-age children. The child should be given the choice of having his parents present for the exam. 2. School-age children can be assessed in a head-to-toe sequence. 3. The nurse should not promise that the exam will not hurt. 4. School-age children are capable of understanding basic functions of the body and can understand what the nurse will be doing if explained in basic terms.)

47. What information should a school nurse include in a discussion on nutrition with a fourth-grade class? 1. The number of calories that a fourth-grade child should consume in a day. 2. A list of high-calorie foods that all fourth-graders should avoid. 3. How to read food labels so that children know which foods are good for them. 4. A list of nutritious foods with basic scientifi c information about how they affect the body organs and systems.

4 (1. School-age children do not engage in calorie counting. This is an adult activity. 2. Children may not want to hear this information, as most of them enjoy consuming high-calorie foods that taste good. 3. School-age children do not engage in calorie counting. This is an adult activity. 4. Reviewing nutritious choices keeps the lesson on a positive note, and school-age children are very interested in how food affects their bodies. They are capable of understanding basic medical terminology.)

30. Which approach should the nurse use to gather information from a child brought to the ED for suspected child abuse? 1. Promise the child that her parents will not know what she tells the nurse. 2. Promise the child that she will not have to see the suspected abuser again. 3. Use correct anatomical terms to discuss body parts. 4. Tell the child that the abuse is not her fault and that she is a good person.

4 (1. The nurse should always be honest with the child to develop a level of trust. The nurse should not promise not to tell. 2. The nurse should not make a promise that cannot be kept. Once again, the trust relationship could be jeopardized if the child feels the nurse lied. 3. The nurse should discuss body parts in relation to the child ' s vocabulary. 4. Many young children believe abuse or illness is their fault, so they should be reminded they are not to blame. Many children this age believe they have acquired a disease or have been abused because they are bad people.)

24. According to developmental theories, which important event is essential to the development of the toddler? 1. The child learns to feed self. 2. The child develops friendships. 3. The child learns to walk. 4. The child participates in being potty-trained.

4 (1. Toddlers are in a stage of life in which they like to do for themselves. However, developmental theorists such as Erickson and Freud believe that toilet training is the essential event that must be mastered by the toddler. 2. Toddlers engage in more parallel play. Building friendships is not common until school age and adolescence. 3. Walking should be mastered by 18 months of age. 4. Developmental theorists such as Erickson and Freud believe that toilet training is the essential event that must be mastered by the toddler.)

25. Which comment should the parent of a 2½-year-old expect from the toddler about a new baby brother? 1. "When the baby takes a nap, will you play with me?" 2. "Can I play with the baby?" 3. "The baby is so cute. I love him." 4. "It is time to put him away so we can play."

4 (1. Toddlers are egocentric and are not yet capable of delayed gratifi cation. It is unlikely that the child will wait to play with her parent until the baby sleeps. 2. Toddlers do not usually engage in play with others. They are generally involved in parallel play. 3. Toddlers usually initially resent the presence of new siblings because they take away some of the parents ' time and attention. 4. This is a typical statement that would be made by a toddler. Toddlers are very egocentric and do not consider the needs of the other child.)

22. A 2-year-old admitted to the hospital 2 days ago has been crying and is inconsolable much of the time. The nurse ' s best response to the child ' s parents who are concerned about this behavior is that the child is in the: 1. Detachment phase of separation anxiety, which is normal for children during hospitalization. 2. Despair stage of separation anxiety, which is normal for children during hospitalization. 3. Bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. Protest stage of separation anxiety, which is normal for children during hospitalization.

4 (22. 1. During the detachment phase of separation anxiety, children are usually fairly cheerful, and they often lack a preference for their parents. 2. During the despair stage of separation anxiety, children usually have a loss of appetite, altered sleep patterns, and a lack of much interest in play. 3. The bargaining stage is not a stage of separation anxiety; it is one of the stages of grief. 4. During the protest stage of separation anxiety, children are often inconsolable and often cry more than they do when they are at home. These children also frequently ask to go home.)