Health Promotion

How much should height increase per year in a school aged child?

2 inches per year

Two years

400 word vocabulary with 2-3 word sentences

What predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age-group

ANS: B Feedback B During growth spurts, the need for sleep is increased.

Which is descriptive of the social development of school-age children? A. Identification with peers is minimal. B. Children frequently have "best friends." C. Boys and girls play equally well with children of either gender. D. Peer approval is not yet an influence toward conformity.

B

According to Erikson, the development task of middle childhood is acquiring a sense of which of the following? A) Trust B) Autonomy C) Initiative D) Industry

D) Industry

3 years

Gender Identity

Two years

Removes one article of clothing

You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunizations cannot be given? Select all that apply. a. DTaP b. HepA c. IPV d. Varicella e. MMR

ANS: D, E Feedback Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children. Incorrect: DTaP, HepA, and IPV can be given safely.

Immunizations for a school age child.

Ages 11 - 12 Tada - Tdap Human - HPV Men - Meningococcal

According to Piaget, what occurs when children can recognize that changing the shape of a substance, such as a lump of clay, does not alter its total mass?

Conservation

Which assessment should the nurse perform last when examining a 5-year-old child? a. Heart b. Lungs c. Abdomen d. Throat ANS: D

D Examination of the mouth and throat is considered to be more invasive than other parts of a physical examination. For preschool children, invasive procedures should be left to the end of the examination.

According to Freud, the school-aged child is in which of the following periods? A) Oral B) Anal C) Oedipal D) Latency

D) Latency

Who runs the risk of early puberty?

Females who are significantly over weight

15-18 months

Turns pages of book

What is the leading cause of death in children older than 1 year?

Unintentional injury

Two years

Uses fork or spoon

4- 5 years

walk backwards

immunization for 12- 2 yrs

12-15 mo. Mnemonic: I'M HPV or IPV (3rd dose 6-18 mo), MMR (subcut), Hib PCV, Varicella (subcut) 12-23 mo. Hep A (two doses 6 months apart) 15-18 mo. DTAP Yearly flu vaccine IM injections until 35 months.

Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply) a. The child spends an inordinate amount of time in the nurse's office. b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.

ANS: A, B, C Feedback Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them.

Which is an appropriate disciplinary intervention for the school-age child? a. Using time-out periods b. Using a consequence that is consistent with the inappropriate behavior c. Using physical punishment d. Using lengthy dialog about inappropriate behavior

ANS: B Feedback B A consequence that is related to the inappropriate behavior is the recommended discipline.

Which is assessed with Tanner staging? a. Hormone levels b. Secondary sex characteristics c. Response to growth hormone secretion tests d. Hyperthyroidism

ANS: B Feedback B Tanner stages are used to assess staging of secondary sex characteristics at puberty.

Which is the preferred site for administration of the Hib vaccine to an infant? a. Deltoid b. Anterolateral thigh c. Upper, outer aspect of the arm d. Dorsal gluteal region

ANS: B Feedback B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants.

Which are characteristic of physical development of a 30-month-old child? (Select all that apply.) a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. f. Left or right handedness is established.

ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at age 12 to 18 months. Birth length is doubled around age 4. Left or right handedness is not established until about age 5.

Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? Select all that apply. a. Plans to try out for the debate team at school b. Skipping classes to go to the mall c. Hanging out with friends they have had since childhood d. Unexplained source of money e. Fear of the police

ANS: B, D, E Feedback Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is also a sign. A change in attitude toward participating in activities is another sign of gang involvement.

What term should be used in the nurse's documentation to describe auscultation of breath sounds that are short, popping, and discontinuous on inspiration? a. Pleural friction rub b. Bronchovesicular sounds c. Crackles d. Wheeze

ANS: C Feedback C Crackles are short, popping, discontinuous sounds heard on inspiration.

In general, the earliest age at which puberty begins is ____ years in girls and _____ years in boys. a. 13; 13 b. 11; 11 c. 10; 12 d. 12; 10

ANS: C Feedback C Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually, there is a 2-year difference in the age at onset.

The nurse is reviewing with a group of school age parents about what to expect regarding their school-aged children. What information should the nurse include? (Select all that apply.) A. The average weight gain is 7 lbs per year. B. The average increase in height is 2 inches per year. C. Children this age like to collect groups of things like coins. D. They really want to please their parents and teachers. E. The developmental task for this age is initiative. F. Children this age are able to understand sports and social rules.

B,C,D,F

15-18 months

Builds tower of 3-4 blocks

There is a developmental sequence in children's capacity to conserve matter. Conservation of __________ is usually grasped before conservation of __________

Numbers; substance

What are some characteristics of relationships with families of school-aged children?

parents are primary influence in personality, behavior, value system increasing independence from parents children not ready to abandon parental control yet

Which statement is the most appropriate advice to give parents of a 16-year-old teenager who is rebellious? *a.* " You need to be stricter so that your teenager feels more secure." *b.* " You need to allow your teenager to make realistic choices while using consistent and structured discipline." *c.* "Increasing your teen's involvement with his peers will improve his self-esteem." *d.* "Allow your teenager to choose the type of discipline that is used in your home."

*b.* "You need to allow your teenager to make realistic choices while using consistent and structured discipline." (Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Setting stricter limits typically does not decrease rebelliousness or increase feelings of security. Increasing peer involvement does not typically increase self-esteem. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.)

Which factor contributes to early adolescents engaging in risk-taking behaviors? *a.* Peer pressure. *b.* A desire to master their environment. *c.* Engagement in the process of separation from their parents. *d.* A belief that they are invulnerable.

*d.* A belief that they are invulnerable. (During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors: they believe negative consequences happen only to others. Impressing peers is more typically the factor influencing behavior of older school-age children. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training.)

Identify the 3 most pronounced physiologic changes that indicate increasing maturity in the school-aged child

1) A decrease in head circumference in relation to standing height 2) A decrease in waist circumference in relation to height 3) An increase in leg length in relation to height

Several factors have been identifies as contributing to childhood obesity. Name 3

1) Easy availability of fas tfood restaurants 2) Influence of mass media 3) Temptation to eat "junk food" (others: sedentary lifestyles, easy availability of high-calorie foods)

Identify 5 factors that influence the amount and manner of discipline and limit-setting imposed on school-age children

1) The psychosocial maturity of the parents 2) Childhood and childrearing experiences of the parents 3) Temperament of children 4) Context of children's misconduct 5) Response of the children to rewards and punishments

Immunization for age 4- adolescents

4-6 yrs Mnemonic: DIM or DTAP, IPV, MMR (subcut) 3-6 yrs annual flu vaccine 11-12 yr ( six grade): Tdap (IM in deltoid with ⅝ to 1 inch needle 22-25 gauge) HPV2/HPV4, Meningococcal. Annual influenza vaccine 16-18 yrs: MCV4 booster; annual flu vaccine

How does the onset of the pubertal growth spurt compare in girls and boys? A. In girls, it occurs about 1 year before it appears in boys. B. In girls, it occurs about 3 years before it appears in boys. C. In boys, it occurs about 1 year before it appears in girls. D. It is about the same in both boys and girls.

A

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is that: a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

When completing the health assessment for a 2-year-old child, the nurse should expect the child to: A. engage in parallel play. B. fully dress self with supervision. C. have a vocabulary of at least 500 words. D. be one third of the adult height.

A. engage in parallel play.

A nurse is reviewing pediatric physical assessment techniques. Which statement about performing a pediatric physical assessment is correct? a. Physical examinations proceed systematically from head to toe unless developmental considerations dictate otherwise. b. The physical examination should be done with parents in the examining room for children of any age. c. Measurement of head circumference is done until the child is 5 years old. d. The physical examination is done only when the child is cooperative.

ANS: A Feedback A Physical assessment usually proceeds from head to toe; however, developmental considerations with infants and toddlers dictate that the least threatening assessments be done first to obtain accurate data.

The nurse palpated the anterior fontanel of a 14-month-old infant and found that it was closed. What does this finding indicate? a. This is a normal finding. b. This finding indicates premature closure of cranial sutures. c. This is abnormal and the child should have a developmental evaluation. d. This is an abnormal finding and the child should have a neurologic evaluation.

ANS: A Feedback A The anterior fontanel should be completely closed by 12 to 18 months of age.

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

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

Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer

ANS: A Feedback A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. B Nesting blocks are more appropriate for a 12- to 15-month-old child. C A bicycle with training wheels is appropriate for a preschool or young school-age child. D A computer can be appropriate as early as the preschool years.

Which strategy is the best approach when initiating the physical examination of a 9-month-old male infant? a. Undress the infant and do a head-to-toe examination. b. Have the parent hold the child on his or her lap. c. Put the infant on the examination table and begin assessments at the head. d. Ask the parent to leave because the infant will be upset.

ANS: B Feedback A The head-to-toe approach needs to be modified for the infant. Uncomfortable procedures, such as the otoscopic examination, should be left until last. B Infants 6 months and older feel stranger anxiety. It is easier to do most of the examination on the parent's lap to lessen anxiety. C The infant may feel less fearful if placed in the parent's lap or with the parent within visual range if placed on the examining table. The head-to-toe approach is modified for the infant. D There is no reason to ask a parent to leave when an infant is being examined. Having the parent with the infant will make the experience less upsetting for the infant.

Which assessment finding is considered a neurologic soft sign in a 7-year-old child? a. Plantar reflex b. Poor muscle coordination c. Stereognostic function d. Graphesthesia

ANS: B Feedback A The plantar reflex is a normal response. When the lateral aspect of the sole of the foot is stroked in a movement curving medially from the heel to the ball, the response will be plantar flexion of the toes. B Poor muscle coordination is a neurologic soft sign. C Stereognostic function refers to the ability to identify familiar objects placed in each hand. D Graphesthesia is the ability to identify letters or numbers traced on the palm or back of the hand with a blunt point.

Which chart should the nurse use to assess the visual acuity of an 8-year-old child? a. Lea chart b. Snellen chart c. HOTV chart d. Tumbling E chart

ANS: B Feedback B The Snellen chart is used to assess the vision of children older than 6 years of age.

Which strategy is not always appropriate for pediatric physical examination? a. Take the history in a quiet, private place. b. Examine the child from head to toe. c. Exhibit sensitivity to cultural needs and differences. d. Perform frightening procedures last.

ANS: B Feedback B The classic approach to physical examination is to begin at the head and proceed through the entire body to the toes. When examining a child, however, the examiner must tailor the physical assessment to the child's age and developmental level.

Which is descriptive of a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time, such as "just a minute" and "in an hour"

ANS: B At this age, the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. When a child puts objects into a container but cannot take them out, this is indicative of tertiary circular reactions. An embryonic sense of time exists, although the children may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

According to Erikson, the psychosocial task of adolescence is to develop a. Intimacy b. Identity c. Initiative d. Independence

ANS: B Feedback B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity.

The most effective way to clean a toddler's teeth is for the: a. child to brush regularly with a toothpaste of his or her choice. b. parent to stabilize the chin with one hand and brush with the other. c. parent to brush the mandibular occlusive surfaces, leaving the rest for the child. d. parent to brush the front labial surfaces, leaving the rest for the child.

ANS: B For young children, the most effective cleaning of teeth is by the parents. Different positions can be used if the child's back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child's teeth. The child can participate in brushing, but for a thorough cleaning, adult intervention is necessary.

Kimberly's parents have been using a rearward-facing, convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child reaches which age? a. 1 b. 2 c. 3 d. 4

ANS: B It is now recommended that all infants and toddlers ride in rear-facing car safety seats until they reach the age of 2 years or height recommended by the car seat manufacturer. Children 2 years old and older who have outgrown the rear-facing height or weight limit for their car safety seat should use a forward-facing car safety seat with a harness up to the maximum height or weight recommended by the manufacturer. One year is too young to switch to a forward-facing position.

A school nurse is screening children for scoliosis. Which assessment findings should the nurse expect to observe for scoliosis? Select all that apply. a. Pain with deep palpation of the spinal column b. Unequal shoulder heights c. The trouser pant leg length appears shorter on one side d. Inability to bend at the waist e. Unequal waist angles

ANS: B, C, E Feedback Correct The assessment findings associated with scoliosis include unequal shoulder heights, trouser pant leg length appearing shorter on one side meaning unequal leg length, and unequal waist angles. Incorrect Scoliosis is a nonpainful curvature of the spine so pain is not expected and the child is able to bend at the waist adequately.

Which should the nurse teach to parents of toddlers about accidental poison prevention? (Select all that apply.) a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants.

ANS: B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, know the number of the nearest poison control center and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances.

When is the most appropriate time to inspect the genital area during a well-child examination of a 14-year-old girl? a. It is not necessary to inspect the genital area. b. Examine the genital area first. c. After the abdominal assessment. d. Do the genital inspection last.

ANS: C Feedback A A visual inspection of all areas of the body is included in a physical examination. B Examination of the genital area can be embarrassing. It is not be appropriate to begin the examination of this area. C It is best to incorporate the genital assessment into the middle of the examination. This allows ample time for questions and discussion. If possible, proceed from the abdominal area to the genital area. D Assessing the genital area earlier in the examination allows more time for the adolescent to ask questions and engage in discussion.

In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. The nurse should recognize in this situation that: a. blocks at this age are used primarily for throwing. b. toddlers are too young to imitate the behavior of others. c. toddlers are capable of building a tower of blocks. d. toddlers are too young to build a tower of blocks.

ANS: C Building with blocks is a good parent-child interaction. The 18-month-old child is capable of building a tower of three or four blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. The 18-month-old child imitates others around him or her.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation? a. Punish the child. b. Leave the child alone until the tantrum is over. c. Remain close by the child but without eye contact. d. Explain to child that this is wrong.

ANS: C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common in toddlers as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The parent's presence is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

Which parameter correlates best with measurements of the body's total muscle-mass to fat ratio? a. Height b. Weight c. Skin-fold thickness d. Mid arm circumference

ANS: D Feedback A Height is reflective of past nutritional status. B Weight is indicative of current nutritional status. C Skin-fold thickness is a measurement of the body's fat content. D Mid arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores.

The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurse's rationale for this action is that they: a. are low in nutritive value. b. are high in sodium. c. cannot be entirely digested. d. can be easily aspirated.

ANS: D Foreign-body aspiration is common during the second year of life. Although they chew well, this age child may have difficulty with large pieces of food, such as meat and whole hot dogs, and with hard foods, such as nuts or dried beans. Peanuts have many beneficial nutrients, but should be avoided because of the risk of aspiration in this age group. The sodium level may be a concern, but the risk of aspiration is more important. Many foods pass through the gastrointestinal tract incompletely undigested. This is not necessarily detrimental to the child.

A nurse is planning care for a 17-month-old child. According to Piaget, which stage should the nurse expect the child to be in cognitively? a. Trust b. Preoperational c. Secondary circular reaction d. Tertiary circular reaction

ANS: D The 17-month-old child is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperational is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips and can hop in place on one foot b. Rides tricycle and broad jumps c. Jumps with both feet and stands on one foot momentarily d. Walks up and down stairs and runs with a wide stance

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step and runs with a wide stance. Skipping and hopping on one foot are achieved by 4-year-old children. Jumping with both feet and standing on one foot momentarily are achieved by 30-month-old children. Tricycle riding and broad jumping are achieved at age 3.

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? A. One dose of HBV vaccine is needed at age 14 years. B. The three-dose series of HBV vaccine should be started. C. Only one dose of HBV vaccine will be needed sometime during adolescence. D. The three-dose series of HBV vaccine should be started at age 16 years or sooner if the adolescent becomes sexually active.

B

4- 5 years

Balances on each foot for 1 second

What are the sex education topics appropriate for a school age child?

Basic anatomy and Physiology, body functions, expected puberty changes, menstruation / nocturnal emissions, reproduction, teenage pregnancy, HIV infection, STD's

immunization Mnemonic birth to 1 yr

Birth: Hep B 2mo: "B. DR. HIP fro Hep B; DTap, RV, IPV; PCV 4mo: Mnemonic: DR. HIP orDTap, RV, Hib, IPV, PCV 6mo: Mnemonic: "B. DR. HIP" or Hep B (3rd dose 6-18 mo), DTap, RV, Hib, IPV (3rd dose 6-18 mo), PCV 6-12 mo: annual flu vaccine

How do school age children react to stress?

By being unhappy, moody, irritable, aggressive, fatigued, hyperactive, complains of physical discomfort (headaches / stomach ache), poor performance in school

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? A. Changing self-esteem is difficult after about age 5 years. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of lowered self-esteem are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

C

Although a 14-month-old girl received a shock from an electrical outlet recently, her parents find her about to place a paper clip in another outlet. The best interpretation of this behavior is that: a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age and represents typical behavior for a toddler. Only some awareness exists of a causal relation between events.

What is the reason behind early childhood poisoning?

Children are curious, they want oral gratification, they have less taste discrimination, seek autonomy.

Which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue are present.

D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

What do you teach parents of school age children about nutrition?

Do not use food as reward, establish consistent times of meals / snacks, offer healthy foods, be role model (eat healthy / exercise)

T/F: During the school-age years, a child will grow approx. 5 cm (2 in) per year and will almost triple in wt

F. Children grow an average of 5 cm (2 in) per year and almost double in their weight

Which statement about performing a pediatric physical assessment is correct for a school-age child? Select all that apply. a. Physical examinations proceed systematically from head to toe. b. The physical examination should be done with parents in the waiting room. c. Measurement of head circumference is obtained. d. The physical examination is done only when the child is cooperative. e. Remove clothing and have the child put on an examination gown.

Feedback a, d, e Correct Physical assessment usually proceeds from head to toe; however if developmental delays exist, considerations dictate that the least threatening assessments be done first to obtain accurate data. School-age children are at a developmental stage when they should be cooperative for the physical examination. Children of this age are usually modest, and an examination gown should be provided.

What would the nurse teach the parents of school age children to promote self esteem?

Give household responsibilities, set reasonable rules, allow to solve problems and make responsible choices, praise what is done well / right, Encourage to do better (but don't be critical), allow children to make mistakes / encourage responsibility of mistakes (accept consequences), emphasize strengths, help improve weaknesses, allow them to do their homework (you can help but do not do it for them), set good example of behavior toward others, show consistent love

3 years

Good eye/hand coordination

What does the school age child need to do to be successful in achieving industry?

Have secure sense of self (separate from loved ones), learn to trust others, have previously developed sense of autonomy and initiative, replace fantasy play with work (homework, crafts, chores, hobbies, athletics), be satisfied after achieving skill and external rewards (good grades, trophies, allowance), enjoy taking on and completing new tasks, develop sense of worth / competence (learn to do things and do them well)

Ericksons stage of development for a school age child

Industry vs inferiority

According to Erikson, failure to develop a sense of accomplishment results in a sense of __________

Inferiority

What opportunities does the school age nurse have regarding sexual development?

Introduction of sex education, Resource person for parents, teachers, and children (available to answer questions)

What would you teach a parent of a school ager in regards to dental care?

Keep tooth moist by placing it in saline, water, milk, or commercial tooth preservative, do not clean or scrub tooth, take child and tooth to dental emergency facility immediately, reinforce need to adhere to discharge instructions and follow up with health care provider

What does a child learn in this stage of development? (industry vs inferiority)

Skills needed to function in society

4- 5 years

Skip, hop, jump, rope, balance on 1 foot

How is safety education best accomplished for school age children?

Stating and providing reinforcement through projects and immediate rewards

Infringements on toddlers freedom but especially frustration with language deficit and inability to communicate.

Temper tantrums are caused by?

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is: a. Erikson. b. Freud. c. Kohlberg. d. Piaget.

a. Erikson. (Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled.

You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunization cannot be given? a. DTaP b. HepA c. IPV d. Varicella

d. Varicella (Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine, and should not be given except in special circumstances. DTaP, HepA, and IPV can be safely given.)

When does "school-age" physiologically end?

ends at puberty with acquisition of final permanent teeth

What are some social development characteristics of school-aged children?

peer group identification with peers promotes independence sex roles strongly influenced by peer relationships

The parents of a preschool child ask the nurse why their child needs to have her "eyes tested." The nurse explains that although evaluating the visual acuity in a young child can be difficult, the American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age _________ years.

three The American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age 3 years. Tools available for testing the visual acuity of preschool children include Lea cards, tumbling Es, and the HOTV chart.

Which immunization can cause fever and rash to occur 1 to 2 weeks after administration? a. HepB b. DTaP c. Hib d. MMR

d. MMR (MMR is a live virus vaccine and can cause fever and rash 1 to 2 weeks after administration. HepB, DTaP, and Hib do not cause fever or rash.)

15-18 months

Places block in cup

3 years

Draws circles

What are common stress factors in the school age child?

Pressure to succeed, physical violence, bullying, media influences, sports, over scheduling (events or activities), family issues

What age does menarche typically occur?

12 years

In assessing adolescents using Tanner staging, sexual maturity is rated using _________ distinct stages. (Your answer should appear as a number.)

ANS: 5 Tanner stages of adolescent sexual development describe five distinct stages of sexual maturity rating. There are separate rating scales for males and females, but both use five stages.

How long after breast buds appear does menarche generally start?

2 years

What is the definition of prepubescence?

2 years preceding puberty

The nurse is assessing parental knowledge of temper tantrums. Which are true statements regarding temper tantrums (select all that apply)? a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.

A, B, D, E Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap prior to fatigue or a snack if mealtime is delayed will be helpful in alleviated the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.

Which gross motor milestones should the nurse assess in an 18-month-old child (select all that apply)? a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily

A, C, D An 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily are not acquired until 30 months of age.

The parents of a toddler state their child is having trouble sleeping. What is the nurse's BEST suggestion to improve sleep habits? A. Using a transitional object. B. Varying the bedtime ritual. C. Restricting stimulating activities during the day. D. Explaining away fears.

A. Using a transitional object.

The nurse is obtaining vital signs on a 1-year-old child. What is the most appropriate site for assessing the pulse rate? a. Apical b. Radial c. Carotid d. Femoral

ANS: A Feedback A Apical pulse rates are taken in children younger than 2 years. B Radial pulse rates may be taken in children older than 2 years. C It is difficult to palpate the carotid pulse in an infant. D The femoral pulse is palpated when comparing peripheral pulses, but it is not used to measure an infant's pulse rate.

Steven, 16 months old, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. Steven is acting in an age-appropriate manner.

Car safety for the school age child

At 4 ft 9 inches and 8-11 years old can use vehicle seat belt instead of car seat / booster seat, shoulder belt needs to cross middle of chest, lap belt rides on thighs, children should sit in back seat away from air bags

The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend which intervention? a. Ignore the "baby talk." b. Explain to the toddler that "baby talk" is for babies. c. Tell the toddler frequently, "You are a big kid now." d. Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddler's preoperational thinking is the nurse using? a. Inability to conserve b. Magical thinking c. Centration d. Irreversibility

ANS: A The nurse is using the toddler's inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told.

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is included in which statement? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old. Having a rapid mood swing is an expected behavior for a toddler.

Which play patterns does a 3-year-old child typically display? Select all that apply. a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play

ANS: A, B, C, E Feedback Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years.

While developing a care plan for a school-age child with a visual impairment, the nurse knows that which of the following actions are important in working with this special needs child? Select all that apply. a. Obtain a thorough assessment of the child's self-care abilities. b. Orient the child to various sounds in the environment. c. Mandate that the child's parents stay continuously with their child during hospitalization. d. Allow the child to handle equipment as procedures are explained. e. Encourage the child to use a dry erase board to write his needs.

ANS: A, B, D Feedback Correct These are correct responses that can be used for a school-age child with a visual impairment. Incorrect Mandating that the child's parents stay continuously with their child may not be possible and is not usually necessary if the school-age child is at the expected level of growth and development. Encouraging a child to write his needs on a dry erase board would be an appropriate intervention for a child who is aphonic, not for a child with a visual deficit.

The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? Select all that apply. a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.

ANS: A, B, D, E Feedback Correct Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap before fatigue or a snack if mealtime is delayed will be helpful in alleviating the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child.

The nurse is evaluating a 7-month-old infant's cognitive development. Which behaviors should the nurse anticipate evaluating? (Select all that apply.) a. Imitates sounds b. Shows interest in a mirror image c. Comprehends simple commands d. Actively searches for a hidden object e. Attracts attention by methods other than crying

ANS: A, B, E A 7-month-old infant is in the secondary circular reactions (4-8 months) stage of cognitive development. Behaviors in this stage include imitating sounds, showing interest in a mirror image, and attracting attention by methods other than crying. Comprehending simple commands and actively searching for a hidden object are behaviors seen in the coordination of secondary schemas (9-12 months).

Which gross motor milestones should the nurse assess in an 18-month-old child? (Select all that apply.) a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily

ANS: A, C, D An 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily is not acquired until 30 months of age.

Trust is important in establishing and maintaining a therapeutic relationship. Maintaining the balance between appropriate involvement and professional separation is quite challenging. Which behaviors may indicate professional separation or underinvolvement? Select all that apply. a. Avoiding the child or his or her family b. Revealing personal information c. Calling in sick d. Spending less time with a particular child e. Asking to trade assignments

ANS: A, C, D, E Feedback Correct Whether nurses become too emotionally involved or find themselves at the other end of the spectrum—being underinvolved—they lose effectiveness as objective professional resources. These are all indications of the nurse who is underinvolved in a child's care.

The nurse is assessing a 4-year-old child's visual acuity. He is planning to attend preschool next week. The results indicate a visual acuity of 20/40 in both eyes. The child's father asks the nurse about his son's results. Which response, if made by the nurse, is correct? a. "Your child will need a referral to the ophthalmologist before he can attend preschool next week." b. "Your child's visual acuity is normal for his age." c. "The results of this test indicate your child may be color blind." d. "Your child did not pass the screening test. He will need to return within the next few weeks to be reevaluated."

ANS: B

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach? Select all that apply. a. Secure in a rear-facing, upright car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

ANS: A, C, E Feedback Correct Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit.

A preschool age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which phrases when explaining procedures to the child? Select all that apply. a. Fluids will be given through tubing connected to a small tiny tube inserted into your arm. b. After surgery we will be doing dressing changes. c. You will get a shot before surgery. d. The doctor will give you medicine that will help you go into a deep sleep. e. We will take you to surgery on a bed on wheels.

ANS: A, D, E Feedback Correct A preschool child needs simple concrete explanations that cannot be misinterpreted. An IV should be explained as fluids going into a tube connected to a small tube in your hand; anesthesia can be explained as a medicine that will help you go into a deep sleep (put to sleep should be avoided); and a stretcher can be described as riding on a bed with wheels. Incorrect The term "dressing changes" is ambiguous and will not be understood by a preschooler. The term "get a shot" should not be used. A preschooler or young child is likely to misinterpret this information.

What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down? a. "You must never leave the child in the room alone with the side rails down." b. "I am very concerned about your child's safety when you leave the side rails down. The hospital has guidelines stating that side rails need to be up if the child is in the bed." c. "It is hospital policy that side rails need to be up if the child is in bed." d. "When parents leave side rails down, they might be considered as uncaring."

ANS: B Feedback B To express concern and then choose words that convey a policy is appropriate.

Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization? a. A detailed explanation of the procedure b. A description of what the child will feel and see during procedure c. An explanation about the dye that will go directly into his vein d. An assurance to the child that he and the nurse can talk about the procedure when it is over

ANS: B Feedback A Explaining the procedure in detail is probably more than the 5-year-old child can comprehend, and it will likely produce anxiety. B For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child's ability to cope with the events of the procedure and will decrease anxiety. C Using the word "dye" with a preschooler can be frightening for the child. D The child needs information before the procedure.

The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with what? a. Cyanosis b. Erythema c. Vitiligo d. Nevi

ANS: B Feedback B In dark-skinned children, erythema appears as dusky red or violet skin coloration. C Vitiligo refers to areas of depigmentation. D Nevi are areas of increased pigmentation.

Which should the nurse expect for a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of holophrases d. Approximately one third of speech understandable

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

Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. Which is the best interpretation of this behavior? a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong.

ANS: B Play develops from the solitary play of infancy to the parallel play of toddlers. The toddler plays alongside other children, not with them. This typical behavior of the toddler is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because the toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore, no right or wrong is associated with taking a toy.

Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Lego b. Set of large plastic building blocks c. Brightly colored balloon d. Coloring book and crayons

ANS: B Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Large plastic blocks are appropriate for a toddler in isolation. Small plastic toys such as Lego can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler.

A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? Select all that apply. a. Concrete thinking b. Egocentrism c. Animism d. Magical thought e. Ability to reason

ANS: B, C, D Feedback Correct The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thought (believes that thinking something causes that event).

A nurse is performing an assessment on a newborn. Which vital signs indicate a normal finding for this age group? Select all that apply. a. Pulse of 80-125 a minute b. B/P of systolic 65-95 and diastolic 30-60 c. Temperature of 36.5-37.3 Celsius (axillary) d. Temperature of 36.4-37 Celsius (axillary) e. Respirations of 30-60 a minute

ANS: B, C, E Feedback Correct The normal vital signs for a newborn are temperature 36.5 to 37.3 Celsius (axillary), pulse rate of 120-160 a minute, respiratory rate of 30-60 a minute, systolic B/P of 65-95, and diastolic B/P of 30-62. A temperature of 36.4-37 Celsius is normal for an older child. A pulse rate of 80-125 is normal for a 4-year-old child. Incorrect A pulse rate of 80-125 per minute and temperature of 36.4-37° C are both too low for a well-newborn.

In planning care for a preschool-age child, the nurse knows that which open body postures encourage positive communication? Select all that apply. a. Leaning away from the preschooler b. Frequent eye contact c. Hands on hips d. Conversing at eye level e. Asking the parents to stay in the room

ANS: B, D Feedback Correct Frequent eye contact and conversing at eye level are both open body postures that encourage positive communication. Incorrect Leaning away from the child and placing your hands on your hips are both closed body postures that do not facilitate effective communication. Asking the parents to stay in the room while the nurse is talking to the child is helpful but is not an open body posture.

What should the nurse recognize as a possible indicator of child abuse in a 4-year-old child being treated for ear pain at the emergency department on a chilly Christmas Day in New York State? Select all that apply. a. The child extends his arms to be hugged by the nurse. b. The child is wearing clean, baggy shorts, sandals, and an oversized T-shirt. c. The child answers all questions in complete sentences, and smiles afterward. d. The child has dirty, broken teeth. e. The child states "I'm so fat" when the nurse tells his mother he weighs 25 lb.

ANS: B, D, E Feedback Correct These clothes are inappropriate attire for December in New York State. Even though the clothes are clean, dressing inappropriately for the weather is a potential indicator of child abuse. Clothing that is too large or small for the child's size also requires further evaluation. Dirty, broken teeth are an indicator of potential child abuse. A child who is 4 years old and weighs only 25 lb is thin for his age. Body image distortion (being thin but describing self as fat) is a potential indicator of child abuse. A child who is too thin for his height should also be further evaluated.

An effective technique for communicating with toddlers is to a. Have the toddler make up a story from a picture. b. Involve the toddler in dramatic play with dress-up clothing. c. Use picture books. d. Ask the toddler to draw pictures of his fears.

ANS: C Feedback A Most toddlers do not have the vocabulary to make up stories. B Dramatic play is associated with older children. C Activities and procedures should be described as they are about to be done. Use picture books and play for demonstration. Toddlers experience the world through their senses. D Toddlers probably are not capable of drawing or verbally articulating their fears.

Which action is appropriate when the nurse is assessing breath sounds of an 18-month-old crying child? a. Ask the parent to quiet the child so the nurse can listen. b. Auscultate breath sounds and chart that the child was crying. c. Encourage the child to play with the stethoscope to distract and to calm down before auscultating. d. Document that data are not available because of noncompliance.

ANS: C Feedback C Distracting the child with an interesting activity can assist the child to calm down so an accurate assessment can be made.

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered a. Unnecessary information, because the child is 3 years old b. An important part of the family history c. An important part of the child's past growth and development d. An important part of the child's review of systems

ANS: C Feedback C Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history.

What is an appropriate preoperative teaching plan for a school-age child? a. Begin preoperative teaching the morning of surgery. b. Schedule a tour of the hospital a few weeks before surgery. c. Show the child books and pictures 4 days before surgery. d. Limit teaching to 5 minutes and use simple terminology.

ANS: C Feedback C Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C Feedback C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child.

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

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

Developmentally, most children at age 12 months: a. use a spoon adeptly. b. relinquish the bottle voluntarily. c. eat the same food as the rest of the family. d. reject all solid food in preference to the bottle.

ANS: C By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and be weaned from the bottle totally by 14 months. The child should be weaned from a milk- or formula-based diet to a balanced diet that includes iron-rich sources of food.

Although a 14-month-old girl received a shock from an electric outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of the inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age. Trying to put things into an outlet is typical behavior for a toddler. Only some awareness exists of a causal relation between events.

When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. What is the best explanation for this? a. Some form of cancer b. Local scalp infection common in children c. Infection or inflammation distal to the site d. Infection or inflammation close to the site

ANS: D Feedback A Tender lymph nodes are not usually indicative of cancer. B A scalp infection usually does not cause inflamed lymph nodes. C The lymph nodes close to the site of inflammation or infection would be inflamed. D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location.

Which cranial nerve is assessed when the child is asked to imitate the examiner's wrinkled frown, wrinkled forehead, smile, and raised eyebrow? a. Accessory b. Hypoglossal c. Trigeminal d. Facial

ANS: D Feedback A To assess the accessory nerve, the examiner palpates and notes the strength of the trapezius and sternocleidomastoid muscles against resistance. B To assess the hypoglossal nerve, the examiner asks the child to stick out the tongue. C To assess the trigeminal nerve, the child is asked to identify a wisp of cotton on the face. The corneal reflex and temporal and masseter muscle strength are evaluated. D The facial nerve is assessed as described in the question.

What is the most important consideration for effectively communicating with a child? a. The child's chronologic age b. The parent-child interaction c. The child's receptiveness d. The child's developmental level

ANS: D Feedback D The child's developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child.

Communication entails much more than words going from one person's mouth to another person's ears. A positive, supportive technique that is effective from birth throughout adulthood is a. Listening b. Physical proximity c. Environment d. Touch

ANS: D Feedback D Touch can convey warmth, comfort, reassurance, security, caring, and support. In infancy, messages of security and comfort are conveyed when they are being held. Toddlers and preschoolers find it soothing and comforting to be held and rocked. School-aged children and adolescents appreciate receiving a hug or pat on the back (with permission).

At what age should the nurse expect a child to give both first and last names when asked? a. 15 months b. 18 months c. 24 months d. 30 months

ANS: D At 30 months, the child is able to give both first and last names and refer to self with an appropriate pronoun. At 15 and 18 months, the child is too young to give his or her own name. At 24 months, the child is able to give first name and refer to self by that name.

The psychosocial developmental tasks of toddlerhood include which characteristic? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

For the child who speaks another language, the nurse must identify an interpreter who is proficient in both languages. The patient's 12-year-old brother has accompanied him to the hospital and would be an ideal candidate to interpret before any treatment or surgical procedure. Is this statement true or false?

ANS: F Other children should not be used as interpreters under any circumstances. An adult family member, a friend of the family, or an interpreter service should be used whenever possible. This is necessary in order to explain procedures, teach new skills, and assess patient needs.

Which factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy

The CDC recommends that all health care providers use the World Health Organization (WHO) growth standards to monitor growth for infants and children aged 0-2 years. For children ages 2 and older the CDC growth chart should be used. These charts are standardized and appropriate for all children. Is this statement true or false?

ANS: F There are special growth charts available for premature or very low birth weight infants, and children with specific conditions that may affect size and growth (i.e., Down syndrome).

An important part of the physical exam is the otoscopic examination of the ear. The ear canal should be straightened prior to visualization. If the child is younger than 3, this is accomplished when the nurse pulls the pinna of the ear down and back. Is this the correct procedure?

ANS: T If the child is older than 3, the pinna is pulled up and back. As much of the ear canal as possible should be visible before the speculum is inserted into the auditory meatus.

What describes a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time such as "just a minute" and "in an hour"

B At this age the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. Putting an object in a container but being unable to take it out indicates tertiary circular reactions. An embryonic sense of time exists; although toddlers may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

Which of the following best describes the older (11-12 y/o) school-age child's perception of rules and judgement of actions? A) Does not understand the reason for rules B) Takes into account different points of view to make a judgement C) Judges an act by its consequences D) Believes that rules and judgements are absolute

B) Takes into account different points of view to make a judgement

A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage (select all that apply)? a. Concrete thinking b. Egocentrism c. Animism d. Magical thinking e. Ability to reason

B, C, D The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thinking (believes that thinking something causes that event). Concrete thinking is seen in school-age children and ability to reason is seen with adolescents.

Which should the nurse teach to parents of toddlers about accidental poison prevention (select all that apply)? a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants.

B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, to know the number of the nearest poison control center, and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications, in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances.

A mother of a 28-month-old active boy talks with the nurse about safety in the home. She is most concerned about him burning himself because he is so curious. What information should the nurse share with the mother? (Select all that apply.) A. Use the front burners of the stove. B. Supervise the toddler when cookies are baking in the oven. C. Keep the toddler positioned nearby so he can hear the hiss of the steam iron to teach him that it is hot. D. Check that electrical outlets are still secured with safety plugs. E. Keep matches and lighters in a secured area. F. Turn pot handles away from the front of the stove.

B,D,E,F

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: A. nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. C. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. D. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first.

What nursing intervention to promote health during middle childhood would be appropriate? A. Stress the need for increased calorie intake to meet increased demands. B. Instruct parents to defer questions about sex until the child reaches adolescence. C. Reinforce the need for good dental hygiene because these are the years in which permanent teeth erupt. D. Advise parents that the child will need decreasing amounts of rest toward the end of this period.

C

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which of the following suggestions should the nurse include? A. Send the child to his or her room. B. If the child cries, refuses, or is more disruptive, try another approach. C. Select an area that is safe and nonstimulating, such as a hallway. D. The general rule for length of time is 1 hour per year of age.

C. Select an area that is safe and nonstimulating, such as a hallway.

Safety and the school aged child

Car safety, fire safety, gun safety, bicycle safety, playground safety, pedestrian safety, water safety, sin protection, good / bad touch safety, exposure to contact allergens, sports safety, home / stranger safety, reason to contact 911

The psychosocial developmental tasks of toddlerhood include: a. Development of a conscience. b. Recognition of sex differences. c. Ability to get along with age mates. d. Ability to withstand delayed gratification.

D If the need for basic trust has been satisfied, toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to withstand delayed gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age mates develops during the preschool and school-age years.

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

D The 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and the ability to broad jump are skills acquired at age 3. Tricycle riding is achieved at age 4.

Which of the following best describes the younger (6 to 7 y/o) school-age child's perception of rules and judgement actions? A) Judges an act by its intentions rather than by the consequences alone B) Believes that rules and judgements are not absolute C) Understands the reason behind rules D) Interprets accidents and misfortunes as punishment for misdeeds

D) Interprets accidents and misfortunes as punishment for misdeeds

After age 4 yrs: # 5 Dtap, # 2 MMR, # 4 IPV (check Hep B and Varicella status) TST for school entry

What shots should kids be getting after 4 years?

Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain

b. A 2-year-old toddler admitted for cystic fibrosis (Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments.

Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? *Select all that apply* *a.* Plans to try out for the debate team at school. *b.* Skips classes to go to the mall. *c.* Hangs out with friends they have had since childhood. *d.* Has an unexplained source of money. *e.* Fears the police.

*b.* Skips classes to go to the mall. *d.* Has an unexplained source of money. *e.* Fears the police. (Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is another sign, so hanging out with friends they have had since childhood is not a sign of gang involvement. A change in attitude toward participating in activities is another sign of gang involvement. Plans to try out for the debate team at school are not a sign of gang involvement.)

Place in order the signs of female sexual maturity beginning with the first sign and ending with the last. Use the following format for your answers: A, B, C, D *a.* Growth of pubic hair. *b.* Menarche. *c.* Appearance of breast buds. *d.* Ovulation is established.

*c.* Appearance of breast buds. *a.* Growth of pubic hair. *b.* Menarche. *d.* Ovulation is established. (Sexual maturation in girls begins with the appearance of breast buds (thelarche), which is the first sign of ovarian function. Thelarche occurs at approximately age 8 to 11 years and is followed by growth of pubic hair. Linear growth slows, and menarche begins approximately 1 year after the peak height velocity (PHV). Ovulation occurs with menarche but may or may not accompany the first 2 years of menarche so it is not established until later.)

In an interview with the nurse, a mother states that she is concerned that her 14-year-old teen is critical and finding fault with her. The nurse counsels the mother that: *a.* the family needs to change its value system to meet the teenager's changing needs. *b.* the parent-teen relationship is important for the teenager and conflicts are to be expected. *c.* teenagers create psychological distance from the parent to separate from the parent. *d.* parents need to relinquish their relationship with their teenager to the teen's peers.

*c.* teenagers create psychological distance from the parent to separate from the parent. (The teenager uses critical and fault-finding behavior as a mechanism to separate from the parent and become independent. Changing the family's value system to meet the teenager's needs is not realistic and will result in only the teenager's being critical of the new system. The parent-teen relationship is not as important to the teenager as it was in earlier years. Friends and peers become more important. Parents should not relinquish their relationship with their teenager to the teen's peers. Maintaining a consistent parental relationship with the adolescent is important.)

In girls, the initial indication of puberty is a. Menarche b. Growth spurt c. Growth of pubic hair d. Breast development

ANS: D Feedback D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche.

Which immunizations should be used with caution in children with an allergy to eggs? a. HepB b. DTaP c. Hib d. MMR

ANS: D Feedback D Live measles vaccine is produced by using chick embryo cell culture, so there is a remote possibility of anaphylactic hypersensitivity in children with egg allergies. Most reactions are actually the result of other components in the vaccine.

Which is an important consideration in preventing injuries during middle childhood? A. Most injuries occur in or near school or home. B. Peer pressure is not strong enough to affect risk-taking behavior. C. Injuries from burns occur with the highest frequency at this age because of the fascination with fire. D. Lack of muscular coordination and control results in an increased incidence of injuries.

A

Which activity is most appropriate for developing fine motor skills in the school-age child? a. Drawing b. Singing c. Soccer d. Swimming

ANS: A Feedback A Activities such as drawing, building models, and playing a musical instrument increase the school-age child's fine motor skills.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. The nurse should interpret this as being a. A belief common at this age b. A belief that forms the basis for most religions c. Suggestive of excessive family pressure d. Suggestive of a failure to develop a conscience

ANS: A Feedback A Children at this age may view illness or injury as a punishment for a real or imagined mystique.

According to Piaget, the adolescent is in the fourth stage of cognitive development, or period of what? a. Formal operations b. Concrete operations c. Conventional thought d. Postconventional thought

ANS: A Feedback A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage.

Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth.

ANS: A Feedback A Development, a continuous and orderly process, provides the basis for increases in the child's function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child.

A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.

ANS: A Feedback A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls.

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is a. Erikson b. Freud c. Kohlberg d. Piaget

ANS: A Feedback A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled.

A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The best explanation for this is that a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs

ANS: A Feedback A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life.

The environment, both physical and psychosocial, is a significant determinate of growth and development outcomes before and after birth. Nurses can assist parents in preventing environmental injury for their 2-year-old toddler by teaching them to avoid the most common sources of exposure. This anticipatory guidance includes teaching related to a. Avoiding sun exposure, secondhand smoke, and lead b. Socioeconomic status, primarily poverty c. Maternal smoking and alcohol intake during pregnancy d. The passing of environmental toxins through breast milk

ANS: A Feedback A Lead can be present in the home and in toys made overseas. Environmental injury can also be the result of mercury, pesticides (flea and tick collars), radon, and exposure to the sun and secondhand smoke. It is important for the nurse to provide health teaching related to these factors.

A preschool aged child will be receiving immunizations. Which statement identifies an appropriate level of language development for a 4-year-old child? a. The child has a vocabulary of 300 words and uses simple sentences. b. The child uses correct grammar in sentences. c. The child is able to pronounce consonants clearly. d. The child uses language to express abstract thought.

ANS: B Feedback B The 4-year-old child is able to use correct grammar in sentence structure.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as a. Signs of stress b. Developmental delay c. Physical problem causing emotional stress d. Lack of adjustment to school environment

ANS: A Feedback A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors.

A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is a. Testicular enlargement b. Facial hair c. Scrotal enlargement d. Voice deepens

ANS: A Feedback A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered.

The parent of 16-month-old Chris asks, "What is the best way to keep Chris from getting into our medicines at home?" The nurse should advise that a. "All medicines should be locked away securely." b. "The medicines should be placed in high cabinets." c. "Chris just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A Feedback A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe.

Which statement characterizes moral development in the older school-age child? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them.

ANS: A Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. The situation and the morality of the rule itself influence reactions.

You are working as the triage nurse in a pediatric emergency room. You receive a telephone call from the mother of an adolescent whose front tooth was completely knocked out of his mouth while he was playing soccer. The mother is seeking advice. Which is the appropriate response? Select all that apply. a. Rinse the tooth in lukewarm tap water. b. Place the tooth in saline, milk, or water. c. Scrub the tooth with a disinfectant, such as mouth wash. d. Bring the child to the emergency room within the next hour for the best prognosis.

ANS: A, B Feedback Rinse the tooth in lukewarm tap water—this is a correct response. Place the tooth in saline, milk, or water—this is a correct response.

Which demonstrates the school-age child's developing logic in the stage of concrete operations? Select all that apply. a. The school-age child is able to recognize that 1 lb of feathers is equal to 1 lb of metal. b. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time. c. The school-age child understands the principles of adding, subtracting, and reversibility. d. The school-age child has thinking that is characterized by egocentrism, animism, and centration

ANS: A, B, C Feedback Correct The school-age child understands that the properties of objects do not.change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs asthe school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations.

Which interventions are appropriate for preventing childhood obesity? Select all that apply. a. Establish consistent times for meals and snacks. b. Eliminate all snacks. Eat three nutritious meals a day. c. Teach the family and child how to select foods and prepare foods. d. Encourage schools to provide snack machines with popcorn, cookies, and diet soda. e. Limit computer and television time.

ANS: A, C, E Feedback Preventing obesity includes encouraging families to establish consistent times for meals and snacks and discouraging between-meal eating. Parents and children also need to be taught how to select and prepare healthful foods. Because snacks are an important aspect in childhood nutrition, nutritious snacks should be identified. School-age children usually require a healthful snack after school and in the evening. A child who spends time with social media has less interest in physical activity and going outdoors.

Injuries claim many lives during adolescence. Which factors contribute to early adolescents engaging in risk-taking behaviors? Select all that apply. a. Peer pressure b. A desire to master their environment c. Engagement in the process of separation from their parents d. A belief that they are invulnerable e. Impulsivity

ANS: A, D, E Feedback Correct Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability ("It can't happen to me") are evident in adolescence. Impulsivity places adolescents in unsafe situations.

Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious? a. "You need to be stricter so that your teen stops trying to test the limits." b. "You need to collaborate with your daughter and set limits that are perceived as being reasonable." c. "Increasing your teen's involvement with her peers will improve her self-esteem." d. "Allow your teenager to choose the type of discipline that is used in your home."

ANS: B Feedback B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process.

Which expected outcome is developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times.

ANS: B Feedback B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness.

A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development? a. The child's addition and subtraction ability b. The child's ability to classify c. The child's vocabulary d. The child's play activity

ANS: B Feedback B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes.

A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development b. Moral development c. Psychosocial development d. Psychosexual development

ANS: B Feedback B The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment.

An important consideration for the school nurse who is planning a class on bicycle safety is a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear bicycle helmets if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra-large seat.

ANS: B Feedback B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities.

Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry? a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty in completing assignments d. Decreasing expectations to eliminate potential failures

ANS: B Feedback B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery.

The nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.

ANS: B Feedback B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language).

Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain

ANS: B Feedback B Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments.

Tattoos have become increasingly popular among mainstream adolescents. Like clothing and hairstyles, tattoos serve to define one's identity. It is important for nurses to caution adolescents on the health risks of obtaining a tattoo. These include (select all that apply) a. Amateur tattoos are difficult to remove. b. Tattoos pose a risk for bloodborne and skin infections. c. Health care professionals must be notified of the existence of a tattoo before magnetic resonance imaging (MRI) scan. d. Tattoo dyes may cause allergic reactions. e. Tattoo parlors are well regulated.

ANS: B, C, D Feedback Correct Tattoos carry the risk for contracting bloodborne diseases such as hepatitis B and HIV. Infection, allergic reaction to the dye, scarring, or keloid formation can occur. Should an MRI ever be required, it is important to notify the health care professionals, because the dyes can contain iron and other metals.

A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.) a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor.

ANS: B, C, D Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children's social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.

Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? Select all that apply. a. The child should be allowed to stay home until the anxiety about going to school is resolved. b. Parents should be empathetic yet firm in their insistence that the child attends school. c. A modified school attendance may be necessary. d. Parents need to pick the child up at school whenever the child wants to come home. e. Parents need to communicate with the teachers about the situation.

ANS: B, C, E Feedback Correct In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselor's or school nurse's office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school.

What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby? a. "Have you talked with your parents about this?" b. "Do you have plans to continue school?" c. "Will you be able to support the baby?" d. "Can you tell me how your life will be if you have an infant?"

ANS: D Feedback D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen's perception and reality orientation.

The nurse is planning a teaching session for a young child and her parents. According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the _______ period of cognitive development. a. Sensorimotor b. Formal operations c. Concrete operations d. Preoperational

ANS: C Feedback A The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant's world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. B Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy. D The preoperational stage is a period of egocentrism in which the child's judgments are illogical and dominated by magical thinking and animism.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as a. Behavior that encourages bullying and sexism b. Behavior that reinforces poor peer relationships c. Characteristic of social development of this age d. Characteristic of children who later are at risk for membership in gangs

ANS: C Feedback C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs.

The nurse is planning a teaching session for a young child and her parents. According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the _______ period of cognitive development. a. Sensorimotor b. Formal operations c. Concrete operations d. Preoperational

ANS: C Feedback C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy.

A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? a. DTaP, Hib, HepB, MCV, varicella b. DTaP, Hib, HepB, HPV, IPV, Rota c. DTaP, Hib, HepB, PCV, Rota d. DTaP, Hib, HepB, PCV, HepA

ANS: C Feedback C DTaP, Hib, HepB, PCV, IPV, and Rota are appropriate immunizations for an unimmunized 2-month-old child.

What is the primary purpose of a transitional object? a. It helps the parents deal with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

ANS: C Feedback C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy.

The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. "Your teenager needs clearer and stricter limits about her behavior." b. "Your teenager needs more responsibility at home." c. "During adolescence this behavior is not unusual." d. "The behavior is abnormal and needs further investigation."

ANS: C Feedback C Egocentric and narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity.

Which children are at greater risk for not receiving immunizations? a. Children who attend licensed daycare programs b. Children entering school c. Children who are home schooled d. Young adults entering college

ANS: C Feedback C Home-schooled children are at risk for being underimmunized and need to be monitored.

What does the nurse need to know when observing a chronically ill child at play? a. Play is not important to hospitalized children. b. Children need to have structured play periods. c. Children's play is a form of communication. d. Play is to be discouraged because it tires hospitalized children.

ANS: C Feedback C Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments.

Which statement is the most accurate about moral development in the 9-year-old school-age child? a. Right and wrong are based on physical consequences of behavior. b. The child obeys parents because of fear of punishment. c. The school-age child conforms to rules to please others. d. Parents are the determiners of right and wrong for the school-age child.

ANS: C Feedback C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval.

Why do peer relationships become more important during adolescence? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C Feedback C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power.

What should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)? Select all that apply. a. The child's height and weight b. The parent's ability to comprehend the results c. The child's mood d. The parent-child interaction e. The child's chronologic age

ANS: C, E Feedback The results of the screening test are valid if the child acted in a normal and expected manner. The child's chronologic age in years, months, and days must be calculated in order to draw the age line. This is necessary in order to perform an accurate DDST-II. Reliability and validity of the test can be altered if the child is not feeling well or is under the influence of medications.

A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "My mother has told us that if we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will have to go back in for my cat Fluffy because she will be scared."

ANS: D Feedback D Children should be taught never to return to a burning house, not even for a pet.

In providing anticipatory guidance to parents, which parental behavior is the most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe

ANS: D Feedback D Parents living what they believe gives nonambivalent messages and fosters the child's moral development and reasoning.

Which assessment finding in a preschooler suggests the need for further investigation? a. The child is able to dress independently. b. The child rides a tricycle. c. The child has an imaginary friend. d. The child has a 2-lb weight gain in 12 months.

ANS: D Feedback D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated

When planning care for adolescents, the nurse should a. Teach parents first, and they, in turn, will teach the teenager. b. Provide information for their long-term health needs because teenagers respond best to long-range planning. c. Maintain the parents' role by providing explanations for treatment and procedures to the parents only. d. Give information privately to adolescents about how they can manage the specific problems that they identify.

ANS: D Feedback D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider.

The most common cause of death in the adolescent age-group involves a. Drownings b. Firearms c. Drug overdoses d. Motor vehicles

ANS: D Feedback D Risk taking behaviors play a major role in the high incidence of motor vehicle injuries and death among teenagers i.e. alcohol use, failure to wear a seatbelt, and inexperience.

Which comment is most developmentally typical of a 7-year-old boy? a. "I am a Power Ranger, so don't make me angry." b. "I don't know whether I like Mary or Joan better." c. "My mom is my favorite person in the world." d. "Jimmy is my best friend."

ANS: D Feedback D School-age children form friendships with peers of the same sex, those who live nearby, and other children who have toys that they enjoy.

Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment

ANS: D Feedback A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age. C Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment. D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment.

The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his primary immunizations. Which immunizations will the nurse consider? Select all that apply. a. Meningococcal b. DTaP c. OPV d. Smallpox

a. Meningococcal b. DTaP (Meningococcal conjugate vaccine should be given to all children at age 11 to 12 years. The American Academy of Pediatrics recommends one dose of DTaP vaccine for children at age 11 to 12 years, as long as they have received the primary DTaP series. Oral polio vaccine is no longer administered in the U.S. The current smallpox vaccine is not recommended for healthy, low-risk children younger than 18 years of age.)

Which should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)? a. The child's height and weight b. The parent's ability to comprehend the results c. The child's mood d. The parent-child interaction

c. The child's mood (The results of the screening test are valid if the child acted in a normal and expected manner. The child's height and weight are not relevant to the DDST-II screening process. The parent's ability to understand the results of the screening is not relevant to the validity of the test. The parent-child interaction is not significantly relevant to the test results.)

Place in order the gross motor developmental milestones a nurse expects to assess in an infant. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained. a. Turns from abdomen to back b. Lifts head off of bed when in a prone position c. Walks holding on to furniture d. Turns from back to abdomen e. Sits unsupported

b. Lifts head off of bed when in a prone position a. Turns from abdomen to back d. Turns from back to abdomen e. Sits unsupported c. Walks holding on to furniture (The infant lifts its head off of the bed when in a prone position at 3 months, turns from abdomen to back at 4 to 5 months, turns from back to abdomen at 6 to 7 months, sits unsupported at 8 to 9 months, and can walk holding on to furniture at 10 to 12 months.)

What does the nurse need to know when observing chronically ill children at play? a. Play is not important to hospitalized children. b. Children need to have structured play periods. c .Children's play is an indication of a child's response to treatment. d. Play is to be discouraged because it tires hospitalized children.

c .Children's play is an indication of a child's response to treatment. (Play for all children is an activity woven with meaning and purpose and is a mechanism for mastering their environment. For chronically ill children, play can indicate their state of wellness and response to treatment. Play is important to all children in all environments. Although children's play activities appear unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. Children who have fewer energy reserves still require play. For these children, less-active play activities will be important.)

During a routine healthcare visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an understanding of child development? a. "She's a little slow." b. "If she is pulling up, you can help her by holding her hand." c. "Babies progress at different rates. Your infant's development is within normal limits." d. "Maybe she needs to see a behavioral specialist."

c. "Babies progress at different rates. Your infant's development is within normal limits." (Ninety percent of infants walk by 14 months of age. The infant is within normal developmental limits. It is inappropriate for the nurse to state that the infant is a little slow. Infants will walk when they are developmentally ready.

A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? a. DTaP, Hib, HepB, IPV, varicella b. DTaP, Hib, HepB, MMR, IPV c. DTaP, Hib, HepB, PCV, IPV, rotavirus d. DTaP, Hib, HepB, PCV, IPV, HepA

c. DTaP, Hib, HepB, PCV, IPV, rotavirus (DTaP, Hib, HepB, PCV, IPV, and rotavirus are appropriate immunizations for an unimmunized 2-month-old child. The child should not receive varicella until at or after 12 months of age. MMR is not given to children until at or after 12 months of age. HepA is recommended for all children at 1 year of age.)

Parents of a 4-month-old child ask the nurse what they can do to help relieve the discomfort of teething. The nurse should include which suggestions for the parents? Select all that apply. a. Provide warm liquids. b. Rub the gums with aspirin. c. Over-the-counter topical medications for gum pain relief can be used as directed. d. Administer acetaminophen (Tylenol) as directed. e. Provide a hard food such as a frozen bagel for chewing.

c. Over-the-counter topical medications for gum pain relief can be used as directed. d. Administer acetaminophen (Tylenol) as directed. e. Provide a hard food such as a frozen bagel for chewing. (To help parents cope with teething, nurses can suggest that they provide cool liquids and hard foods (e.g., dry toast, Popsicles, frozen bagels) for chewing. Hard, cold teethers and ice wrapped in cloth may also provide comfort for inflamed gums. Nurses should explain to parents that over-the-counter topical medications for gum pain relief should be used only as directed. Home remedies, such as rubbing the gums with whiskey or aspirin, should be discouraged, but acetaminophen administered as directed for the child's age can relieve discomfort.)

A nurse is planning diversionary activities for children on an inpatient unit. Which play activities should be used for toddlers? (Select all that apply) a. Building simple models. b. Working with clay. c.Filling and emptying containers. d. Playing with blocks. e. Looking at picture book

c. filling and emptying containers develop fine motor skills and coordination. d. playing with blocks helps develop fine motor skills. e. looking at picture books helps with preparation for learning to read.