Nclex Peds Exam 1

The nurse is assessing heart rate for children on the pediatric ward. Which of the following is a normal finding based on developmental age? A) An infant's rate is 90 bpm. B) A toddler's rate is 150 bpm. C) A preschooler's rate is 130 bpm. D) A school-age child's rate is 50 bpm.

A

The nurse is conducting a routine health assessment of a 3-month-old boy and notices a flat occiput. The nurse provides teaching and emphasizes the importance of tummy time. Which of the following responses by the mother indicates a need for further teaching? A) "He must be positioned on his tummy as much as possible." B) "I need to watch him during his tummy time." C) "I need to change his head position while he is in an upright chair." D) "His head has flattened due to the pressure of his head position."

A

The nurse is inspecting the genitals of a prepubescent girl. Which of the following are normal signs of the onset of puberty? A) Appearance of pubic hair around 11 to 13 years old B) Swelling or redness of the labia minora C) Presence of a small amount of downy pubic hair D) Lesions on the external genitalia

A

The nurse is preparing to assess the pulse of an 18-month-old child. Which pulse would be most difficult for the nurse to palpate? A) Radial B) Brachial C) Pedal D) Femoral

A

The nurse is teaching the student nurse the sequence for performing the assessment techniques during a physical examination. What is the appropriate order? A) Inspection, palpation, percussion, auscultation B) Inspection, percussion, palpation, auscultation C) Palpation, percussion, inspection, auscultation D) Inspection, auscultation, palpation, percussion

A

Which of the following would be least effective in gaining the cooperation of a toddler during a physical examination? A) Tell the child that another child the same age wasn't afraid. B) Allow the child to touch and hold the equipment when possible. C) Permit the child to sit on the parent's lap during the examination. D) Offer immediate praise for holding still or doing what was asked.

A

A group of students are reviewing information about major and minor congenital disorders. The students demonstrate understanding of the information when they identify which of the following as a minor disorder? A) Webbed neck B) Omphalocele C) Cutaneous hemangioma D) Facial asymmetry

A Feedback: A minor congenital anomaly is webbed neck. Omphalocele, cutaneous hemangioma, and facial asymmetry are considered major congenital anomalies.

A nursing student is preparing an oral presentation about autosomal recessive inheritance. Which of the following must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? A) Both parents must be heterozygous carriers. B) One parent must have the disease. C) The mother must be a carrier. D) The father must be affected by the disease.

A Feedback: Autosomal recessive inheritance occurs when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, two abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be heterozygous carriers of the gene (clinically normal, but carriers of the gene).

The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. Which of the following will be the priority nursing diagnosis? A) Imbalanced nutrition, less than body requirements related to the effects of hypotonia B) Deficient knowledge related to the presence of a genetic disorder C) Delayed growth and development related to a cognitive impairment D) Impaired physical mobility related to poor muscle tone

A Feedback: Children with Down syndrome may have difficulty sucking and feeding due to lack of muscle tone and the structure of their mouths and tongues. This can lead to poor nutritional intake and makes this the priority diagnosis. This also uses the strategy that physiologic needs have priority using Maslow's hierarchy of needs. Deficient knowledge due to lack of information about the disorder is a close second in priority, as the mother did not know of her daughter's condition before birth and has much to learn now. This child is at risk for a number of complications such as infection, heart disease, and leukemia and will require frequent assessment. Most children with Down syndrome experience some degree of intellectual disability, but early intervention will allow the child maximum development within the limits of the disease. Mobility is delayed but should not be a problem at this time.

Which of the following would lead the nurse to suspect that a child has Turner syndrome? A) Webbed neck B) Microcephaly C) Gynecomastia D) Cognitive delay

A Feedback: Manifestations of Turner syndrome include webbed neck, low posterior hairline, wide-spaced nipples, edema of the hands and feet, amenorrhea, and absence of secondary sex characteristics, along with short stature and slow growth. Microcephaly is commonly associated with trisomy 13. Gynecomastia and cognitive delay are associated with Klinefelter syndrome

A nurse is reviewing an article about genetic disorders and patterns of inheritance. The nurse demonstrates understanding of the information by identifying which of the following as an example of an autosomal dominant genetic disorder? A) Neurofibromatosis B) Cystic fibrosis C) Tay-Sachs disease D) Sickle cell disease

A Feedback: Neurofibromatosis is an example of an autosomal dominant genetic disorder. Cystic fibrosis, Tay-Sachs disease, and sickle cell disease are examples of autosomal recessive genetic disorders.

When teaching a class about trisomy 21, the instructor would identify this disorder as due to which of the following? A) Nondisjunction B) X-linked recessive inheritance C) Genomic imprinting D) Autosomal dominant inheritance

A Feedback: Trisomy 21 is an example of a genetic disorder involving an abnormality in chromosomal number due to nondisjunction. X-linked recessive inheritance disorders, such as hemophilia and Duchenne muscular dystrophy, involve altered genes on the X chromosome. Genomic imprinting disorders, such as Prader-Willi syndrome, involve expression of only the maternal or paternal allele, with the other being inactive. Autosomal dominant inheritance disorders, such as neurofibromatosis and achondroplasia, involve a single gene in the heterozygous state that is capable of producing the phenotype, thus overshadowing the normal gene.

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? A)The family is the constant in the child's life and the primary source of strength. B)The care provider is the constant in the child's life and the primary source of strength. C)The child must be prepared to be his or her own source of strength during times of crisis. D)The wishes of the family should direct the nursing care plan for the child.

A) Family-centered care involves a partnership between the child, family, and health care providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

The nurse is caring for a 14-year-old boy with an osteosarcoma. Which communication technique would be least effective for him? A)Letting him choose juice or soda to take pills B)Seeking the teenager's input on all decisions C)Discussing the benefits of chemotherapy with him D)Avoiding undue criticism of noncompliance

A) Letting the child choose juice or soda to take pills is the least effective communication technique for an adolescent. It may provide some sense of control, but is not as effective as seeking his input on all care decisions, including him during discussions of the benefits of chemotherapy, and avoiding undue criticism of noncompliance.

The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS? A)Decrease anxiety and fear during hospitalization and painful procedure. B)Keep children who are hospitalized distracted from pain. C)Perform medical procedures using atraumatic principles. D)Act as a liaison between the nurse and the child.

A) The CLS is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful (Child Life Council, 2010a, 2010b). The goal of the CLS is to decrease the anxiety and fear while improving and encouraging understanding and cooperation of the child. The CLS may use distraction techniques and act as a liaison, but that is not the primary goal of the CLS role. The CLS does not perform medical procedures.

The nurse is enlisting the parents' assistance for therapeutic hugging prior to an otoscopic examination. What should the nurse emphasize to the parents? A)"You will need to keep his hands down and his head still." B)"If this does not work, we will have to apply restraints." C)"If you are not capable of this, let me know so I can get some assistance." D)"I may need you to leave the room if your son will not remain still."

A) The nurse needs to provide a specific explanation of the parents' role and what body parts to hold still in a safe manner. Implying that the parents may not be capable or may have to leave the room is inappropriate. Telling the parents that restraints may be required is not helpful, does not teach, and may be perceived as a threat.

The nurse is educating the parents of a 7-year-old boy with asthma about the medications that have been prescribed. Which of the following drugs would the nurse identify as an adjunct to a b2-adrenergic agonist for treatment of bronchospasm? A) Ipratropium B) Montelukast C) Cromolyn D) Theophylline

A) Ipratropium Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a b2-adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation.

The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which of the following? A) Suctioning a tracheostomy tube B) Administering drugs with a nebulizer C) Providing tracheostomy care D) Suctioning with a bulb syringe

A) Suctioning a tracheostomy tube Supplemental oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen.

The nurse is assessing a 7-year-old boy with pharyngitis. The nurse would least likely expect to assess which of the following? A) Working hard to breathe B) Difficulty swallowing C) Rash on the abdomen D) Sore throat and headache

A) Working hard to breathe Disorders of the nose and throat do not result in increased work of breathing, so that would not be observed by the nurse. Difficulty swallowing, sore throat, and headache are consistent with pharyngitis, as is the rash, which would be fine, red, and sandpaper-like (called scarlatiniform).

The nurse has obtained the services of an interpreter to assist with communicating with a child and parents who have a limited understanding of English. Which behaviors may impede the communication? Select all that apply. A)The nurse speaks to the interpreter, who then translates the information to the parents and child. B)The nurse speaks with the parents and child, and then the interpreter translates the information to the parents and child. C)The nurse limits the sessions with the interpreter to 1 hour. D)The nurse stops talking every 45 to 60 seconds to allow the interpreter to catch up with the information provided. E)The nurse avoids the use of slang in the exchange of information.

A),C),D) When using an interpreter the nurse should speak to the parents and child. Then the interpreter will translate the information to the family in their native language. This promotes the relationship between the nurse and family. Exchanges with the interpreter should be limited to 20 to 30 minutes. A one-hour time period would be tiring and counterproductive. The nurse should stop speaking about every 30 seconds to allow the interpreter to catch up. The remaining actions are appropriate.

The nurse is providing atraumatic care to children in a hospital setting. What are principles of this philosophy of care? Select all that apply. A)Avoid or reduce painful procedures B)Avoid or reduce physical distress C)Minimize parent-child interactions D)Provide child-centered care E)Minimize child control F)Use core primary nursing

A)Avoid or reduce painful procedures B)Avoid or reduce physical distress F)Use core primary nursing When using atraumatic care, the nurse would avoid or reduce painful procedures, avoid or reduce physical distress, use core primary nursing, maximize parent-child interactions, provide family-centered care, and provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.

When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? A)Parallel play B)Cooperative play C)Dramatic play D)Fantasy play

A)Parallel play Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.

The nurse is assessing the psychosocial development of a preschooler. What are normal activities characteristic of the preschooler? Select all that apply. A)Plans activities and makes up games B)Initiates activities with others C)Acts out roles of other people D)Engages in parallel play with peers E)Classifies or groups objects by their common elements

A)Plans activities and makes up games B)Initiates activities with others C)Acts out roles of other people The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior? A)The need for separation and control B)The need for love and belonging C)The need for safety and security D)The need for peer approval

A)The need for separation and control Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.

The nurse is assessing a 2-day-old newborn and suspects Down syndrome based on which of the following? Select all answers that apply. A) Flat facial profile B) Downward slant to the eyes C) Large tongue compared to mouth D) Simian crease E) Epicanthal folds F) Rigid joints

A,C,D,E Feedback: Common clinical manifestations of Down syndrome include flat facial profile, upward slant to the eyes (oblique palpebral fissures), tongue that is large in comparison to the mouth size, simian, crease, epicanthal folds, and loose joints.

The nurse is caring for a 7-year-old girl who is scheduled for a hernia repair and is very scared. Which fear would she also most likely have at this age? A) Fear of being kidnapped B) Fear of cutting her finger C) Fear of sudden loud noises D) Fear of the neighbor's dog

Ans: A Feedback: At this age, the child will be fearful of being kidnapped. She should have outgrown her fears of harm to her body, noises, and dogs, all of which are typical preschooler fears.

After teaching the parents of a 9-year-old girl about safety, which statement indicates the need for additional teaching? A) "She can ride in the front seat of the car once she is 10 years old." B) "We need to buy her a helmet so she can ride her scooter." C) "She should ride her bike with the traffic on the side of the road." D) "We signed her up for swim lesions at the local community center."

Ans: A Feedback: Children younger than 12 years of age must sit in the back seat of the car. Laws in most states require helmets for riding bicycles and scooters. When riding a bike, the child should ride on the side of the road traveling with the traffic. Children should know how to swim. If swimming skills are limited, the child must wear a life preserver at all times.

A mother brings her 6-year-old son in for a check-up because the child is reporting stomachaches. It is the beginning of the school year. What might the mother also mention? A) The child cries before going to school. B) The child made friends the first day of school. C) The child fights with siblings more often. D) The child loves the crowds in the lunchroom.

Ans: A Feedback: This child has a slow-to-warm-up temperament. The child may also be crying before going to school. Making friends the first day of school and enjoying the crowds in the lunchroom are typical of a child with an easy temperament. Irritability is typical of a child with a difficult temperament.

A 12-year-old girl is experiencing prepubescence, and tells the school nurse that she feels "very out of place" in her school. What would be acceptable responses by the nurse? Select all that apply. A) "It must be difficult for you. Why don't you sit down and we can talk about it." B) "I would suggest that you talk to your parents about your feelings. This isn't something that I can talk to you about." C) "All of the girls and boys will be going through the same thing as you so that should make you feel a little better." D) "Tell me how this makes you feel. Talking about your feelings may help you feel better about school." E) "I went through the same thing when I was in school. I know it doesn't feel like it now but I promise it will get easier."

Ans: A, D Feedback: Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics, a period of rapid growth for girls, and a period of continued growth for boys. Acknowledging the student's feelings and encouraging her to talk about her feelings will likely help her to feel better about herself. She may not be comfortable with talking about her feelings with her parents at this point, and the nurse discussing this topic with the student is acceptable. Telling her that everyone goes through it and that it will "get easier" does not address the student's feelings and is nontherapeutic communication.

When providing anticipatory guidance to a group of parents with school-aged children, what would the nurse describe as the most important aspect of social interaction? A) School B) Peer relationships C) Family D) Temperament

Ans: B Feedback: Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which information would the nurse include in her teaching plan? A) Teachers are the most influential people in the development of the school-age child's social network. B) Continuous peer relationships provide the most important social interaction for school-age children. C) Parents should establish norms and standards that signify acceptance or rejection. D) A characteristic of school-age children is their formation of groups with no rules and values involved.

Ans: B Feedback: Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

What finding would the nurse most likely discover in a 10-year-old child in the period of concrete operational thought? A) Participation in abstract thinking B) Ability to classify similar objects C) Problem solving via the scientific method D) Ability to make independent decisions

Ans: B Feedback: During the period of concrete operational thought, children are able to classify or group objects based on their common elements. Abstract thinking, problem solving via the scientific method, and independent decision making are higher-level functions, typically seen in adolescents.

The mother of a 12-year-old boy is talking with the school nurse about her son's clumsiness. She reports that he seems to fall a lot, his writing is horrible, and as much as he practices he can't play his guitar very well. How should the nurse respond to the mother? A) "Boys tend to take a bit longer than girls to mature." B) "Have you spoken with your pediatrician about your observations?" C) "Boys tend to refine their fine motor skills by this age." D) "I will make a note of your observations and talk to his teachers."

Ans: B Feedback: Myelinization of the central nervous system is reflected by refinement of fine motor skills. The child between 10 and 12 years of age begins to exhibit manipulative skills comparable to adults. In order to determine if the child is delayed in fine motor skill development, the pediatrician should be made aware because further examination or testing may be warranted. Just stating the fact that his motor skills should be developed by this age, although true, does not address the mother's concerns. The teachers can be notified of the mother's observations, but the child should still be assessed by the pediatrician.

The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. What advice might be helpful for these parents? A) School-age children are not ready to absorb information that deals with drugs and alcohol. B) School-age children can think critically to interpret messages seen in advertising, media, and sports. C) Parents must prevent their child from being exposed to messages that are in conflict with their values. D) Discussions with children need to be based on facts and focused on the past and future.

Ans: B Feedback: School-age children can be taught how to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities. School-age children are ready to absorb information that deals with drugs and alcohol and may be exposed to messages that are in conflict with their parents' values regarding smoking and alcohol. This may occur at school and cannot be prevented. Discussions with children need to be based on facts and focused on the present.

The nurse has determined that an 8-year-old girl is at risk for being overweight. Which intervention would be a priority prior to developing the care plan? A) Determining the need for additional caloric intake B) Asking the parents who they want to work with the child C) Interviewing the parents about their eating habits D) Discussing the influence of peers on the child's diet

Ans: C Feedback: The nurse would need to find out what the parents' eating habits are like. It would not be necessary to determine the need for additional caloric intake. Developing a multidisciplinary plan is an intervention for a child with growth and development problems. Discussing the influence of peers is an intervention used for preventing injury.

The nurse is counseling the parents of a 10-year-old child who was caught stealing at school. Which topic should the nurse cover? A) Having the child return the property in front of his or her class B) Discussing ways for the child to save face C) Finding out what is currently going on at home D) Reminding the child daily that stealing is wrong

Ans: C Feedback: The parents need to understand the child's behavior. The reason for stealing at age 10 may be that the child wants the item or is trying to impress peers, or it may be a sign of anxiety. More information is needed before the nurse can effectively work with the family. The parents should work together with the child to decide how the item will be returned. The child will lose face but gain integrity by returning the stolen item. Reminding the child about stealing on a daily basis may ruin the child's self-esteem.

The school nurse is teaching parents about the effects of bullying on school children. What accurately describes this developmental concern? A) Children who bully are those who report themselves as being lonely and having difficulty in forming friendships. B) Children with health issues, such as, disabilities, obesity and food allergies, are at a decreased risk of being bullied. C) In general, about 20% of all children attending school are frightened and afraid most of the day. D) Both boys and girls are bullied; boys usually bully boys and use force more often.

Ans: D Feedback: Both boys and girls are bullied and can bully others. Boys usually bully boys and use force more often, and boys are twice as likely to be victims of bullying. Bullied children are those who report themselves as being lonely and having difficulty in forming friendships. Children with health issues, such as disabilities, obesity, and food allergies, are at an increased risk of being bullied. In general, about 10% of all children attending school are frightened and afraid most of the day.

The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which fact might the nurse include in the introduction? A) Children in the United States spend about 6 hours a day either watching TV or playing video games. B) A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. C) A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. D) Parents should limit television watching and video-game playing to 2 hours per day.

Ans: D Feedback: Parents should limit television watching and video-game playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image.

During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? A) "The child's best friends will continue playing soccer." B) "The children will cheer for each other regardless of the sport being played." C) "Your child will rarely talk to you about his friends." D) "Acceptance by friends, especially of the same sex, is very important at this age."

Ans: D Feedback: Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.

The nurse is preparing a class for a group of adolescents about promoting safety. What would the nurse plan to include as the leading cause of adolescent injuries? A) Motor vehicles B) Firearms C) Water D) Fires

Ans: A Feedback: Although firearms, water, and fires all pose a risk for injury for adolescents, most adolescent injuries are due to motor vehicle crashes.

The mother of a 14-year-old girl complains to the nurse that her daughter is moody, shuts herself in her room, and fights with her younger sister. Which comment is most valuable to the mother? A) "Calmly talk to her about your concerns." B) "This is normal for her age." C) "She may be hanging with a bad crowd." D) "Set some rules for family etiquette."

Ans: A Feedback: Getting the mother and daughter talking and sharing information is the most valuable advice. Telling the mother that this is normal does nothing for the family situation. Setting rules will alienate the child. Suggesting an underlying problem can cause a rift between the mother and daughter.

The nurse teaches parents of adolescents that adolescents need the support of parents and nurses to facilitate healthy lifestyles. What should be a priority focus of this guidance? A) Reducing risk-taking behavior B) Promoting adequate physical growth C) Maximizing learning potential D) Teaching personal hygiene routines

Ans: A Feedback: The adolescent experiences drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. With this rapid growth during adolescence, the development of secondary sexual characteristics, and interest in the opposite sex, the adolescent needs the support and guidance of parents and nurses to facilitate healthy lifestyles and to reduce risk-taking behaviors. Promoting physical growth, maximizing learning potential, and teaching hygiene are secondary to reducing risky behavior.

The nurse is caring for a 7-month-old girl during a well-child visit. Which of the following interventions is most appropriate for this child? A) Discussing the type of sippy cup to use B) Advising about increased caloric needs C) Explaining how to prepare table meats D) Describing the tongue extrusion reflex

Ans: A Feedback: The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months.

23. During a health check-up without his parents, a 17-year-old tells the nurse he is gay. Which approach should the nurse take? A) "Tell me what makes you think you are gay." B) "This puts you in an at-risk category." C) "We need to talk about safe sex." D) "You're not gay; you're confused."

Ans: A Feedback: The nurse needs to get more information from the teenager (assessment) before making any comment and then proceed in a sensitive and caring way. Comments about being at risk or needing to know about safe sex are negative and should be replaced with health promotion comments. Denying the statement shows the teenager that you are not an ally.

When assessing adolescents for health risks, the nurse must keep in mind the factors related to the prevalence of adolescent injuries. What accurately describes these factors? Select all that apply. A) Increased physical growth B) Insufficient psychomotor coordination C) Tiredness, lack of energy D) Lack of impulsivity E) Peer pressure F) Inexperience

Ans: A, B, E, F Feedback: Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes.

28. The school nurse is teaching parents risk factors for suicide in adolescents. What would the nurse discuss? Select all that apply. A) Mental health changes B) History of previous suicide attempt C) Higher socioeconomic status D) Greatly improved school performance E) Family disorganization F) Substance abuse

Ans: A, B, E, F Feedback: Suicide is the third leading cause of death in adolescents 15 to 19 years of age. Risk factors for suicide include mental health changes, history of previous suicide attempt, family disorganization, and substance abuse. Other risk factors include poor school performance, crowded conditions/housing, low socioeconomic status, limited parental supervision, single-parent families/both parents in workforce, access to guns or cars, drug or alcohol use, low self-esteem, racism, peer or gang pressure, and aggression.

The school nurse is conducting a seminar for parents of adolescents on how to communicate with teenagers. Which guidelines might the nurse recommend? Select all that apply. A) Talk face to face and be aware of body language. B) Ask questions to see why he or she feels that way. C) Do not give praise unless the adolescent deserves it. D) Speak to your child as an authority figure, not an equal. E) Don't admit that you make mistakes. F) Don't pretend you know all the answers.

Ans: A, B, F Feedback: In order to improve communication with teenagers, the parents should talk face to face and be aware of body language, ask questions to see why the teenager feels that way, not pretend they know all the answers, give praise and approval to the teenager often, speak to him or her as an equal (not talk down to him or her), and admit that they do make mistakes.

After assessing a 10-year-old girl, the nurse documents the appearance of breast buds, identifying this as what body change? A) Menarche B) Thelarche C) Puberty D) Tanner stage 5

Ans: B Feedback: "Thelarche" is the term used to describe breast budding. Menarche refers to the first menstrual period. Puberty refers to the biological changes that occur during adolescence. Tanner stage 5 involves maturation of the breast tissue to adult configuration. activity of sebaceous glands

Based on Erikson's developmental theory, what is the major developmental task of the adolescent? A) Gaining independence B) Finding an identity C) Coordinating information D) Mastering motor skills

Ans: B Feedback: According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.

The school nurse is preparing a program on sexuality and birth control for a class of 14- to 16-year-olds. Which behavior will have the most influence on how the information is presented? A) Teens are adjusting to new body images. B) Adolescents tend to take risks. C) Teenagers are able to think in the abstract. D) Adolescents understand that actions have consequences.

Ans: B Feedback: Adolescents are risk takers. This tendency enables them to overcome common sense and their own better judgment. Although adolescents are capable of abstract thinking and understand that actions have consequences, they are not yet committed to these attributes. Changing body image would not have significant influence on the presentation.

The nurse is teaching the parents of a 12-year-old boy about appropriate approaches when raising an adolescent. Which comment should be included in the discussion? A) "Find out if his friends are worthy of him." B) "Try to be open to his views." C) "Maintain a firm set of rules." D) "Remind him that he is still your little boy."

Ans: B Feedback: It is most important to be open to the child's views. This will encourage the child to consider parental concerns and promote communication. Being judgmental about his friends will make the child defensive about his choice of friends. Rules need to be flexible so they can apply to new situations. Avoid condescension. The child will appreciate being treated like a young man.

The school nurse is performing a physical examination on a 13-year-old boy who is on the soccer team. What is a physical quality that develops during these early adolescent years? A) Coordination B) Endurance C) Speed D) Accuracy

Ans: B Feedback: It is usually during early adolescence that teenagers begin to develop endurance. Their concentration has increased so they can follow complicated instructions. Coordination can be a problem because of the uneven growth spurts. During middle adolescence, speed and accuracy increase while coordination also improves.

The school nurse knows that dating is a milestone for adolescents. Which statement accurately describes a trend in teen dating? A) Most late adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. B) Most teens have been involved in at least one romantic relationship by middle adolescence. C) Teens that date frequently report slightly lower levels of self-esteem and decreased autonomy. D) Homosexual behavior as a teen usually indicates that the adolescent will maintain a homosexual orientation.

Ans: B Feedback: Most teens have been involved in at least one romantic relationship by middle adolescence. Most early adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. Teens who date frequently report slightly higher levels of self-esteem and increased autonomy. Homosexual behavior as a teen does not necessarily indicate that the adolescent will maintain a homosexual orientation.

At which age would the nurse expect to find the beginning of object permanence? A) 1 month B) 4 months C) 8 months D) 12 months

Ans: B Feedback: Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.

The nurse is assessing a 4-month-old boy during a scheduled visit. Which of the following findings might suggest a developmental problem? A) The child does not coo or gurgle. B) The child does not babble or laugh. C) The child never squeals or yells. D) The child does not say dada or mama.

Ans: B Feedback: The fact that the child does not babble or laugh might suggest a developmental problem. At 4 to 5 months of age most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child should have developed past cooing or gurgling, but is too young to squeal, yell, or say dada or mama.

The nurse knows that barriers to the adolescent's health and successful achievement of the tasks of adolescence exist. What is the major barrier to health for this population? A) Cultural B) Socioeconomic C) Marital status D) Racial

Ans: B Feedback: The major barrier to the adolescent's health and successful achievement of the tasks of adolescence is socioeconomic status. Adolescents at a lower socioeconomic level are at higher risk for developing health care problems and risk-taking behaviors; this may be due to their inability to access health care and to obtain needed services. In caring for adolescents, the nurse should also recognize the influence of their culture, ethnicity, and race upon them.

The nurse assesses the spirituality of an adolescent. What are normal moral and spiritual milestones in this age group? Select all that apply. A) Adolescents will base their actions on the avoidance of punishment and the attainment of pleasure. B) Adolescents develop their own set of morals and values and question the status quo. C) Adolescents undergo the process of developing their own set of morals at different rates. D) Adolescents are more interested in the spiritualism of their religion than in the actual practices of their religion. E) Adolescents can understand the concepts of right and wrong and

Ans: B, C, D Feedback: It is during the adolescent years that teenagers develop their own set of values and morals at different rates. At the beginning of this stage, teenagers begin to question the status quo. The majority of their choices are based on emotions while they are questioning societal standards. Adolescents also begin to question their formal religious practices. As they progress through adolescence, teenagers become more interested in the spiritualism of their religion than in the actual practices of their religion. The toddler will base his or her actions on the avoidance of punishment and the attainment of pleasure. The preschool child can understand the concepts of right and wrong and is developing a conscience. The school-age child is able to understand and incorporate into his behavior the concept of the "golden rule."

The nurse has seen a 15-year-old girl and a 16-year-old boy during health surveillance visits. Which physical characteristics would be seen in both teenagers? A) Decreased respiratory rates of 15 to 20 breaths per minute B) Eruption of last four molars C) Increased shoulder, chest, and hip widths D) Fully functioning sweat and sebaceous glands

Ans: C Feedback: Both teenagers are in the middle state of adolescence, which is marked by an increase in shoulder, chest, and hip widths. Decreased respiratory rate occurs in early adolescence, as do fully functioning sweat and sebaceous glands. Eruption of the last four molars occurs in late adolescence.

6When describing the various changes that occur in organ systems during adolescence, what would the nurse include? A) Significant increase in brain size B) Ossification completed later in girls C) Decrease in heart rate D) Decrease in activity of sebaceous glands

Ans: C Feedback: During adolescence, the heart rate decreases while the systolic blood pressure increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous gland activity increases during adolescence.

The nurse is promoting learning and school attendance to a 13-year-old girl. Which factor will affect the child's attitude most? A) Her parents' values and desires B) The dramatic changes to her body C) Peer group behaviors and attitudes D) Desire for attention from boys

Ans: C Feedback: In this age group, children have a strong desire to conform to their peer group and to be accepted. It is important to know the peer group's attitude about school and learning. Early adolescence marks the beginning of separation from the family, including its values and desires. Physiologic changes and sexual attraction would not have significant or lasting influence in this matter.

During a health maintenance visit, a 15-year-old girl mentions that she is not happy with being overweight. Which approach is best for the nurse to take? A) "Good observation. Let's talk about diet and exercise." B) "Don't worry; you are within the weight and height guidelines." C) "What specifically have you been noticing?" D) "Tell me about your parents. Are they overweight?"

Ans: C Feedback: It is best to find out what caused the teenager to make the comment so that you can work with her about the issue. This is an assessment and must be done first. Launching into a lecture on diet and exercise will be of no value if the teenager wants to talk about dealing with snide comments from her peers. Telling the teenager she is statistically in the normal range for weight and height may close the conversation prematurely. The focus is on the teenager, not her parents. Obtaining that information would be important, but not at this time.

The nurse is performing a health assessment of a 3-month-old Black American boy. For what condition should this infant be monitored based on his race? A) Jaundice B) Iron deficiency C) Lactose intolerance D) Gastroesophageal reflux disease (GERD)

Ans: C Feedback: Many dietary practices are affected by culture, both in the types of food eaten and in the approach to progression of infant feeding. Some ethnic groups tend to be lactose intolerant (particularly blacks, Native Americans, and Asians); therefore, alternative sources of calcium must be offered. Jaundice, iron deficiency, and GERD are not seen at a significantly higher rate in African American infants.

The school nurse is performing health assessments on students in middle school. Of what developmental milestone should the nurse be aware? A) Height in girls increases rapidly after menarche and usually ceases immediately after menarche. B) Boys' growth spurts usually begin between the ages of 8 and 14 years and end between the ages of 13 1/2 and 17 1/2 years. C) Peak height velocity (PHV) occurs at approximately 12 years of age in girls or about 6 to 12 months after menarche. D) Boys reach PHV and peak weight velocity (PWV) at about 16 years of age.

Ans: C Feedback: PHV occurs at approximately 12 years of age in girls or about 6 to 12 months after menarche. Height in girls increases rapidly after menarche and usually ceases 2 to 21/2 years after menarche. Boys' growth spurt occurs later than girls' and usually begins between the ages of 101/2 and 16 years and ends sometime between the ages of 131/2 and 171/2 years. Boys reach PHV at about 14 years of age. PWV occurs about 6 months after menarche in girls and at about 14 years of age in boys.

A 12-year-old boy reports to the nurse that he is one of the shortest kids in his class. He asks the nurse if he will ever grow. What response by the nurse is most appropriate? A) "At your age you are largely done growing taller." B) "Since you are the shortest now, you will likely always be the shortest in the class." C) "Boys do not have their growth spurt until about age 17." D) "There is no way to know how tall you will grow because you are still well within the window for growth."

Ans: D Feedback: Boys' growth spurt occurs later than girls' and usually begins between the ages of 10.5 and 16 years and ends sometime between the ages of 13.5 and 17.5 years.

The nurse is promoting nutrition to a 13-year-old boy who is overweight. Which comment should the nurse expect to include in the discussion? A) "You need to go on a low-fat diet." B) "Eat what your parents eat." C) "Go out for a sport at school." D) "Keep a food diary."

Ans: D Feedback: Having the boy keep a detailed food diary for 1 week will determine current patterns of eating. This can then be used to show him how to make small changes with results, especially if eating is done before periods of inactivity such as before going to bed or when he is bored. Speaking and thinking in terms of diet are negative and can lead to poor body image. If the parents have poor eating habits, telling the child to eat what his parents eat could be bad advice. The child could too easily choose the wrong sport or do poorly. It is best to offer solutions with more variety.

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate? A) "Put the infant in an infant seat after eating." B) "Limit burping to once during a feeding." C) "Feed the same amount but space out the feedings." D) "Keep the baby sitting up for about 30 minutes afterward."

Ans: D Feedback: Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended.

The adolescent continues to develop self-concept and self-esteem. What is most important to a teen's self-esteem? A) Strong authority figures B) Spirituality C) Morals and values D) Body image

Ans: D Feedback: Self-concept and self-esteem are tied to body image many times. Adolescents who perceive their body as being different than peers or as less than ideal may view themselves negatively. Sexual characteristics are important to the adolescent's self-concept and body image. Authority figures, spirituality, and morals and values play a role in development of self-esteem, but body image is most influential in the development of self-concept/self-esteem.

The nurse is performing an assessment of the reproductive system of a 17-year-old girl. What would alert the nurse to a developmental delay in this girl? A) Areola and papilla separate from the contour of the breast B) Mature distribution and coarseness of pubic hair C) Developed breast tissue D) Occurrence of first menstrual period

Ans: D Feedback: The first menstrual period usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately ages 9 to 11 years and is followed by the growth of pubic hair.

The nurse teaching safety to teens knows that which of these is the leading cause of death among adolescents? A) Drowning B) Poisoning C) Diseases D) Unintentional injuries

Ans: D Feedback: Unintentional injuries are the leading causes of death in adolescents (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2008). Injuries kill more adolescents than all diseases combined, with 46% of injury-related deaths due to motor vehicle accidents (U.S. Department of Health and Human Services, 2007). Unintentional injury accounts for about 48% of adolescent injury deaths, violence and homicide for 15.2%, and suicide for 11.8% of adolescent injury deaths (U.S. Department of Health and Human Services, 2007). Males are more likely than females to die of any type of injury.

The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing: A) little to no pain. B) mild pain. C) moderate pain. D) severe pain.

Ans: D Feedback: With the FLACC behavioral scale, five parameters are measured and scored as 0, 1, or 2. They are then totaled to achieve a maximum score of 10. The higher the score, the greater the pain. A score of 9 indicates severe pain.

The nurse is administering a crushed tablet to an 18-month-old infant. What is a recommended guideline for this intervention? A)Mix the crushed tablet with a small amount of applesauce. B)Place the crushed tablet in the infant's formula. C)Mix the crushed tablet with the infant's cereal. D)Crushed tablets should only be mixed with water.

Ans:A If a tablet or capsule is the only oral form available for children younger than 6 years, it needs to be crushed or opened and mixed with a pleasant-tasting liquid or a small amount (generally no more than a tablespoon) of a nonessential food such as applesauce. The crushed tablet or inside of a capsule may taste bitter, so it should never be mixed with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat it.

The nurse is caring for an 8-year-old girl who requires medication that is only available in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication. Which statement indicates a need for further teaching? A)"I can encourage her to place it on the back of her tongue." B)"I can pinch her nose to make it easier to swallow." C)"We cannot crush this type of pill as it will affect the delivery of the medication." D)"We can place the tablet in a spoonful of applesauce."

Ans:B The mother should be advised to never pinch the child's nose as it increases the risk for aspiration. The other statements are correct.

The nurse is monitoring the output for a 10-year-old child. The medical record indicates the child weighs 78 pounds. How much urine can be anticipated for this child for a 12-hour period? A)300 to 1200 mL B)360 to 900 mL C)420 to 840 mL D)600 to 1200 mL

Ans:C 1. 78 pounds = 35kg 2. 1 mL X 35kg = 35 mL/hr and 2 mL X 35 = 70 mL/hr 3. 35 mL X 12 hours = 420 mL 4. 70 mL X 12 hours = 840 mL Urinary output for a child will vary. As a general rule, output anticipated will be approximately 1.0 to 2.0 mL/kg/hour for children and adolescents. In a child who weighs 78 pounds, this will calculate as follows: (the rest of this was not available)

The nurse is explaining to the student nurse the therapeutic effects of total parenteral nutrition (TPN). What accurately describes the use of TPN? A)It is used short term to supply additional calories and nutrients as needed. B)It is delivered via the peripheral vein to allow rapid dilution of hypertonic solution. C)It is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. D)It is usually used when the child's nutritional status is within acceptable parameters.

Ans:C TPN is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. TPN provides all nutrients to meet a child's needs. It is delivered via central venous access to allow rapid dilution of hypertonic solution. It is usually used in a child with a nonfunctioning gastrointestinal (GI) tract, such as a congenital or acquired GI disorder; a child with severe failure to thrive or multisystem trauma or organ involvement; and preterm newborns.

The nurse is determining the amount of IV fluids to administer in a 24-hour period to a child who weighs 40 kg. How many milliliters should the nurse administer? A)1,000 mL B)1,500 mL C)1,750 mL D)1,900 mL

Ans:D Typically, the amount of fluid to be administered in a day (24 hours) is determined by the child's weight (in kg) using the following formula: 100 mL per kg of body weight for the first 10 kg (1,000) 50 mL per kg of body weight for the next 10 kg (500) 20 mL per kg of body weight for the remainder of body weight in kg (400).

For which of the following children would the nurse conduct an immediate comprehensive health history? A) A child who is brought to the emergency room with lacerations B) A child who is a new client in a pediatric office C) A child who is a routine client and presents with signs of a sinus infection D) A child whose condition is improving

B

The nurse is assessing the temperature of a diaphoretic toddler who is crying and being uncooperative. What would be the best method to assess temperature in this child? A) Oral thermometer B) Axillary method C) Temporal scanning D) Rectal route

B

The nurse is conducting a health history for a 9-year-old child with stomach pains. Which of the following is a recommended guideline when approaching the child for information? A) Wear a white examination coat when conducting the interview. B) Allow the child to control the pace and order of the health history. C) Use quick deliberate gestures to get your point across. D) Do not make physical contact with the child during the interview.

B

The nurse is inspecting the fingernails of an 18-month-old girl. Which of the following findings indicates chronic hypoxemia? A) Nails that curve inward B) Clubbing of the nails C) Nails that curve outward D) Dry, brittle nails

B

The nurse is teaching the student nurse how to perform a physical assessment based on the child's developmental stage. Which of the following statements accurately describes a recommended guideline for setting the tone of the examination for a school-age child? A) Keep up a running dialogue with the caregiver, explaining each step as you do it. B) Include the child in all parts of the examination; speak to the caregiver before and after the examination. C) Speak to the child using mature language and appeal to his or her desire for self- care. D) Address the child by name; speak to the caregiver and do the most invasive parts last.

B

The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include? A) Getting cervical radiographs between 3 and 5 years of age B) Adhering to the special dietary needs of the child C) Getting an echocardiogram before 3 months of age D) Monitoring for symptoms of respiratory infection

B Feedback: Children with Down syndrome do not require a special diet unless underlying gastrointestinal disease is present. However, a balanced, high-fiber diet and regular exercise are important. Getting cervical radiographs between 3 and 5 years of age is the screening method for atlantoaxial instability, which is seen in about 14% of children with Down syndrome. Evaluation by a pediatric cardiologist before 3 months of age, including an echocardiogram, is important since children with Down syndrome are at higher risk for heart disease. The child will be more susceptible to infectious diseases.

A pregnant woman is to undergo testing to evaluate for chromosomal abnormalities. Which test would the nurse expect to be done the earliest? A) Amniocentesis B) Chorionic villi sampling C) Triple screen D) Fetal nuchal translucency

B Feedback: Chorionic villi sampling is performed at 7 to 11 weeks' gestation. Amniocentesis usually is performed after 15 weeks' gestation. A triple screen is usually done between 16 and 19 weeks' gestation. Fetal nuchal translucency must be performed between 11 and 14 weeks.

When teaching the parents of a child with phenylketonuria, the nurse would instruct them to include which of the following foods in the child's diet? A) Milk B) Oranges C) Meat D) Eggs

B Feedback: Foods that contain phenylalanine are to be avoided. These include milk, meat, and eggs. Foods such as oranges would be allowed.

The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. Which of the following responses indicates the need for further teaching? A) "The father can't be a carrier if he doesn't have hemophilia." B) "If the father doesn't have it, then his kids won't either." C) "If the mother is a carrier, her daughter could be one too." D) "If the mother is a carrier, her sons may have hemophilia."

B Feedback: Hemophilia is an X-linked recessive disorder. This means that both the father and the mother must have the gene for hemophilia to pass it on to their children. Also, their male children will have hemophilia, while their female children have only a 50% chance of having the disorder. If the father has hemophilia and the mother has hemophilia, their children will have the disease. If the father has hemophilia and the mother is a carrier, all their children have a 50% chance of getting the disease.

When providing support and education to the family of a child who is diagnosed with a serious genetic abnormality, which of the following would be the highest priority? A) Assisting with scheduling follow-up visits B) Establishing a trusting relationship C) Teaching the family what to expect D) Using measures to promote growth and development

B Feedback: Regardless of the genetic abnormality, learning of a genetic abnormality may be shattering to the family. Therefore, the initial priority is to establish a trusting relationship. Once this is accomplished, other aspects of care, such as assisting with scheduling follow-up visits, teaching, and implementing measures to promote growth and development, can be addressed.

The nurse is caring for a couple who have just learned that their infant has a genetic disorder. Which of the following would be least appropriate for the nurse to do at this time? A) Actively listening to the parents' concerns B) Teaching the parents about the child's medical needs C) Providing time for the parents to ask questions D) Offering suggestions for support services

B Feedback: The parents are most likely overwhelmed with learning the diagnosis and are dealing with a wide range of emotions and reactions. Therefore, it would be inappropriate at this time to attempt teaching them. Rather, the nurse would provide emotional support, actively listening to the parents, allowing time for questions, and offering suggestions for support to assist them in dealing with this new challenge. Teaching can be done at a later time.

The nurse is explaining a discharge plan to the parents of an infant being discharged from the hospital. Which characteristic regarding adult learning should the nurse incorporate into her plan? A)Adults are dependent learners. B)Adults are problem focused. C)Adults are future focused. D)Adults do not value past learning.

B) Adults are problem focused and task oriented; they learn best when they perceive there is a gap in their knowledge base and want information and skills to fill the gap. Adults are self-directed; they value independence and want to learn on their own terms. Adults want an immediate need satisfied; they learn best at a time when learning meets an immediate need. Adults value past experiences and beliefs; they bring an accumulated wealth of experiences to each health care encounter.

The nurse has completed diabetic education regarding insulin administration to a 14-year-old child newly diagnosed with diabetes and his family. The nurses knows the teaching was effective if the client and family: A)can list appropriate sites for insulin administration. B)have demonstrated correct insulin administration over the past several days. C)indicate that they understand proper nutrition for a person with diabetes. D)state that they understand hypoglycemic reaction signs and symptoms.

B) Demonstration is the best way to determine if teaching was effective in any situation. Listing, identifying, and stating understanding of a concept are desirable, but these behaviors are not the best way to determine understanding.

The nurse is caring for a child who is scheduled to begin chemotherapy. When planning education for the parents, what action by the nurse is most correct? A)Obtain a large classroom to allow the nurse to stand at the front and present information. B)Obtain a small conference room and arrange the chairs in a circle for both the nurse and family members to sit. C)Provide written information to the family and allow them to review it, with instructions to contact the nurse if there are additional questions. D)Provide a video of information to the family, with instructions to contact the nurse if there are additional questions.

B) Teaching is an important function of the nurse. When providing education, it is important to offer the information in an environment that is conducive to learning. A circular set of chairs will allow the nurse to face the parents during the exchange. A large class that has the nurse standing and the parents sitting does not provide the ability for a personal interaction needed for this session. Giving the parents information in writing should be done in conjunction with a face to face teaching session. Video information may be beneficial but does not replace the face-to-face teaching session.

The child life specialist (CLS) is preparing a 6-year-old child for a magnetic resonance imaging (MRI) scan. Which statement reflects the use of atraumatic principles when explaining the procedure? A)'You will be taken to a magnetic resonance imaging machine for an x-ray of your liver.' B)'You may hear some loud noises when you are lying in the machine, but they won't hurt you.' C)'You have nothing to worry about; the MRI machine is safe and will not cause you any pain.' D)'Let's just get you to the x-ray department for your test and you'll see how simple it is.'

B) When using atraumatic principles, the CLS would explain any sensations, such as noises that will be experienced. The language should be simple and at the child's developmental age; using the technical term for the machine might frighten the child. Telling the child there is nothing to worry about does not allay the child's fears. Allowing the child to experience the machine without explaining the sensations does not follow atraumatic principles.

The nurse is caring for a teen who will be hospitalized for physical rehabilitation for an extended period of time after an auto accident. When working to promote a good working relationship with the teen, what action by the nurse will be most beneficial? A)Allow the teen to control the daily schedule. B)Keep your word with regard to promises and statements made to the teen. C)Allow the teen to make decisions about the plan of care. D)Include the teen in the weekly interdisciplinary care conferences

B) When working with teens the establishment of trust and rapport are of the highest priority. Establishing trust can best be done by demonstrating consistency and keeping promises made to the teen. Control of the daily schedule may not be feasible. The teen can be allowed to have an impact on some elements of the plan of care but this does not have a greater importance than the establishment of trust. The teen may be able to attend care conferences but this is not of the highest priority.

A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A) Salmeterol B) Albuterol C) Ipratropium D) Cromolyn

B) Albuterol Albuterol is a short-acting b2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting b2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to b2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cellstabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which of the following? A) Children's demand for oxygen is lower than that of adults. B) Children develop hypoxemia more rapidly than adults do. C) An increase in oxygen saturation leads to a much larger decrease in pO2. D) Children's bronchi are wider in diameter than those of an adult.

B) Children develop hypoxemia more rapidly than adults do. Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement.

The nurse is preparing to perform a physical examination of a child with asthma. Which of the following techniques would the nurse be least likely to perform? A) Inspection B) Palpation C) Percussion D) Auscultation

B) Palpation When examining the child with asthma, the nurse would inspect, auscultate, and percuss. Palpation would not be used.

The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which of the following as most helpful in determining the extent of the child's hypoxia? A) Pulmonary function test B) Pulse oximetry C) Peak expiratory flow D) Chest radiograph

B) Pulse oximetry Pulse oximetry is a useful tool for determining the extent of hypoxia. It can be used by the nurse for continuous or intermittent monitoring. Pulmonary function testing measures respiratory flow and lung volumes and is indicated for asthma, cystic fibrosis, and chronic lung disease. Peak expiratory flow testing is used to monitor the adequacy of asthma control. Chest radiographs can show hyperinflation, atelectasis, pneumonia, foreign bodies, pleural effusion, and abnormal heart or lung size.

The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, which of the following would be least appropriate for the nurse to perform? A) Providing 100% oxygen B) Visualizing the throat C) Having the child sit forward D) Auscultating for lung sounds

B) Visualizing the throat The child is exhibiting signs and symptoms of epiglottitis, which can be life-threatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in the least invasive manner that is most acceptable to the child is a sound intervention, as is allowing the child to assume a position of sitting forward with the neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway.

The nurse is admitting a 7-year-old child to the medical-surgical unit. The child answers questions with very short answers, makes little eye contact with the nurse, and looks to the parent to answer most questions. Which interventions would be appropriate during this admission assessment? Select all that apply. A)Tell the child that you are going to be their nurse so it would be best if they answered your questions. B)When asking questions, look at the child as well as the parent. C)Sit at the child's eye level during the admission questioning process. D)Stop asking questions for the present time and return later when the child feels more comfortable. E)Ask the child if they are always nervous around new people.

B), C) The goal is to establish rapport with the patient and encourage communication. It is common for young children to be shy, so it is acceptable for the nurse to ask both the child and parent questions until the child feels comfortable talking with the nurse. Sitting at eye level is less intimidating and may help in establishing a trusting relationship. Telling the child that they need to answer the questions appears as condemning the child's behavior. Admission questions are important and can't be delayed until a later time. Asking the child if they are nervous around new people is intimidating and may further block communication.

The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? A)The mother is suffering from depression. B)The child is homeless and has no toys. C)The mother describes an inadequate diet. D)The child is unperturbed by a loud noise.

B)The child is homeless and has no toys. Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.

A child is diagnosed with cri-du-chat syndrome. Which of the following would the nurse expect to assess? Select all answers that apply. A) Hypertonia B) Short stature C) Simian crease D) Wide and flat nasal bridge E) Hydrocephaly

B, C, D Feedback: Manifestations of cri-du-chat syndrome include hypotonia, short stature, microcephaly, moon-like round face, bilateral epicanthal folds, wide and flat nasal bridge, and simian crease.

A mother brings her 3 1/2-year-old daughter to the emergency department because the child has been vomiting and having diarrhea for the past 36 hours. When assessing this child's temperature, which method would be least appropriate? A) Oral B) Tympanic C) Rectal D) Axillary

C

The nurse is assessing the heart rate of a healthy 13-month-old child. The nurse knows to auscultate which of the following sites to obtain an accurate assessment? A) Radial pulse B) Brachial pulse C) Apical pulse at the third or fourth intercostal space D) Apical pulse at the fourth or fifth intercostal space at the midclavicular line

C

The nurse is conducting a physical examination of a child following a comprehensive health history. What should be the focus of the physical examination? A) The child B) The parents C) Chief complaint D) Developmental age

C

The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond? A) "Your daughter has acrocyanosis; this is causing her blue hands and feet." B) "Let's watch her carefully to make sure she does not have a circulatory problem." C) "This is normal; her circulatory system will take a few days to adjust." D) "This is a vasomotor response caused by cooling or warming."

C

After teaching a class about inborn errors of metabolism, the instructor determines that additional teaching is needed when the class identifies which of the following as an example of an inborn error of metabolism? A) Galactosemia B) Maple syrup urine disease C) Achondroplasia D) Tay-Sachs disease

C Feedback: Achondroplasia is an autosomal dominant genetic disorder, not an inborn error of metabolism. Galactosemia, maple syrup urine disease, and Tay-Sachs are considered inborn errors of metabolism.

The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? A) Interrupted family process related to the child's diagnosis B) Deficient knowledge deficit related to the genetic disorder C) Grieving related to the child's poor prognosis D) Ineffective coping related to stress of providing care

C Feedback: Grieving related to the child's prognosis is a diagnosis specific to this child's care. The prognosis for trisomy 18 is that the child will not survive beyond the first year of life. Ineffective coping related to the stress of providing care, deficient knowledge related to the genetic disorder, and interrupted family process due to the child's diagnosis could be appropriate for any family of a child with a genetic disorder.

The nurse is assessing a 4-year-old boy whose mother was 40 years old when he was born. Which of the following findings suggests this child has a genetic disorder? A) Inquiry determines the child had feeding problems. B) Observation shows nasal congestion and excess mucus. C) Inspection reveals low-set ears with lobe creases. D) Auscultation reveals the presence of wheezing.

C Feedback: Low-set ears are associated with numerous genetic dysmorphisms. Additionally, the mother's age during pregnancy is a risk factor for genetic disorders. Feeding problems could have been due to low birthweight, prematurity, or a variety of other reasons. The nasal congestion may be a cold. The wheezing could be bronchiolitis or asthma.

The nurse is assessing an infant and notes that the infant's urine has a musty odor. Which of the following would the nurse suspect? A) Maple syrup urine disease B) Tyrosinemia C) Phenylketonuria D) Trimethylaminuria

C Feedback: The urine of a child with phenylketonuria has a mousy or musty odor. For the child with maple syrup urine disease, excretions have a maple syrup odor. With tyrosinemia, excretions have a cabbage-like or rancid butter odor. With trimethylaminuria, excretions smell like rotting fish.

The nurse knows that effective communication with children and their parents is critical to providing atraumatic quality nursing care. Which statement accurately describes the communication patterns of children? A)Communication patterns are similar from one child to the next. B)Children often use more words than adults to describe their fears. C)Children rely more on nonverbal communication and silence. D)Parents more often require affective communication rather than neutral communication.

C) Children often use fewer words than adults and may rely more on nonverbal communication and silence. Communication patterns can vary greatly from one child to the next. Some children are very talkative, while others are quiet. Parents more often require neutral communication (i.e., verbal communication that is related to assessing and solving problems), whereas children more often desire affective communication (establishment of rapport and trust, giving comfort).

The nurse is implementing interventions to prevent physical stressors for a 9-year-old child receiving chemotherapy in the hospital. What is an example of using atraumatic care for this child? A)Use restraint or 'holding down' of the child during the procedure to prevent injury. B)Have the parent stand near and/or rub the child's feet during the procedure. C)Insert a saline lock if the child will require multiple doses of parenteral medications. D)Avoid using numbing techniques for multiple blood draws or IV insertion.

C) The nurse should insert a saline lock if the child will require multiple doses of parenteral medications. During painful or invasive procedures, the nurse should avoid traditional restraint or "holding down" of the child and use alternative positioning such as "therapeutic hugging." If therapeutic hugging is not an option, the nurse could have the parent stand near the child's head not his feet to provide visual and verbal comfort. The nurse should also use numbing techniques for blood draws or IV insertion.

The nurse is educating a 16-year-old girl who has just been diagnosed with acute myelogenous leukemia. Which statement best demonstrates therapeutic communication? A)Discussing the treatment plan in detail for the next few weeks B)Using medical terms when describing the disease C)Assessing the adolescent's emotional status in private D)Talking about clothing and the stores where she shops

C) Therapeutic communication is goal directed and purposeful. Assessing the child's emotional status in private is goal directed and purposeful. Talking about clothing and shopping is not therapeutic communication unless its purpose is to find head coverings or wigs to mask hair loss and that information was not presented. Discussing the treatment plan for the next few weeks in detail is too much information for someone who has just been diagnosed. Using medical terms when describing the disease does not promote understanding.

The nurse is preparing a child and his family for a lumbar puncture. Which would be a primary intervention instituted to keep the child safe? A)Distraction methods B)Stimulation methods C)Therapeutic hugging D)Therapeutic touch

C) Therapeutic hugging (a holding position that promotes close physical contact between the child and a parent or caregiver) may be used for certain procedures or treatments where the child must remain still. Alternatively, distraction or stimulation (such as with a toy) can help to gain the child's cooperation, but therapeutic hugging would be used to keep the child safe during the procedure. Therapeutic touch is an energy therapy used to promote healing and decrease anxiety and stress and is not related to safety.

The nurse is teaching the student nurse how to communicate effectively with children. Which method would the nurse recommend? A)Position self above the child's level to denote authority. B)If possible, communicate with the child apart from the parent. C)Direct questions and explanations to the child. D)Use the medical terms for body parts and medical care.

C) To communicate effectively with children, the nurse should direct questions and explanations to the child; position self at the child's level; allow the child to remain near the parent if needed, so the child can remain comfortable and relaxed; and use the child's or family's terms for body parts and medical care when possible.

When performing the physical examination of a child with cystic fibrosis , which of the following would the nurse expect to assess? A) Dullness over the lung fields B) Increased diaphragmatic excursion C) Decreased tactile fremitus D) Hyperresonance over the liver

C) Decreased tactile fremitus Examination of a child with cystic fibrosis typically reveals decreased tactile fremitus over areas of atelectasis, hyperresonance over the lung fields from air trapping, decreased diaphragmatic excursion, and dullness over the liver when enlarged.

A nurse is preparing a teaching program for a parenting group about preventing foreign body aspiration. Which of the following would the nurse include? A) Avoid giving popcorn to children younger than the age of 2 years. B) Withhold peanuts from children until they are at least 5 years of age. C) If an object fits through a standard toilet paper roll, the child can aspirate it. D) Keep pennies and dimes out of the child's reach; quarters do not pose a problem.

C) If an object fits through a standard toilet paper roll, the child can aspirate it. Items smaller than 1.25 inches can be aspirated easily. A simple way for parents to estimate the safe size of a small item or toy piece is to gauge its size against a standard toilet paper roll, which is generally about 1.5 inches in diameter. If it fits through the roll, it can be aspirated. Popcorn and peanuts should not be given to children until they are at least 3 years old. All coins should be kept out of the reach of children.

The nurse hears wheezing when auscultating a 4-year-old. Which of the following conditions would the nurse most likely rule out based on the assessment findings? A) Bronchiolitis B) Asthma C) Influenza D) Cystic fibrosis

C) Influenza Wheezing typically is not associated with influenza. Wheezing is caused by an obstruction of the bronchioles that may be caused by bronchiolitis, asthma, cystic fibrosis, or chronic lung disease. In addition, if the bronchiolitis is due to influenza, wheezing may be heard.

The nurse is consulting with a child life specialist (CLS) to help minimize the stress of hospitalization for a child. Which services would the CLS provide? Select all answers that apply. A)Medical preparation for tests, surgeries, and other medical procedures B)Support before and after, but not during, medical procedures C)Activities to support normal growth and development D)Grief and bereavement support E)Emergency room interventions for children and families F)Only inpatient consultations with families

C),D),E) The CLS would provide activities to support normal growth and development, grief and bereavement support, and emergency room interventions for children and families. The CLS would also provide nonmedical preparation for tests, surgeries, and other medical procedures; support during medical procedures; and outpatient consultation with families.

The nurse is performing a physical assessment of a 3-year-old girl. What finding would be a concern for the nurse? A)The toddler gained 4 pounds in weight since last year. B)The toddler gained 3 inches in height since last year. C)The toddler's anterior fontanel is not fully closed. D)The circumference of the child's head increased 1 inch since last year.

C)The toddler's anterior fontanel is not fully closed. -The anterior fontanel should be closed by the time the child is 18-months old. The average toddler weight gain is 3 to 5 pounds per year. Length/height increases by an average of 3 inches per year. Head circumference increases about 1 inch from when the child is between 1 and 2 years of age, then increases an average of a half-inch per year until age 5.

The nurse is performing a cultural assessment of an Asian family that has a child hospitalized for leukemia. What is the best technique for providing culturally competent care for this family? A)Research the culture and base care on findings. B)Ask other Asians to explain their culture. C)Just ask the family about their culture and listen. D)Hire an interpreter to explain the family culture.

C. Understanding and respecting the family's culture helps foster good communication and improves child and family education about health care. The best way to assess the family's cultural practices is to ask and then listen. Determine the language spoken at home and observe the use of eye contact and other physical contact. Demonstrate a caring, nonjudgmental attitude and sensitivity to the child's and family's cultural diversity. An interpreter should be hired for a family who does not speak English.

A nurse is assessing the fontanels of a crying newborn and notes that the posterior fontanel pulsates and briefly bulges. What do these findings indicate? A) Increased intracranial pressure B) Overhydration C) Dehydration D) These are normal findings.

D

The nurse is performing a health history on a 6-year-old boy who is having trouble adjusting to school. Which of the following questions would be most likely to elicit valuable information? A) "Do you like your new school?" B) "Are you happy with your teacher?" C) "Do you enjoy reading a book?" D) "What are your new classmates like?"

D

When providing guidance to the parents of a child with Down syndrome, which of the following would be most appropriate? A) Encourage the parents to home-school the child. B) Advise the parents that the child will need monthly thyroid testing. C) Instruct them on the need for yearly dental visits. D) Teach the parents about the need for a high-fiber diet.

D Feedback: A high-fiber intake is important for children with Down syndrome because their lack of muscle tone may decrease peristalsis, leading to constipation. Early intervention programs with special education are important to promote growth and development. The child should be integrated into mainstream education whenever possible. Children with Down syndrome should undergo thyroid testing yearly and see the dentist every 6 months.

The nurse is caring for a 9-year-old boy with achondroplasia. Which of the following would the nurse expect to assess? A) Narrow passages from the nose to the throat B) Slim stature, hypotonia, and a narrow face C) Craniosynostosis and a small nasopharynx D) Trident hand and persistent otitis media

D Feedback: Achondroplasia results in disordered growth with an average adult height of 4 feet for males or females. Other distinguishing symptoms are a separation between the middle and ring fingers, called trident hand, and persistent otitis media and middle ear dysfunction. Narrow passages from nose to throat are a symptom of CHARGE syndrome. Slim stature, hypotonia, and a narrow face are symptoms of Marfan syndrome. Craniosynostosis and a small nasopharynx are symptoms of Apert syndrome.

The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. Which of the following would the nurse include as a major congenital anomaly? A) Overlapping digits B) Polydactyly C) Umbilical hernia D) Cleft palate

D Feedback: Cleft palate is considered a major congenital anomaly, one that creates a significant medical problem or requires surgical or medical management. Overlapping digits, polydactyly, and umbilical hernia are considered minor congenital anomalies because they do not cause an increase in morbidity in and of themselves.

The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. Which of the following would be most important for the nurse to incorporate into the plan of care when working with this family? A) Gathering information from at least three generations B) Informing the family of the need for a wide range of information C) Maintaining the confidentiality of the information D) Presenting the information in a nondirective manner

D Feedback: It is essential to respect client autonomy and present information in a factual, nondirective manner. In these situations, the nurse needs to understand that the choice is the couple's to make. Gathering information for three generations obtains a broad overview of what has been seen in both sides of the family. Maintaining confidentiality of the information is as important as with any other client information gathered. Informing family of the need for information is necessary because of its personal nature.

The nurse is teaching a couple about the pros and cons of genetic testing. Which of the following statements best describes the capabilities of genetic testing? A) "Various genetic tests help the physician choose appropriate treatments." B) "Genetic testing helps couples avoid having children with fatal diseases." C) "Genetic tests identify people at high risk for preventable conditions." D) "Some genetic tests can give a probability for developing a disorder."

D Feedback: The fact that some tests only provide a probability for developing a disorder raises a problem. A serious limitation of these susceptibility tests is that some people who carry a disease-associated mutation never develop the disease. The other statements affirm the value of genetic tests.

The nurse is caring for a 4-year-old boy with Ewing sarcoma who is scheduled for a computed axial tomography (CAT) scan tomorrow. Which is the best example of therapeutic communication? A)Telling him he will get a shot when he wakes up tomorrow morning B)Telling him how cool he looks in his baseball cap and pajamas C)Using family-familiar words and soft words when possible D)Describing what it is like to get a CAT scan using words he understands

D) Describing what it is like to get a CAT scan using age-appropriate words is the best example of therapeutic communication. It is goal-directed, focused, and purposeful communication. Using family-familiar words and soft words is a good teaching technique. Telling him how cool he looks in his baseball cap and pajamas is not goal-directed communication. Telling the child he will get a shot when he wakes up could keep him awake all night.

The nurse is educating the parents of a 7-year-old girl who has just been diagnosed with epilepsy. Which teaching technique would be most appropriate? A)Assessing the parents' knowledge of the anticonvulsant medications B)Demonstrating proper seizure safety procedures C)Discussing the surgical procedure for epilepsy D)Giving the parents information in small amounts at a time

D) Parents, when given a life-altering diagnosis, need time to absorb information and to ask questions. Therefore, giving the parents information in small amounts at a time is best. The child has just been diagnosed with epilepsy, and surgical intervention is not used unless seizures persist in spite of medication therapy. Therefore, discussing surgery would be inappropriate at this time. Assessing the parents' knowledge of the anticonvulsant medications identifies a knowledge gap and need to learn, but it would be unreasonable to think that they would understand the medications when the diagnosis had just been made. Demonstrating proper seizure safety procedures is an effective way to present information to an adult.

A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. Which of the following would the nurse have most likely assessed? A) High fever B) Dysphagia C) Toxic appearance D) Inspiratory stridor

D) Inspiratory stridor A child with croup typically develops a bark-like cough often at night. This may be accompanied by inspiratory stridor and suprasternal retractions. Temperature may be normal or slightly elevated. A high fever, dysphagia, and toxic appearance are associated with epiglottitis

A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which of the following would the nurse instruct the parents to administer orally? A) Recombinant human DNase B) Bronchodilators C) Anti-inflammatory agents D) Pancreatic enzymes

D) Pancreatic enzymes Most people with CF need to take pancreatic enzyme capsules before every meal and snack so their bodies can digest the nutrients. Meals and snacks include breast milk, formula, milk and nutritional supplements. People with CF should take enzymes with any food, unless it is pure sugar (such as a clear Popsicle, hard candy or fruit juice).

Which activity would the nurse least likely include as exemplifying the preconceptual phase of Piaget's preoperational stage? A)Displays of animism B)Use of active imaginations C)Understanding of opposites D)Beginning questioning of parents' values

D)Beginning questioning of parents' values In the intuitive phase of Piaget's preoperational stage, the child begins to question parents' values. Animism, active imaginations, and an understanding of opposites would characterize the preconceptual phase of Piaget's preoperational stage.

The nurse is teaching the parents of a 2-year-old girl how to deal with common toddler situations. Which is the best advice? A)Discipline the child for regressive behavior. B)Scold the child for public thumb sucking. C)Tell the older sibling to not act like a baby. D)Have the child help clean up a bowel accident.

D)Have the child help clean up a bowel accident. Having the child help clean up a bowel accident is the best advice. Toddlers should never be punished for bowel or bladder "accidents," but gently reminded about toileting. Regressive behavior is best ignored, while appropriate behavior should be praised. Telling the older sibling to not act like a baby is a negative approach. It would be better to have the child be mother's helper. Calmly telling the child that thumb sucking is something that is done at home is better than scolding the child.

The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which task would the nurse expect the toddler to be able to perform? A)Completing puzzles with four pieces B)Winding up a mechanical toy C)Playing make-believe with dolls D)Knowing which are his or her toys

D)Knowing which are his or her toys The toddler in Piaget's sensorimotor stage of cognitive development (18 to 24 months) understands requests, is capable of following simple directions, and has a sense of ownership (knowing which toys are his). The other tasks are accomplished by the child in the preoperational stage (2 to 7 years).

The nurse is performing a cognitive assessment of a 2-year-old. Which behavior would alert the nurse to a developmental delay in this area? A)The child cannot say name, age, and gender. B)The child cannot follow a series of two independent commands. C)The child has a vocabulary of 40 to 50 words. D)The child does not point to named body parts.

D)The child does not point to named body parts. The 2-year-old can point to named body parts and has a vocabulary of 40 to 50 words. At 30 months old a child can follow a series of two independent commands and at 3-years old a child can say name, age, and gender.

The nurse is watching toddlers at play. Which normal behavior would the nurse observe? A)Toddlers engage in parallel play. B)Toddlers engage in solitary play. C)Toddlers engage in cooperative play. D)Toddlers do not engage in play outside the home.

A)Toddlers engage in parallel play. Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

During a health history, the nurse explores the sleeping habits of a 3-year-old boy by interviewing his parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group? A)'Our son sleeps through the night, and we insist that he takes two naps a day.' B)'We keep a strict bedtime ritual for our son, which includes a bath and bedtime story.' C)'Our son still sleeps in a crib because we feel it is the safest place for him at night.' D)'Our son occasionally experiences night walking so we allow him to stay up later when this happens.'

'We keep a strict bedtime ritual for our son, which includes a bath and bedtime story.' Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.

After teaching a group of parents about language development in toddlers, what if stated by a member of the group indicates successful teaching? A)"When my 3-year-old asks 'why?' all the time, this is completely normal." B)"A 15-month-old should be able to point to his eyes when asked to do so." C)"At age 2 years, my son should be able to understand things like under or on." D)"An 18-month-old would most likely use words and gestures to communicate."

A)"When my 3-year-old asks 'why?' all the time, this is completely normal." Language development occurs rapidly in a toddler. By age 3 years, the child asks "why?" Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.

When providing anticipatory guidance to parents about their preschool son who was caught in a lie, what would the nurse emphasize? A)"You need to determine the reason for lying before punishing the child." B)"Lying should never be tolerated and the child should be punished." C)"The misbehavior is usually more serious than the lying itself." D)"It is okay to become angry when dealing with the child's lying."

A)"You need to determine the reason for lying before punishing the child." Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A)A less discriminating sense of taste B)A lack of fully developed hearing C)Visual acuity that has not fully developed D)A less discriminating sense of touch

A)A less discriminating sense of taste The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which best examplifies a school-ager working toward accomplishing this developmental task? A) The child signs up for after-school activities. B) The child performs his bedtime preparations autonomously. C) The child becomes aware of the opposite sex. D) The child is developing a conscience.

Ans: A Feedback: Erikson (1963) describes the task of the school-age years to be a sense of industry versus inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. Achieving independence is a task of the preschooler who also is developing a conscience at that age. Awareness of the opposite sex occurs in, but is not the focus of, the school-age child.

The nurse is teaching good sleep habits for toddlers to the mother of a 3-year-old boy. Which response indicates the mother understands sleep requirements for her son? A)"I'll put him to bed at 7 p.m., except Friday and Saturday." B)"He needs 12 hours of sleep per day including his nap." C)"I need to put the side down on the crib so he can get out." D)"His father can give him a horseback ride into his bed."

B)"He needs 12 hours of sleep per day including his nap." The mother understands her child needs 12 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. However, a horseback ride to bed may cause problems because it may not provide a calming transition from play to sleep. A bath and reading a book would be better. If the child can climb out of a crib, he needs to be in a youth bed or regular bed to avoid injury.

The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which of the following statements would indicate that the boy is having nightmares instead of night terrors? A)"It usually happens about an hour after he falls asleep." B)"He will tell us about what happened in his dream." C)"He is completely unaware that we are there." D)"When we try to comfort him, he screams even more."

B)"He will tell us about what happened in his dream." During a nightmare, a child will have a memory of the occurrence and may remember the dream and talk about it later. With night terrors, the child has no memory of the event. The other statements are indicative of night terrors.

The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer to prevent confrontations? A)"Respond in a calm but firm manner." B)"You need to adhere to various routines." C)"Put her in time-out when she misbehaves." D)"It's important to toddler-proof your home."

B)"You need to adhere to various routines." Making expectations known through everyday routines helps to avoid confrontations. This helps the child know what to expect and how to behave. It is the best guidance to give these parents. Calm response and time-out are effective ways to discipline, but do not help to prevent confrontations. Toddler-proofing the house doesn't eliminate all the opportunities for confrontation.

A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother? A)"It is best to avoid the playground until she outgrows the fear." B)"She needs to face her fears head-on; take her to the park as much as possible." C)"Acknowledge her fear and help her develop a strategy for dealing with it." D)"Try to minimize her fears and insist that she go to the park."

C)"Acknowledge her fear and help her develop a strategy for dealing with it." Preschoolers have vivid imaginations and experience a variety of fears. It is best to acknowledge the fear, rather than minimize it, and then collaborate with the child on strategies for dealing with the fear. Avoiding the playground will not address the child's fears. Forcing the child to face her fear without enlisting her input to help deal with the fear does not teach. It is also important for the mother to find out if an incident involving cats and dogs occurred without her knowledge.

The pediatric nurse is planning quiet activities for hospitalized 18-month-old. What would be an appropriate activity for this age group? A)Painting by number B)Putting shapes into appropriate holes C)Stacking blocks D)Using crayons to color in a coloring book

C)Stacking blocks At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly? A)Telling the child to stop tearing pages from magazines B)Asking the child if he would please quit throwing toys C)Telling the child firmly that we don't scream in the office D)Saying, "Please come over here and sit in this chair. OK?"

C)Telling the child firmly that we don't scream in the office Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

The nurse is supervising lunch time for children on a pediatric ward. Which observation is considered abnormal for this age group? A)The child has a full set of primary teeth. B)The child has no difficulty chewing and swallowing meat. C)The child uses his fingers and refuses to use a fork. D)The child is a picky eater.

C)The child uses his fingers and refuses to use a fork. The preschool child has learned to use utensils fairly effectively to feed himself or herself, has a full set of primary teeth, and is able to chew and swallow competently. Preschool children may be picky eaters. They may eat only a limited variety of foods or foods prepared in certain ways and may not be very willing to try new things.

The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. What might alert the nurse to a potential problem with the child's sensory development? A)The toddler places the nurse's stethoscope in his mouth. B)The toddler's vision tests at 20/50 in both eyes. C)The toddler does not respond to commands whispered in his ear. D)The toddler's taste discrimination is not at adult levels yet.

C)The toddler does not respond to commands whispered in his ear. Hearing should be at the adult level, as infants are ordinarily born with hearing intact. Therefore, the toddler should hear commands whispered in his ear. Toddlers examine new items by feeling them, looking at them, shaking them to hear what sound they make, smelling them, and placing them in their mouths. Toddler vision continues to progress and should be 20/50 to 20/40 in both eyes. Though taste discrimination is not completely developed, toddlers may exhibit preferences for certain flavors of foods.

Growth and Development

Growth and Development

The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem? A)Lack of social and emotional readiness for school B)Stuttering C)Speech and language delays D)Fine motor skills delay

A)Lack of social and emotional readiness for school Risk factors for lack of social and emotional readiness for school include insecure attachment in the early years, maternal depression, parental substance abuse, and low socioeconomic status.

The nurse is caring for a 5-year-old girl posttonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process? A)Magical thinking B)Centration C)Transduction D)Animism

A)Magical thinking The nurse understands that the girl is demonstrating magical thinking. Magical thinking is a normal part of preschool development. The preschool-age child believes her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as the basis for another situation whether or not they are truly causally linked. Animism is attributing life-like qualities to inanimate objects. Centration is focusing on one aspect of a situation while neglecting others.

The school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all that apply. A)Preschoolers enjoy books with pictures that tell stories. B)Preschoolers like stories with repeated phrases as they help keep their attention. C)Preschoolers like stories that describe experiences different from their own. D)Preschoolers demonstrate early literacy skills by reciting stories or portions of books. E)Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story.

A)Preschoolers enjoy books with pictures that tell stories. B)Preschoolers like stories with repeated phrases as they help keep their attention. D)Preschoolers demonstrate early literacy skills by reciting stories or portions of books. E)Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. Preschoolers enjoy books with pictures that tell stories. Stories with repeated phrases help to keep the child's attention. Also, children like stories that describe experiences similar to their own. The preschool child demonstrates early literacy skills by reciting stories or portions of books. He or she also may retell the story from the book, pretend to read books, and ask questions about the story. The preschool child has enough focus and expanded attention to notice when a page is skipped during reading and will call it to the parent's attention.

The nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth? A)Remove high-calorie, low-nutrient foods from the diet. B)Ensure 30 minutes of unstructured activity per day. C)Avoid sharing your snacks and candy with the child. D)Reduce the amount of high-fat food the child eats.

A)Remove high-calorie, low-nutrient foods from the diet. The most effective intervention will be to remove high-calorie, low-nutrient foods from the diet in order to reduce the number of calories and increase the nutritional value. Exercise is also important, but a child this age should have 30 minutes of structured physical activity plus several hours of unstructured physical activity per day. The parents should set an example for good eating habits. Dietary fat should not be restricted for an 18-month-old child because it is necessary for nervous system development.

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. What is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? A)Reward the child for initiative in order to build self-esteem. B)Change the routine of the preschooler often to stimulate initiative. C)Do not set limits on the preschooler's behavior as this results in low self-esteem. D)As a parent, decide how and with whom the child will play.

A)Reward the child for initiative in order to build self-esteem. The building of self-esteem continues throughout the preschool period. It is of particular importance during these years, as the preschooler's developmental task is focused on the development of initiative rather than guilt. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. Routine and ritual continue to be important throughout the preschool years, as they help the child to develop a sense of time as well as provide the structure for the child to feel safe and secure. Also, consistent limits provide the preschooler with expectation and guidance. Giving children opportunities to decide how and with whom they want to play also helps them develop initiative.

The parents of a 1-year-old girl, both of whom have perfect teeth, are concerned about their child getting dental caries. Which is the best advice the nurse can provide? A)Tell the parents to limit the child's eating to meal and snack times. B)Urge the parents to take the child to a dentist for a check-up. C)Advise the parents to reduce carbohydrates in the child's diet. D)Advise the parents to use fluoride toothpaste.

A)Tell the parents to limit the child's eating to meal and snack times. Telling the parents to limit eating to meal and snack times is the best advice for preventing dental caries. This reduces the amount of exposure the child's teeth have to food. Urging them to take the child to see a dentist is sound advice but doesn't suggest actions they can take now to prevent caries. Carbohydrates react with oral bacteria to cause caries, but they should not be reduced from the diet. Avoiding fluoridated toothpaste may help prevent fluorosis.

The nurse is performing an annual check-up for an 8-year-old child. Compared to the previous assessment of this child, which characteristic would most likely be observed? A) Breathing is diaphragmatic. B) Pulse rate is increased. C) Secondary sex characteristics are present. D) Blood pressure has reached adult level.

Ans: A Feedback: The child's respiratory system is maturing, so abdominal breathing has been replaced by diaphragmatic breathing. Pulse rate will decrease, rather than increase, during this time. Secondary sex characteristics will not appear until the late school-age years. Blood pressure will not reach the adult level until adolescence.

The school nurse providing school health screenings knows that the 7- to 11-year-old is in Piaget's stage of concrete operational thoughts. What should this age group accomplish when developing operations? Select all that apply. A) Ability to assimilate and coordinate information about the world from different dimensions B) Ability to see things from another person's point of view and think through an action C) Ability to use stored memories of past experiences to evaluate and interpret present situations D) Ability to think about a problem from all points of view, ranking the possible solutions while solving the problem E) Ability to think outside of the present and incorporate into thinking concepts that do exist as well as concepts that might exist F) Ability to understand the principle of conservation—that matter does not change when its form changes

Ans: A, B, C, F Feedback: Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about the world from different dimensions. He or she is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. The school-age child is able to use stored memories of past experiences to evaluate and interpret present situations. Also, during concrete operational thinking, the school-age child develops an understanding of the principle of conservation—that matter does not change when its form changes. According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one in the formal operational period. During this period, the adolescent is able to think about a problem from all points of view, ranking the possible solutions while solving the problem. The adolescent also develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. His or her thinking becomes logical, organized, and consistent.

The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which behaviors would the child also be expected to exhibit? A) Showing no interest in what the nurse sees in her ears B) Explaining what is right and what is wrong C) Demonstrating independence from her mother D) Showing no concern when the nurse hurts her own finger

Ans: B Feedback: At this age, behavior is seen by the child as either completely right or wrong. The child will almost surely want to know why the nurse looks in her ears. The child depends heavily on parents for support and encouragement at this age. This is a time when children gain empathy, so the child would show concern for the nurse's injury.

The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up the child weighed 80 pounds. According to average growth for this age group, what would be his expected current weight? A) 81 pounds B) 85 pounds C) 87 pounds D) 89 pounds

Ans: C Feedback: From 6 to 12 years of age, an increase of 7 pounds (3 to 3.5 kg) per year in weight is expected.

The nurse is assessing the gross motor skills of an 8-year-old boy. Which of interview question would facilitate this assessment? A) 'Do you like to do puzzles?' B) 'Do play any instruments?' C) 'Do you participate in any sports?' D) 'Do you like to construct models?'

Ans: C Feedback: To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

The school nurse knows that school-age children are developing metalinguistic awareness. Which is an example of this skill? A) The child enjoys reading books. B) The child enjoys conversations with peers. C) The child enjoys speaking on the phone. D) The child enjoys telling jokes.

Ans: D Feedback: Language skills continue to accelerate during the school-age years. School-age children develop metalinguistic awareness—an ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles due to their understanding of double meanings and play on words and sounds.

A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation? A) "This is normal behavior for infants unless the stool passed is hard and dry." B) "This is normal behavior for infants due to the immaturity of the gastrointestinal system." C) "This indicates a blockage in the intestine and must be reported to the physician." D) "This is normal behavior for infants unless the stool passed is black or green."

Ans: A Feedback: Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.

The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which of the following is the priority intervention to promote adequate growth? A) Monitoring the child's weight and height B) Encouraging a more frequent feeding schedule C) Assessing the child's current feeding pattern D) Recommending higher-calorie solid foods

Ans: A Feedback: Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.

The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which of the following topics would be most appropriate? A) Advising how to create a toddler-safe home B) Warning about small objects left on the floor C) Cautioning about putting the baby in a walker D) Telling about safety procedures during baths

Ans: A Feedback: The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.

The parent of a 6-month old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent? A) "Thumb sucking is a healthy self-comforting activity." B) "Thumb sucking leads to the need for orthodontic braces." C) "Caregivers should pay special attention to the thumb sucking to stop it." D) "Thumb sucking should be replaced with the use of a pacifier."

Ans: A Feedback: Thumb sucking is a healthy self-comforting activity. Infants who suck their thumbs or pacifiers often are better able to soothe themselves than those who do not. Studies have not shown that sucking either thumbs or pacifiers leads to the need for orthodontic braces unless the sucking continues well beyond the early school-age period. The infant who has become attached to thumb sucking should not have additional attention drawn to the issue, as that may prolong thumb sucking. Pacifiers should not be used to replace thumb sucking as this habit will also need to be discouraged as the child grows.

The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which statement by the parents indicates a need for further teaching? A) "It's better if we are not in the room for this." B) "We can use kangaroo care before and after." C) "We hope you are using a very tiny needle." D) "We can offer him nonnutritive sucking to calm him."

Ans: A Feedback: Unless contraindicated, the parents should be encouraged to be present before, during, and after the procedure to provide comforting support to the child. Kangaroo care, small-gauge needles, and nonnutritive sucking are other methods to provide atraumatic care.

The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which methods might the nurse choose? Select all that apply. A) Relaxation B) Distraction C) Thought stopping D) Massage E) Sucking

Ans: A, B, C Feedback: Common behavioral-cognitive strategies include relaxation, distraction, imagery, thought stopping, and positive self-talk. Sucking and massage are examples of biophysical interventions.

The nurse is explaining the effects of heat application for pain relief. Which effect would the nurse be likely to include? A) Decreased blood flow to the area B) Increased pressure on nociceptive fibers C) Possible release of endogenous opioids D) Altered capillary permeability

Ans: B Feedback: Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.

The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which examples are behavioral indicators? Select all that apply. A) The infant grimaces. C) The infant flails his arms and legs. E) The infant is crying uncontrollably.

Ans: A, C, E Feedback: In preterm and term newborns, behavioral and physiologic indicators are used for determining pain. Behavioral indicators include facial expression, body movements, and crying. Physiologic indicators include changes in heart rate, respiratory rate, blood pressure, oxygen saturation levels, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels.

When the nurse is assessing a child's pain, which is most important? A) Obtaining a pain rating from the child with each assessment B) Using the same tool to assess the child's pain each time C) Documenting the child's pain assessment D) Asking the parents about the child's pain tolerance

Ans: B Feedback: Although obtaining a pain rating, documenting the assessment, and asking the child's parents about the pain are important, the most important aspect of pain assessment is to use the same tool each time so that appropriate comparisons can be made and effective interventions can be planned and implemented. Consistency allows the most accurate assessment of the child's pain.

The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment? A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

Ans: B Feedback: Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need. Assessment of how the pain impacts the child's and family's stress, feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.

The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using? A) Relaxation B) Distraction C) Imagery D) Thought stopping

Ans: B Feedback: Distraction involves having the child focus on another stimulus, thereby attempting to shield him from pain. Humor has been demonstrated to be an effective distracting technique for pain management.

The nurse is educating a first-time mother who has a 1-week-old boy. Which of the following is the most accurate anticipatory guidance? A) Describing the effect of neonatal teeth on breastfeeding B) Explaining that the stomach holds less than 1 ounce C) Informing that fontanels will close by 6 months D) Telling that the step reflex persists until the child walks

Ans: B Feedback: Explaining that the child's stomach holds less than 1 ounce gives the mother a reason for frequent, small feedings and is the most helpful and accurate anticipatory guidance. Telling that the step reflex persists until the child walks and informing that fontanels will close by 6 months are inaccurate. The step reflex disappears at about 2 months and fontanels close between 12 and 18 months. Neonatal teeth are highly unusual and need no explanation unless they occur.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? A) "I'll start with baby oatmeal cereal mixed with low-fat milk." B) "The cereal should be a fairly thin consistency at first." C) "I can puree the meat that we are eating to give to my baby." D) "Once he gets used to the cereal, then we'll try giving him a cup."

Ans: B Feedback: Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? A) "This is a primitive reflex known as the plantar grasp." B) "This is a primitive reflex known as the palmar grasp." C) "This is a protective reflex known as rooting." D) "This is a protective reflex known as the Moro reflex."

Ans: B Feedback: Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."

The nurse is counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother? A) Carrying the baby may increase the length of crying. B) Reducing stimulation may decrease the length of crying. C) Using vibration, white noise, or swaddling may increase crying. D) Using a swing or car ride may increase the incidence of crying episodes.

Ans: B Feedback: Prolonged crying leads to increased stress among caregivers. Reducing stimulation may decrease the length of crying, and carrying the infant more may be helpful. Some infants respond to the motion of an infant swing or a car ride. Vibration, white noise, or swaddling may also help to decrease fussing in some infants. Parents should try one intervention at a time, taking care not to stimulate the infant excessively in the process of searching for solutions.

The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance? A) Promoting the digestibility of breast milk B) Telling how and when to introduce rice cereal C) Describing root reflex and latching on D) Advising how to choose a good formula

Ans: B Feedback: Telling the mother how to introduce rice cereal is the most appropriate subject for anticipatory guidance. Since this mother is already breast- or bottle-feeding her baby, educating her about these subjects would not inform her about what to expect in the next phase of development.

The nurse is teaching a new mother about the development of sensory skills in her newborn. Which of the following would alert the mother to a sensory deficit in her child? A) The newborn's eyes wander and occasionally are crossed. B) The newborn does not respond to a loud noise. C) The newborn's eyes focus on near objects. D) The newborn becomes more alert with stroking when drowsy.

Ans: B Feedback: Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 inches. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.

The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which of the following is a recommended guideline that should be implemented? A) Wash the hands and breasts thoroughly prior to breastfeeding. B) Stroke the nipple against the baby's chin to stimulate wide opening of the baby's mouth. C) Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. D) When finished the mother can break the suction by firmly pulling the baby's mouth away from the nipple.

Ans: C Feedback: Before each breastfeeding session, mothers should wash their hands, but it is not necessary to wash the breast in most cases. The mother should then stroke the nipple against the baby's cheek to stimulate opening of the mouth and bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola When the infant is finished feeding, the mother can break the suction by inserting her finger into the baby's mouth.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week old baby. Which of the following recommended guidelines might be included in the teaching plan? A) Place the baby on a soft mattress with a firm flat pillow for the head. B) Place the head of the bed near the window to provide fresh air, weather permitting. C) Place the baby on his or her back when sleeping. D) If the baby sleeps through the night, wake him or her up for the night feeding.

Ans: C Feedback: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

The nurse is administering pain medication for a child with continuous pain from internal injuries. Which method would be ordered to dispense the medication? A) Administer the medication PRN (as needed). B) Administer the mediation when pain has peaked. C) Administer the medication around the clock at timed intervals. D) Administer the medication when the child complains of pain.

Ans: C Feedback: With any medication administered for pain management, the timing of administration is vital. Timing depends on the type of pain. For continuous pain, the current recommendation is to administer analgesia around the clock at scheduled intervals to achieve the necessary effect. As-needed or PRN dosing is not recommended for continuous pain. This method can lead to inadequate pain relief because of the delay before the drug reaches its peak effectiveness. For pain that can be predicted or considered temporary, such as with a procedure, analgesia is administered so that the peak action of the drug matches the time of the painful event. It is not recommended to wait until the child complains of pain because therapeutic levels will be difficult to reach at this point.

A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. Which of the following is the priority nursing intervention? A) Talking about solid food consumption B) Discouraging daily fruit juice intake C) Increasing the number of breastfeedings D) Discussing the child's feeding patterns

Ans: D Feedback: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.

The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which of the following is the most effective anticipatory guidance? A) Encouraging breastfeeding until the sixth month B) Advocating iron supplements with bottle-feeding C) Advising fluid intake per feeding of 5 or 6 ounces D) Discouraging the addition of fruit juice to the diet

Ans: D Feedback: Discouraging the addition of fruit juice to the child's diet is the most effective anticipatory guidance. Fruit juice can displace important nutrients from breast milk or formula. Encouraging breastfeeding until the sixth month is only halfway to the Healthy People goal of breastfeeding for the first year. Advising fluid intake per feeding of 5 or 6 ounces is too much for this neonate, but is typical for an infant 4 to 6 months of age. Advocating iron supplements with bottle-feeding is unnecessary so long as the formula is fortified with iron.

The neonatal nurse assesses newborns for iron-deficiency anemia. Which of the following newborns is at highest risk for this disorder? A) A postterm newborn B) A term newborn with jaundice C) A newborn born to a diabetic mother D) A premature newborn

Ans: D Feedback: Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Infants born prematurely miss all or at least a portion of this iron store transfer, placing them at increased risk for iron-deficiency anemia compared with term infants. An infant having jaundice, having been born to a mother with diabetes, or have been born postterm does not significantly place the infant at risk for iron-deficiency anemia.

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain? A) FACES pain rating scale B) Oucher pain rating scale C) Poker chip tool D) Numeric pain intensity scale

Ans: D Feedback: The numeric pain intensity scale can be used with children as young as 5 years of age, but the preferred minimum age for using this tool is 7 years. The FACES and Oucher pain rating scales and the poker chip tool are appropriate pain assessment tools for a 4-year-old.

The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which adverse effect of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression

Ans: D Feedback: The nurse needs to monitor for signs of respiratory depression, a potential adverse effect of the opioid medication. Epidural hematoma, arachnoiditis, and spinal headache are potential adverse effects of the insertion of the epidural catheter.

The nurse is caring for a 6-year-old child who has multisystem trauma due to a motor vehicle accident. The child is receiving total parenteral nutrition (TPN). What is a recommended nursing intervention for children on TPN? A)Initially, check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. B)Be vigilant in monitoring the infusion rate, change the rate as necessary, and report any changes to the physician or nurse practitioner. C)If for any reason the TPN infusion is interrupted or stops, begin an infusion of a 10% saline at the same infusion rate as the TPN. D)Administer TPN continuously over an 8-hour period, or after initiation it may be given on a cyclic basis, such as over a 12-hour period during the night.

Ans:A Initially, the nurse should check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. Throughout TPN therapy, the nurse should be vigilant in monitoring the infusion rate, and report any changes in the infusion rate to the physician or nurse practitioner immediately. Adjustments may be made to the rate, but only as ordered by the physician or nurse practitioner. If for any reason the TPN infusion is interrupted or stops, the nurse should begin an infusion of a 10% dextrose solution at the same infusion rate as the TPN. TPN can be administered continuously over a 24-hour period, or after initiation it may be given on a cyclic basis, such as over a 12-hour period during the night.

The nurse is preparing to administer insulin to a diabetic child. Which would be the recommended route for this administration? A)Subcutaneous B)Intradermal C)Intramuscular D)Oral

Ans:A Subcutaneous (SQ) administration distributes medication into the fatty layers of the body. It is used primarily for insulin administration, heparin, and certain immunizations, such as MMR. Intradermal administration is used primarily for tuberculosis screening and allergy testing. Intramuscular administration is used to administer certain medications, such as many immunizations. Insulin is not administered orally.

A physician orders a medication dosage that is above the normal dosage. The nurse administers the medication without questioning the dosage. What error did the nurse make? A)The nurse violated one of the "rights" of medication administration. B)The nurse performed an act outside the scope of practice for nursing. C)The nurse has not made an error, but the physician did by ordering the wrong dosage of medication. D)The nurse has committed an act of maleficence by administering the medication.

Ans:A The nurse violated one of the "rights" of medication administration, the right dosage, because the nurse is responsible for being aware and questioning an incorrect dosage of medication. Medication administration is within the scope of nursing practice. Maleficence is performing a harmful act intentionally.

The nurse is preparing to administer a medication to a 5-year-old who weighs 35 pounds. The prescribed single dose is 1 to 2 mg/kg/day. Which is the appropriate dose range for this child? A)8 to 16 mg B)16 to 32 mg C)35 to 70 mg D)70 to 140 mg

Ans:B The nurse should convert the child's weight in pounds to kilograms by dividing the child's weight in pounds by 2.2. (35 pounds divided by 2.2 = 16 kg). The nurse would then multiply the child's weight in kilograms by 1 mg for the low end (16 kg × 1 mg = 16 mg) and then by 2 mg for the high end (16 kg × 2 mg = 32 mg).

The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select? A)Rectus femoris B)Vastus lateralis C)Dorsogluteal muscle D)Deltoid

Ans:B The preferred injection site in infants is the vastus lateralis muscle. An alternative site is the rectus femoris. The dorsogluteal site is not used in children until the child has been walking for at least 1 year. The deltoid muscle is used as a site in children after the age of 4 or 5 years.

The parents of a child receiving total parenteral nutrition ask the nurse why their child must have their blood glucose monitored so frequently since they are not diabetic. What is the best response by the nurse? A)"We like to keep a close check on the blood glucose for all children receiving total parenteral nutrition." B)"It is important to monitor the blood glucose level because the solution has a high concentration of carbohydrates that convert to glucose." C)"This is a good time for us to monitor your child in case they start developing signs of diabetes related to receiving total parenteral nutrition." D)"I would suggest you ask the physician why blood glucose checks have been ordered so frequently."

Ans:B Total parenteral nutrition has a high concentration of carbohydrates, which convert to glucose. Informing the parents that this is the reason for frequent monitoring of the blood glucose adequately addresses their question. It is routine for any patient receiving total parenteral nutrition to have frequent monitoring of blood glucose, but this does not answer the parent's question. There is no need to monitor a child for diabetes without reason. There is no reason to suggest asking the physician when this question can be answered by the nurse.

The nurse is administering immunizations to children in a neighborhood clinic. What is the most frequent route of administration? A)Oral B)Intradermal C)Intramuscular D)Topical

Ans:C Intramuscular (IM) administration delivers medication to the muscle. In children, this method of medication administration is used infrequently because it is painful and children often lack adequate muscle mass for medication absorption. However, IM administration is used to administer certain medications, such as many immunizations.

The nurse is preparing to administer oral ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child? A)50 to 100 mg per dose B)100 to 500 mg per dose C)500 to 1,000 mg per dose D)1,000 to 5,000 mg per dose

Ans:C To calculate the dosage, the nurse would set up a proportion to calculate the low dose as follows: 50 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 50 × 40; x = 2,000 mg divided by 4 doses per day = 500 mg. Then calculate the high safe dose range using the following proportion: 100 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 100 × 40; x = 4,000 mg divided by 4 doses per day = 1,000 mg.

When describing the differences affecting the pharmacokinetics of drugs administered to children, which would the nurse include? A)Oral drugs are absorbed more quickly in children than adults. B)Absorption of intramuscularly administered drugs is fairly constant. C)Topical drugs are absorbed more quickly in young children than adults. D)Absorption of drugs administered by subcutaneous injection is increased.

Ans:C Topical absorption of drugs is increased in infants and young children because the stratum corneum is thinner and well hydrated. The absorption of oral drugs is slowed by slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, high gastric pH, and decreased lipase and amylase secretion. The absorption of drugs given intramuscularly or subcutaneously is erratic and may be decreased.

The nurse is administering acetaminophen PRN to a 9-year-old child on the pediatric ward of the hospital. Which answers reflect nursing actions that follow the rules of the 'eight rights' of pediatric medication administration? Select all that apply. C)The nurse checks the documented time of the last dosage administered. D)The nurse calculates the dosage according to the child's weight. E)The nurse explains the therapeutic effects of the medication to the child and parents.

Ans:C, D, E Following the 'right patient' rule, the nurse checks the documented time of the last dosage administered. For the 'right dose,' the nurse calculates the dosage according to the child's weight. For the 'right to be educated,' the nurse explains the therapeutic effects of the medication to the child and parents. To ensure the 'right patient,' the nurse confirms the child's identity and then checks with the caregivers for further identification. To administer at the 'right time,' the nurse gives the medication within 20 to 30 minutes of the ordered time, and to protect the child's 'right to refuse,' the nurse respects the child's or parents' option to refuse.

The nurse is administering a liquid medication to a 3-year-old using an oral syringe. Which action would be most appropriate? A)Direct the liquid toward the anterior side of the mouth. B)Keep the child's hand away from the oral syringe when squirting the medication. C)Give all of the drug in the syringe at one time with one squirt. D)Allow the child time to swallow the medication in between amounts.

Ans:D When using an oral syringe to administer liquid medications, give the drug slowly in small amounts and allow the child to swallow before placing more medication in the mouth. The syringe is directed toward the posterior side of the mouth. The toddler or young preschooler may enjoy helping by squirting the medication into his or her mouth.

The nurse caring for a 6-year-old patient enters the room to administer an oral medication in the form of a pill. The dad at the bedside looks at the pill and tells the nurse that his daughter has a hard time swallowing pills. Which of the following is the best response by the nurse? A)Ask the child to try swallowing the pill and offer a choice of drinks to take with it. B)Crush the pill and add it to applesauce. C)Request that the physician prescribe the medication in liquid form. D)Call the pharmacy and ask if the pill can be crushed.

Ans:D The father is the best source of knowledge on medication administration for the child. The pharmacy should be called to determine if the pill might be crushed. Asking the child to try swallowing the pill disregards the information the father has just given. Requesting that the physician order the medication in liquid form is not necessary at this point.

The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse? A)'The preschooler has no sense of right and wrong.' B)'The preschooler is developing a conscience.' C)'The preschooler sees morality as internal to self.' D)'The preschooler's morals are their own, right or wrong.'

B)'The preschooler is developing a conscience.' The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own.

The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 inches tall at her last examination at age 4. Which height measurement would be within the normal range of growth expected for a preschooler? A)41 inches B)43 inches C)45 inches D)47 inches

B)43 inches The average preschool-age child will grow 2.5 to 3 inches (6.5 to 7.8 cm) per year. The average 3-year-old is 37 inches tall (96.2 cm), the average 4-year-old is 40.5 inches tall (103.7 cm), and the average 5-year-old is 43 inches tall (118.5 cm).

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. What is a recommended guideline when dealing with this issue? A)Be prepared to thoroughly cover a topic before the child asks about it. B)Before answering questions, find out what the child thinks about the subject. C)Expand upon the topic when answering questions to prevent further confusion. D)Provide a less than honest response to shelter the child from knowledge that is too advanced.

B)Before answering questions, find out what the child thinks about the subject. Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to answer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting.

The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's 'negativism.' Based on Erickson's theory of development, what would be an appropriate intervention for this child? A)Discourage solitary play; encourage playing with other children. B)Encourage the child to pick out his own clothes. C)Use 'time-outs' whenever the child says 'no' inappropriately. D)Encourage the child to take turns when playing games.

B)Encourage the child to pick out his own clothes. Erikson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism and always saying "no" is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with 'time-outs.' The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which intervention would be appropriate advice? A)Allow the child to pick out his or her own foods for meals. B)Present the food matter-of-factly and allow the child to choose what to eat. C)Offer high-fat snacks if the child does not eat to get them to eat something. D)Offer the child a special treat if he or she eats all the food on the plate.

B)Present the food matter-of-factly and allow the child to choose what to eat. The parents should maintain a matter-of-fact approach, offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat. High-fat, nutrient-poor snacks should not be substituted for healthy foods just to coax the child to "eat something." If the preschooler is growing well, then the pickiness is not a cause for concern. A larger concern may be the negative relationship that can develop between the parent and child relating to mealtime. The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to try new foods or even eat the ones he or she likes that are served. The child should be offered a healthy diet, with foods from all groups over the course of the day as recommended by the U.S. Department of Agriculture.

The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? A)The child has trouble undressing himself. B)The child is unable to push a toy lawnmower. C)The child is unable to unscrew a jar lid. D)The child falls when he bends over.

B)The child is unable to push a toy lawnmower. Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age.

What activity would the nurse expect to find in an 18-month-old? A)Standing on tiptoes B)Pedaling a tricycle C)Climbing stairs with assistance D)Carrying a large toy while walking

C)Climbing stairs with assistance Toddlers continue to progress with motor skills. An 18-month-old should be able to climb stairs with assistance. A 24-month-old should be able to stand on his or her tiptoes and carry a large toy while walking. A 36-month-old would be able to pedal a tricycle.

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. What is a recommended intervention for this age group? A)Remove children's security blankets at this stage to help them assert their autonomy. B)Distract toddlers from exploring their own body parts, particularly their genitals. C)Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. D)Offer toddlers many choices to foster control over their environment.

C)Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely upon a security item to self-soothe as this is a function of autonomy and is viewed as a sign of a nurturing environment, rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? A)Can copy a square on another piece of paper B)Can dress and undress herself without help C)Draws a person with three body parts D)Is beginning to tie her own shoelaces

C)Draws a person with three body parts By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. What is an appropriate response to this concern? A)Tell the child in a firm manner that this behavior is not acceptable. B)When the child displays this behavior, place him in a 'time-out.' C)Treat the action in a matter-of-fact manner emphasizing safety. D)Consult a psychotherapist to determine the reason for this behavior.

C)Treat the action in a matter-of-fact manner emphasizing safety. Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do? A)"Place her in a booster seat with lap and shoulder belts in the front seat." B)"Place her in the back seat with the lap and shoulder belts in place." C)"Place her in a forward-facing car seat with a harness and top tether." D)"Place her in a booster seat with lap and shoulder belts in the back seat."

D)"Place her in a booster seat with lap and shoulder belts in the back seat." A child who weighs between 40 and 80 pounds should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap/shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 pounds.

The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond? A)"Is there a family history of diabetes?" B)'Suddenly having accidents can be a sign of diabetes." C)"That's normal; don't worry about it." D)"Tell me about the circumstances when this occurs."

D)"Tell me about the circumstances when this occurs." Bladder control is present in 4- and 5-year-olds, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.

The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which safety intervention should the nurse address? A)Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. B)Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. C)Encourage parents to smoke only in designated rooms in the house or outside the house. D)Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.

D)Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car. Safety is of prime concern throughout the toddler period. The safest place for the toddler to ride is in the back seat of the car. Parents should use the appropriate size and style of car seat for the child's weight and age as required by the state. At a minimum, all children over 20 pounds and up to 40 pounds should be in a forward-facing car seat with harness straps and a clip. Parents who want to enroll a toddler in a swimming class should be aware that a water safety skills class would be most appropriate. However, even toddlers who have completed a swimming program still need constant supervision in the water. Pot handles on stoves should be turned inward to avoid accidental burn. Nurses should counsel parents to stop smoking (optimal), but if they continue smoking never to smoke inside the home or car with children present.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching? A)Telling them either one may demonstrate toilet use B)Assuring them that bladder control occurs first C)Telling them that curiosity is a sure sign of readiness D)Advising them to use praise, not scolding

D)Advising them to use praise, not scolding The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which behavior would warrant nursing intervention? A)The child pretends he is talking to an imaginary friend when the nurse addresses the child. B)The child states that her fairy godmother is going to come and take her home. C)The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. D)The child does not want to play games with other children on the hospital ward.

D)The child does not want to play games with other children on the hospital ward. The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses transduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

The nurse is preparing a presentation for a local parent-teacher organization about the growth and development of school-age children. Which of the following would the nurse include? A) Boys mature much more quickly than girls of the same age during this time. B) From 6 to 12 years of age, children grow an average of 4 inches per year. C) The child's body sizeis in direct correlation with his or her maturity level. D) Secondary sex characteristics are often embarrassing for both sexes.

D. Secondary sex characteristics are often embarrassing for both sexes.