PEDIATRICS EXAM

During a well-child visit for a 2-month-old infant, the nurse explains the need to perform a hearing screening on the child within the next few months. The child's mother reports she has not noticed any deficits and does not see the need for this being done. Which response by the nurse is indicated?

"Unfortunately hearing losses in infants are common and it is best to check hearing before your child is 6 months old to rule out problems.

A 6-month-old infant, who was born 8 weeks premature, is seen in the clinic for a well-child visit. Which statement by the parent is evidence further education is needed?

"My infant should begin solids now, because my infant is 6 months old."

The postpartum nurse observes new mothers as they put their newborns in the bassinet to sleep. Which actions by the new mothers require further instruction from the nurse? Select all that apply.

- A mother states her baby looks too warm, so she is moving the bassinet in front of the air conditioner to cool him off. - A mother states all of her children like sleeping on their abdomen and this newborn likes it too. - A mother places the baby comforter her grandmother made over the newborn's body. - A mother places her newborn on its side after falling asleep

The nurse is assisting with the physical examination on a sleeping10-month-old infant being held by the parent against the parent's shoulder. In what sequence would the nurse complete the assessment?

back and extremities; head and neck; then the ears, nose, mouth, and eyes

The nurse is assessing a 4-month-old infant during a scheduled visit. Which findings might suggest a developmental problem?

The child does not make sounds in response to voices

When assessing the oral cavity of a 2 1/2-year-old toddler, which finding is expected? A. 12 deciduous teeth B. 20 deciduous teeth C. 16 deciduous and 2 permanent teeth D. 6 deciduous and 12 permanent teeth

B. 20 deciduous teeth

The nurse is caring for a 5-year-old child. The child's parent reports that the parent and child are constantly fighting about the child's choice of clothing. The child insists on selecting ones own clothes. The parent is tired of the power struggle and is embarrassed by the child's mismatched apparel. The parent asks for guidance. How should the nurse respond? A. "Offer two or three coordinated outfits and let the child choose." B. "Lay the clothes out in the order in which they are to be put on." C. "Only give your child clothes that are easy to put on." D. "Remind your child of the importance of dressing appropriately."

A. "Offer two or three coordinated outfits and let the child choose."

At which age would the nurse expect to find the beginning of object permanence?

6 months

The nurse is caring for an infant who was injured in a severe automobile accident. The child experienced several fractures and is in significant pain. The child's mother questions if this will impact her child later in life. What information should be provided by the nurse?

Experiences with pain even in infancy can influence an individual's response to pain later

What action shows an example of Erik Erikson's developmental task for the infant?

The infant cries and the caregiver picks the child up

A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child?

The infant says "da-da" when looking at her father

A toddler's mother reports that her child will only eat peanut butter and jelly sandwiches for several days in a row. The child will then refuse to eat them for several weeks. Which term would the nurse use to document this behavior? A. Physiologic anorexia B. Echolalia C. Food jag D. Egocentrism

C. Food jag

The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk?

Uses only the left hand to grasp

The nurse is interacting with several families with children during their health visits. Which child would the nurse prioritize to receive a hearing screening?

the 3-week-old infant who was discharged without a hearing screening

When describing play by the school-aged child to a group of nursing students, the instructor would emphasize the need for which of the following? A. Rules B. Recreation C. Physical activity D. Ritualism

A. Rules

A nurse is teaching parents of a 2-year-old child about discipline and limit setting. When describing the use of time out, the nurse would inform the parents that the maximum duration of time out should be how many minutes per each year of age? A. 1 minute B. 30 seconds C. 90 seconds D. 2 minutes

A. 1 minute

A nurse is conducting a class for new mothers about infants and nutrition. One of the women asks, "What is the best nutrition for my 3-month-old infant?" Which response by the nurse would be most appropriate?

Human milk is the best nutrition for your child

The nurse caring for a hospitalized child with failure to thrive (FTT) will focus first on

assisting the child to attain adequate nutrition to demonstrate weight gain

A nurse is working with the local community on promoting physical fitness for children. The nurse encourages the community to develop programs that meet the needs of the school-aged child for physical activity, based on the understanding that this age group requires how much physical activity daily? A. 60 minutes B. 15 minutes C. 30 minutes D. 90 minutes

A. 60 minutes

A nurse is working with a preceptor in a well-baby clinic that deals with children aged birth to 12 years old. During the routine physical assessment of a 2-year-old, the nurse identifies which finding as being abnormal for this age group? A. heart rate of 92 beats/min, regular B. respiration rate of 20 bpm, abdominal breathing noted C. blood pressure of 116/80 mm Hg D. wears diapers since not potty trained

C. blood pressure of 116/80 mm Hg

The parents of a 6-month-old boy, born 8 weeks' prematurely, ask the visiting home nurse when they should consider starting the infant on solid foods. What would the nurse's best response be?

I suggest you wait until he is 8 months old.

The parents of a 2 year old are concerned because the toddler only says a few words. What strategies should the nurse suggest to the parents? Select all that apply

A. Read books aloud to the toddler B. Name aloud the objects being played with. C. Always answer questions using correct grammar.

The nurse is reviewing the medical record for a 13-year-old child who is being seen for concerns about school attendance. The physician has noted the child has "school phobia". What behaviors may be noted in a child experiencing this phenomena? Select all that apply. A. Reports of fear when attending school B. Demonstrates negative behaviors before school C. Chronically late for school D. Reports of feeling bored at school E. Difficulty making friends

A. Reports of fear when attending school B. Demonstrates negative behaviors before school C. Chronically late for school

The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which topic 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. Instructing on safety procedures during baths

A. Advising how to create a toddler-safe home

The mother of an 11-year-old child tells the nurse that her child seems to be "hungry all of the time" and seems to "never get full". The nurse suspects a physiological developmental problem. What is the rationale for the nurse suspecting a physiological developmental issue? Select all that apply. A. Stomach capacity increases, which should permit retention of food for longer periods of time B. The caloric needs of the school-age child are lower than in the earlier years of life C. School-age children typically consume less food than adolescents D. Peer pressure tends to cause the child to eat less E. The school-age child is very selective in the type of foods they prefer

A. Stomach capacity increases, which should permit retention of food for longer periods of time B. The caloric needs of the school-age child are lower than in the earlier years of life

The mother of a school-age child is distraught because the child has been diagnosed with obesity. What actions should the nurse suggest to the mother to help the child with this problem? Select all that apply. A. Explain that obesity will lead to an early death. B. Maintain a balanced eating approach in the home. C. Purchase books explaining the latest ways to lose weight. D. Seek out a preteen weight loss group for the child to participate. E. Encourage increased activity such as walking the dog after school.

B. Maintain a balanced eating approach in the home. D. Seek out a preteen weight loss group for the child to participate. E. Encourage increased activity such as walking the dog after school

The mother of a 2 year old asks the nurse, "How can I help to foster my child's language skills?" Which of the following would be most appropriate for the nurse to suggest? Select all that apply. A. Accepting the child's "no" as indicating actual refusal B. Reading to the child often C. Naming objects as they are used with the child D. Answering the child's questions in simple terms E. Supplying things to the child before he or she asks for them

B. Reading to the child often C. Naming objects as they are used with the child D. Answering the child's questions in simple terms

A 2-year-old child is shopping with her mother when she suddenly falls to the ground and begins to scream, "I want it!" over and over regarding a bag of candy. What would the nurse recommend to the mother to deal with this behavior? Select all that apply. A. Reason with the toddler and explain that the candy is not nutritious for her. B. Remain calm and ignore the tantrum. C. Do not reward the behavior by giving into the toddler's demands and buying the D. Pick the toddler up and take her to the restroom for a spanking. E. Pick the toddler up and move her to a safe environment but do not give in to her desires.

B. Remain calm and ignore the tantrum. C. Do not reward the behavior by giving into the toddler's demands and buying the candy E. Pick the toddler up and move her to a safe environment but do not give in to her desires

A 12-year-old child tells the school nurse, "I do not understand why my parents will not allow me to go to concerts without chaperones like some of my friends' parents. I feel like a baby compared to my friends." How will the nurse respond? A. "Your parents are right. Twelve years old is too young to be attending concerts without a chaperone." B. "I'm sure your parents are just very worried that you could get into trouble attending concerts at a young age." C. "Have you given any thought to why they don't let you go without a chaperone? Let's talk about some of the reasons they feel this way." D. "You are so young that you have plenty of time to go to concerts alone. Your parents just care about you."

C. "Have you given any thought to why they don't let you go without a chaperone? Let's talk about some of the reasons they feel this way."

A group of 10-year-old girls have formed a "girls only" club. It is only open to girls who still like to play with dolls. How should this behavior be interpreted? A. poor peer relationships B. encouragement for bullying and sexism C. appropriate social development D. immaturity for this age group

C. appropriate social development Nine-year-olds take the values of their peer group seriously.

The nurse is caring for the family with a 2-month-old boy with colic. The mother reports feeling very stressed by the baby's constant crying. Which intervention would provide the most help in the short term?

Urging the baby's mother to take time for herself away from the child

The nurse is completing a physical assessment of a 15-month-old Which objective data would the nurse document as normal findings? Select all that apply. A. Heart rate of 100 beats per minute B. Predominance of baby fat C. Sunken abdomen D. Lordosis E. Waddling gait

A. Heart rate of 100 beats per minute D. Lordosis E. Waddling gait

After teaching a group of nursing students about developmental milestones for children, between the ages of 1 to 4 years, the instructor determines that the teaching was successful when the students identify which of the following as a gross motor developmental milestone that occurs between 2 to 3 years of age? A. Jumping in place B. Riding a tricycle C. Climbing D. Standing on one foot with help

A. Jumping in place

What is the correct amount of wet diapers a mature infant should produce each day?

An infant should have 6 to 8 wet diapers/day

A child is refusing to use the potty and having accidents, even though he has achieved toilet training. This is an example of which type of behavior? A. Regression B. Positive redirection C. Desensitization D. Phobia

A. Regression

An anxious 12-year-old girl receives an injection from the nurse and sighs with relief when it is done. After a moment of reflection, the girl asks the nurse, "Is it hard to give someone an injection?" This girl's question is evidence that she has developed which cognitive skill? A. Decentering B. Accommodation C. Conservation D. Class inclusion

A. Decentering Decentering is the ability to project one's self into other people's situations and see the world from their viewpoint rather than focusing only on their own

A nurse is providing anticipatory guidance to parents of a 3-year-old about nutrition and finger foods. Which of the following would be most appropriate for the nurse to suggest? Select all that apply A. Diced fruit B. Shredded cheese C. Cereal D. Grapes E. Chunks of carrots

A. Diced fruit B. Shredded cheese C. Cereal

A nurse is carrying on a conversation with a 7-year-old girl during an office visit. Which of the following is an example of the level of language development the nurse should expect in this child? A. Difficulty understanding the concept of "half past" in reference to time B. Ability to carry on an adult conversation C. Inability to speak in full sentences D. Fascination with bathroom language

A. Difficulty understanding the concept of "half past" in reference to time

The father of a 12-year-old girl reports his daughter does not have high self-esteem. He asks for suggestions to increase her feels of self-worth. What activities would be appropriate for the nurse to suggest? Select all that apply. A. Encourage the child to join a club at school. B. Recommend she begin to participate in after-school activities. C. Provide her with a weekly allowance. D. Allow the child to begin staying home alone after school when possible. E. Recommend the child investigate opportunities for volunteering at local charities.

A. Encourage the child to join a club at school. B. Recommend she begin to participate in after-school activities. E. Recommend the child investigate opportunities for volunteering at local charities.

A nurse is working with a family that has two children who were identified as overweight based on screening. Which of the following strategies would be important for the nurse to include in assisting the family? Select all that apply. A. Encouraging moderate exercise for 60 minutes/day B. Emphasizing that the family not skip meals C. Involving the entire family in the program D. Focusing on rapid weight loss regimens E. Using food as a punishment

A. Encouraging moderate exercise for 60 minutes/day B. Emphasizing that the family not skip meals C. Involving the entire family in the program

A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which finding should concern the nurse? A. Total weight gain of 15 lb in the past year B. Increase in height of 5 inches in the past year C. Prominent abdomen D. Forward curve of the spine at the sacral area

A. Total weight gain of 15 lb in the past year - A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year during the toddler period

A 12-year-old girl has recently begun menstruating and is well into puberty. She is visiting the doctor today for a routine physical examination. Which of the following findings should cause concern in the nurse? A. Vulvar irritation B. Irregular periods C. Breasts of slightly different sizes D. Supernumerary nipple

A. Vulvar irritation Any secretions that cause vulvar irritation should be evaluated by a health care provider, because this does suggest infection.

The parent of a 20-month-old toddler reports the toddler has been becoming distraught when the parent leaves. The parent asks the nurse for advice about what is going on and how to best manage it. What information can be provided? Select all that apply. A. "This is actually a regression for your toddler because separation anxiety normally occurs in infancy." B. "This is a normal happening for a toddler of this age." C. "As your toddler begins to learn that you will return the toddler will become less upset." D. "Your care providers may be frightening to your toddler." E. "Establishing a routine for saying goodbye to your toddler will be helpful."

B. "This is a normal happening for a toddler of this age." C. "As your toddler begins to learn that you will return the toddler will become less upset." E. "Establishing a routine for saying goodbye to your toddler will be helpful."

The parents of a 10-year-old boy report they are having problems with their son. The child's mother reports her son is not a talented athlete but her husband continues to encourage him to play and try to excel. The child's father reports sports will help his son build character. What response by the nurse is most appropriate? A. "Encouraging involvement in sports can build valuable skills for a child." B. "Although your son is not a talented athlete, continue to encourage him to try." C. "Perhaps another pursuit would be better suited for your son." D. "It is important not to let him quit without trying."

C. "Perhaps another pursuit would be better suited for your son."

A mother is concerned that her 2-year-old child is having seizures. He holds his breath until he passes out when he wants something his mother does not want him to have. How should the nurse respond to this mother's concern? A. Seizures rarely occur in toddlers B. With seizures, cyanosis rarely develops. C. Seizures are not provoked; temper tantrums are. D. Seizures typically occur with fever; temper tantrums do not.

C. Seizures are not provoked; temper tantrums are.

The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response? A. Some children have large heads but that does not signal a problem. B. Explain that the child looks normal. C. Share that the heads of children at this age are large in proportion to the rest of their body. D. Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old.

C. Share that the heads of children at this age are large in proportion to the rest of their body.

The nurse is caring for a 5-year-old girl. During a routine wellness examination, the mother tells the nurse that the girl's father has enrolled her in a mini pom-pom cheering squad. The girl dislikes it immensely, but her father doesn't want the girl to be a "quitter." The mother asks for some guidance. How should the nurse respond? A. "Bad experiences can cause her to avoid other similar activities" B. "Tell your husband that requiring her to continue is inappropriate" C. "Your daughter may not be able to keep up with the instructions" D. "This may not suit your child's temperament or her physical abilities"

A. "Bad experiences can cause her to avoid other similar activities"

The nurse determines that a 20-month old is in Piaget's sensorimotor stage of cognitive development. Which actions support this assessment? Select all that apply. A. The child has an imaginary playmate B. The child has a limited concept of time. C. The child demonstrates egocentricity. D. The child understands instructions literally E. The child imitates others' behaviors at a later time

A. The child has an imaginary playmate B. The child has a limited concept of time. C. The child demonstrates egocentricity

A nurse is preparing a presentation for a parent group about media and school-aged children. Which of the following would the nurse most likely include in the presentation? Select all that apply. A. Media use is displacing other activities in a child's life. B. Children watch about 2 hours of television on average per day. C. Programs viewed often glamorize violence. D. A child's weight decreases with the number of hours spent watching television. E. Risky behaviors are often portrayed with little emphasis on consequences.

A. Media use is displacing other activities in a child's life. C. Programs viewed often glamorize violence E. Risky behaviors are often portrayed with little emphasis on consequences.

The parents of twin 2-year-old toddlers are asking the nurse how to discipline the children. It seems they feed off one another's feelings and many times get into fights over everything. When giving advice about discipline, which statement should be shared with the parents? Select all that apply. A. The rule with time out is tell the child why they are going to time out and keep it to 1 minute per year of age. B. Warnings about going to time out should not be done. If the child breaks a rule, send them directly to time out. C. The discipline the parents choose should be consistent for every time the child breaks the same rule. D. If possible, try to praise correct behavior rather than punish wrong behavior. E. It is normal for children to hit their friends if the friend takes one of their toys, so the friend should be warned not to take toys that are being played with.

A. The rule with time out is tell the child why they are going to time out and keep it to 1 minute per year of age. C. The discipline the parents choose should be consistent for every time the child breaks the same rule D. If possible, try to praise correct behavior rather than punish wrong behavior

The nurse has just completed an assessment on a child who voices an interest in how things are made and who needs support when they are not successful. The child further reports he is involved in clubs and sports outside the home. The nurse is aware that this child is in which of Erikson's states of development? A. Initiative versus guilt B. Autonomy versus shame and doubt C. Trust versus mistrust D. Industry versus inferiority

D. Industry versus inferiority

The mother of a toddler is frustrated because no matter what she asks of the child, the response is "no." What can the nurse suggest to the mother to assist with this problem? A. Pretend she does not hear the child. B. Ask no further questions to the child. C. Tell the child to never to say "no" again. D. Give the child secondary, not primary, choices.

Give the child secondary, not primary, choices

Parents of an 8-year-old ask the nurse when they can stop using the booster seat in the car for their child. When responding to the parents, the nurse needs to keep in mind which of the following? Select all that apply. A. The child must be at least 4 ft 9 in. tall. B. It's okay to use the adult seat belt now based on his age. C. The child should be between 8 and 12 years of age. D. The child should wear the lap belt but not the shoulder belt. E. The lap belt must fit snugly over the child's stomach area.

A. The child must be at least 4 ft 9 in. tall. C. The child should be between 8 and 12 years of age

A nurse in the clinic observes a school-age child pushing another child. The parent is watching without disciplining the child and tells the nurse, "He just does what he wants to and doesn't listen to anything I say." What can the nurse inform that parent about the development of self-confidence in the child? Select all that apply. A. The child needs consistent rules to develop self-confidence. B. The child needs to be able to do what he wants to develop self-confidence. C. The child needs positive attention to develop self-confidence. D. The child needs clear expectations to develop self-confidence. E. The child needs to make his own decisions about behavior to develop self-confidence.

A. The child needs consistent rules to develop self-confidence. C. The child needs positive attention to develop self-confidence. D. The child needs clear expectations to develop self-confidence.

The nurse is developing a plan of care for a 10-month-old with a respiratory infection. Which interventions are appropriate to include? Select all that apply

Provide a consistent routine. Provide cuddle time and rock the infant Take time to touch the infant

The parents of a 10-year-old are experiencing problems with their son having fears when faced with new experiences. Which actions by the parents will be beneficial in helping the child effectively manage new experiences? Select all that apply. A. The parents should show support to the child by agreeing that these new experiences are indeed scary. B. The parents should limit exposing the child to new experiences. C. Teach the child relaxation techniques to use when feeling anxious. D. Encourage the child to use positive self-talk, such as saying, "I can do this" when faced with new experiences. E. The parents should allow the child to avoid situations when they feel anxious.

C. Teach the child relaxation techniques to use when feeling anxious. D. Encourage the child to use positive self-talk, such as saying, "I can do this" when faced with new experiences.

A 2-week-old infant responds to a bell during an initial health supervision examination. The infant's records do not show that a newborn hearing screening was done. Which action will the nurse take?

Immediately schedule the infant for a newborn hearing screening